| アブストラクト | AIMS: Evidence for the effect of elevated blood pressure (BP) on the risk of venous thromboembolism (VTE) has been conflicting. We sought to assess the association between systolic BP and the risk of VTE. METHODS AND RESULTS: Three complementary studies comprising an observational cohort analysis, a one-sample and two-sample Mendelian randomization were conducted using data from 5 588 280 patients registered in the Clinical Practice Research Datalink (CPRD) dataset and 432 173 UK Biobank participants with valid genetic data. Summary statistics of International Network on Venous Thrombosis genome-wide association meta-analysis was used for two-sample Mendelian randomization. The primary outcome was the first occurrence of VTE event, identified from hospital discharge reports, death registers, and/or primary care records. In the CPRD cohort, 104 017(1.9%) patients had a first diagnosis of VTE during the 9.6-year follow-up. Each 20 mmHg increase in systolic BP was associated with a 7% lower risk of VTE [hazard ratio: 0.93, 95% confidence interval (CI): (0.92-0.94)]. Statistically significant interactions were found for sex and body mass index, but not for age and subtype of VTE (pulmonary embolism and deep venous thrombosis). Mendelian randomization studies provided strong evidence for the association between systolic BP and VTE, both in the one-sample [odds ratio (OR): 0.69, (95% CI: 0.57-0.83)] and two-sample analyses [OR: 0.80, 95% CI: (0.70-0.92)]. CONCLUSION: We found an increased risk of VTE with lower BP, and this association was independently confirmed in two Mendelian randomization analyses. The benefits of BP reduction are likely to outweigh the harms in most patient groups, but in people with predisposing factors for VTE, further BP reduction should be made cautiously. |
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| 投稿者 | Nazarzadeh, Milad; Bidel, Zeinab; Mohseni, Hamid; Canoy, Dexter; Pinho-Gomes, Ana-Catarina; Hassaine, Abdelaali; Dehghan, Abbas; Tregouet, David-Alexandre; Smith, Nicholas L; Rahimi, Kazem |
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| 組織名 | Deep Medicine, Oxford Martin School, University of Oxford, 1st Floor, Hayes;House, 75 George Street, Oxford OX1 2BQ, UK.;Medical Science Division, Nuffield Department of Women's and Reproductive Health,;University of Oxford, UK.;Faculty of Medicine, University of New South Wales, Sydney, Australia.;NIHR Oxford Biomedical Research Centre, Oxford, UK.;Department of Biostatistics and Epidemiology, School of Public Health, Imperial;College London, UK.;INSERM UMR_S 1219, Bordeaux Population Health Research Center, University of;Bordeaux, Bordeaux, France.;Department of Epidemiology, University of Washington, Seattle, WA.;Kaiser Permanente Washington Health Research Institute, Kaiser Permanente;Washington, Seattle, WA.;Department of Veterans Affairs Office of Research and Development, Seattle;Epidemiologic Research and Information Center, Seattle, WA. |
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