Abstract
AbstractHigh systolic blood pressure (SBP) causes cardiovascular disease (CVD)
and is associated with mortality from other causes, but conventional
multivariably-adjusted results may be confounded. Here we used a son’s SBP (>1
million Swedish men) as an instrumental variable for parental SBP and examined
associations with parents’ cause-specific mortality, avoiding reverse causation. The
hazard ratio for CVD mortality per SD (10.80 mmHg) of SBP was 1.49 (95% CI: 1.43,
1.56); SBP was positively associated with coronary heart disease and stroke. SBP was
also associated positively with all-cause, diabetes and kidney cancer mortality, and
negatively with external causes. Negative associations with respiratory-related
mortality were probably confounded by smoking. Hazard ratios for other causes were
imprecise or null. Diastolic blood pressure gave similar results to SBP. CVD hazard
ratios were intermediate between those from conventional multivariable studies and
Mendelian randomization and stronger than those from clinical trials, approximately
consistent with an effect of exposure duration on effect sizes. Plots of parental
mortality against offspring SBP were approximately linear, supporting calls for
lower SBP targets. Results suggest that conventional multivariable analyses of
mortality and SBP are not substantially confounded by reverse causation and confirm
positive effects of SBP on all-cause, CVD and diabetes mortality.
Funder
RCUK | Medical
Research Council
Publisher
Springer Science and Business Media LLC
Cited by
3 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献