Blood pressure, hypertension, and the risk of aortic aneurysm in the UK Biobank
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Background
Although an association between elevated blood pressure and risk of aortic aneurysm is established, few studies have investigated the association with aortic aneurysm subtypes. We investigated the association between systolic and diastolic blood pressure and hypertension status with the risk of aortic aneurysm in the UK Biobank.
Methods
The analysis included 495,542 men and women aged 37–73 years at recruitment between 2006 and 2010. Aortic aneurysm cases were identified by linkage to hospitalization and mortality records. Multivariable Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between blood pressure and hypertension and risk of aortic aneurysm overall and for subtypes.
Results
During a mean follow-up of 12.3 years, 3,346 incident aortic aneurysm cases were identified. Hypertension vs. no hypertension was associated with increased risk (HR, 95% CI) of aortic aneurysm (1.17, 1.08–1.27), and for thoracic (1.23, 1.04–1.46), abdominal (1.16, 1.04–1.30), and non-ruptured (1.18, 1.08–1.28) aortic aneurysm, and suggestively with unspecified site aortic aneurysm (1.18, 0.96–1.46) and aortic aneurysm mortality (1.26, 0.87–1.82), but not ruptured aortic aneurysm (1.02, 0.67–1.58). Systolic blood pressure was not associated with risk of aortic aneurysm overall or for any subtype. Diastolic blood pressure was positively associated with aortic aneurysm (1.74, 1.26–2.41, ptrend<0.0001) for ≥ 110 vs. <80 mmHg, abdominal aortic aneurysm (1.95, 1.28–2.96, ptrend<0.0001), unspecified site aortic aneurysm (2.02, 0.94–4.33, ptrend=0.005), non-ruptured aortic aneurysm (1.79, 1.29–2.47), and aortic aneurysm mortality (2.32, 0.56–9.58, ptrend<0.0001), and with ruptured aortic aneurysm (2.48, 1.22–5.03, ptrend<0.0001 for 100–109 vs. <80 mmHg), while the association with thoracic aortic aneurysm was less clear (1.30, 0.64–2.63). These associations were strengthened and positive associations emerged for systolic blood pressure and abdominal and non-ruptured aortic aneurysm in sensitivity analyses when excluding participants with prevalent ischemic heart disease, stroke, those using hypertension medications and the first 3 years of follow-up.
Conclusion
We found that hypertension status and higher diastolic blood pressure were associated with increased risk of aortic aneurysm overall and most aortic aneurysm subtypes. No association was observed for systolic blood pressure. Although further studies are needed on aortic aneurysm subtypes, these findings provide strong support that controlling blood pressure is important for reducing the risk of aortic aneurysm.
Although an association between elevated blood pressure and risk of aortic aneurysm is established, few studies have investigated the association with aortic aneurysm subtypes. We investigated the association between systolic and diastolic blood pressure and hypertension status with the risk of aortic aneurysm in the UK Biobank.
Methods
The analysis included 495,542 men and women aged 37–73 years at recruitment between 2006 and 2010. Aortic aneurysm cases were identified by linkage to hospitalization and mortality records. Multivariable Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between blood pressure and hypertension and risk of aortic aneurysm overall and for subtypes.
Results
During a mean follow-up of 12.3 years, 3,346 incident aortic aneurysm cases were identified. Hypertension vs. no hypertension was associated with increased risk (HR, 95% CI) of aortic aneurysm (1.17, 1.08–1.27), and for thoracic (1.23, 1.04–1.46), abdominal (1.16, 1.04–1.30), and non-ruptured (1.18, 1.08–1.28) aortic aneurysm, and suggestively with unspecified site aortic aneurysm (1.18, 0.96–1.46) and aortic aneurysm mortality (1.26, 0.87–1.82), but not ruptured aortic aneurysm (1.02, 0.67–1.58). Systolic blood pressure was not associated with risk of aortic aneurysm overall or for any subtype. Diastolic blood pressure was positively associated with aortic aneurysm (1.74, 1.26–2.41, ptrend<0.0001) for ≥ 110 vs. <80 mmHg, abdominal aortic aneurysm (1.95, 1.28–2.96, ptrend<0.0001), unspecified site aortic aneurysm (2.02, 0.94–4.33, ptrend=0.005), non-ruptured aortic aneurysm (1.79, 1.29–2.47), and aortic aneurysm mortality (2.32, 0.56–9.58, ptrend<0.0001), and with ruptured aortic aneurysm (2.48, 1.22–5.03, ptrend<0.0001 for 100–109 vs. <80 mmHg), while the association with thoracic aortic aneurysm was less clear (1.30, 0.64–2.63). These associations were strengthened and positive associations emerged for systolic blood pressure and abdominal and non-ruptured aortic aneurysm in sensitivity analyses when excluding participants with prevalent ischemic heart disease, stroke, those using hypertension medications and the first 3 years of follow-up.
Conclusion
We found that hypertension status and higher diastolic blood pressure were associated with increased risk of aortic aneurysm overall and most aortic aneurysm subtypes. No association was observed for systolic blood pressure. Although further studies are needed on aortic aneurysm subtypes, these findings provide strong support that controlling blood pressure is important for reducing the risk of aortic aneurysm.
Date Issued
2025-12-01
Date Acceptance
2025-10-13
Citation
BMC Cardiovascular Disorders, 2025, 25 (1)
ISSN
1471-2261
Publisher
BMC
Journal / Book Title
BMC Cardiovascular Disorders
Volume
25
Issue
1
Copyright Statement
© The Author(s) 2025. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
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Publication Status
Published
Article Number
799
Date Publish Online
2025-11-10