American Journal of Epidemiology Advance Access originally published online on November 10, 2006
American Journal of Epidemiology 2007 165(3):294-301; doi:10.1093/aje/kwk014
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ORIGINAL CONTRIBUTIONS |
Blood Pressure and Risk of Death from External Causes among Men Screened for the Multiple Risk Factor Intervention Trial
1 Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
2 Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN
Correspondence to Dr. Paul D. Terry, Department of Epidemiology, Emory University School of Public Health, 1518 Clifton Road, NE, Atlanta, GA 30322 (e-mail: pdterry{at}sph.emory.edu).
A few epidemiologic studies have shown an increased risk of death from external causes among men with hypertension. Previous studies were limited by small numbers of events, however, and none assessed the association of blood pressure with specific types of "accidental" death. The authors examined data obtained from baseline interviews and 25 years of mortality follow-up (1973–1999) for 347,978 men screened for the US Multiple Risk Factor Intervention Trial. Proportional hazards regression analyses were used to quantify associations of blood pressure with all external causes of death and individual causes. There were 3,910 deaths from external causes, including 2,313 unintentional injuries, 1,248 suicides, and 349 homicides. Compared with those for men whose blood pressure status was "normal" according to the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, the multivariate-adjusted hazard ratios and 95% confidence intervals for death from external causes among men with prehypertension, stage 1 hypertension, and stage 2 hypertension were 0.91 (95% confidence interval (CI): 0.83, 1.00), 1.06 (95% CI: 0.96, 1.16), and 1.44 (95% CI: 1.28, 1.62), respectively. Men with stage 2 hypertension had multivariate-adjusted hazard ratios of 1.90 for falls (95% CI: 1.32, 2.74), 1.45 for motor vehicle injuries (95% CI: 1.14, 1.85), 1.33 for other "accidents" (95% CI: 1.06, 1.66), 1.40 for suicide (95% CI: 1.13, 1.73), and 1.35 for homicide (95% CI: 0.92, 1.97). For men, hypertension may signal an increased risk of death from external causes.
accidental falls; accidents; epidemiologic studies; hypertension; mortality
Abbreviations: CI, confidence interval; DBP, diastolic blood pressure; ICD-9, International Classification of Diseases, Ninth Revision; ICD-10, International Statistical Classification of Diseases and Related Health Problems, Tenth Revision; MRFIT, Multiple Risk Factor Intervention Trial; SBP, systolic blood pressure