Elevated blood pressure at the first measurement predicts cardiovascular disease independently from the subsequent second reading in men, but not in women

Clin Exp Hypertens. 2015;37(1):39-44. doi: 10.3109/10641963.2014.897720. Epub 2014 Apr 30.


Background and methods: There have been no investigations concerning the association of each blood pressure (BP) reading with future cardiovascular disease (CVD) when multiple measurements are taken on one occasion. This community-based, prospective cohort study (n = 23 344, mean age = 62.4 years) investigated the associations between the BP obtained from the first and second of two consecutive measurements on one occasion and future cardiovascular events in men and women.

Results: During the mean follow-up of 5.5 years, 624 CVD events were identified. On the Cox regression analysis of age- and BP-adjusted models, the increased CVD risk of a hypertensive first measurement (systolic BP ≥ 140 mmHg) was independent from the second measurement in men. Even in subjects without a hypertensive second measurement, the CVD risk of the hypertensive first measurement was increased in men. In women, despite a hypertensive first measurement, subjects with a systolic BP < 130 mmHg on the second measurement showed a significantly reduced risk for CVD compared with subjects who retained a hypertensive level during the two measurements.

Conclusions: An elevated BP on the first measurement should not be disregarded for CVD risk estimation in men, even if the second BP moves to the normal range. In women, elevated BP on the first measurement may have relatively less meaning for CVD prediction if the second BP shifts to a normal range.

Keywords: Acute myocardial infarction; blood pressure; cardiovascular event; epidemiology; stroke.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Animals
  • Antihypertensive Agents / therapeutic use
  • Blood Pressure / physiology*
  • Blood Pressure Determination / methods
  • Blood Pressure Monitoring, Ambulatory
  • Cardiovascular Diseases / diagnosis*
  • Cardiovascular Diseases / physiopathology
  • Female
  • Humans
  • Hypertension / drug therapy
  • Hypertension / physiopathology*
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Prospective Studies
  • Sex Characteristics


  • Antihypertensive Agents