This is a sel -a chi ed e sion o an o iginal a icle. This e sion
may di e om he o iginal in pagina ion and ypog aphic de ails.
Au ho (s):
Ti le:
Yea :
Ve sion:
Copy igh :
Righ s:
Righ s u l:
Please ci e he o iginal e sion:
CC BY-NC-ND 4.0
h ps://c ea i ecommons.o g/licenses/by-nc-nd/4.0/
Join e ec o blood p essu e and C- eac i e p o ein and he isk o sudden ca diac
dea h : a p ospec i e coho s udy
© 2020 Else ie
Accep ed e sion (Final d a )
Ku l, Sudhi ; Jae, Sae Y.; Vou ilainen, A i; Mäkikallio, Timo; Laukkanen, Ja i A.
Ku l, S., Jae, S. Y., Vou ilainen, A., Mäkikallio, T., & Laukkanen, J. A. (2021). Join e ec o blood
p essu e and C- eac i e p o ein and he isk o sudden ca diac dea h : a p ospec i e coho
s udy. In e na ional Jou nal o Ca diology, 326, 184-188.
h ps://doi.o g/10.1016/j.ijca d.2020.10.071
2021
Jou nal P e-p oo
Join e ec o blood p essu e and C- eac i e p o ein and he isk
o sudden ca diac dea h: A p ospec i e coho s udy
Sudhi Ku l, Sae Y. Jae, A i Vou ilainen, Timo Mäkikallio, Ja i A.
Laukkanen
PII: S0167-5273(20)34062-6
DOI: h ps://doi.o g/10.1016/j.ijca d.2020.10.071
Re e ence: IJCA 29043
To appea in: In e na ional Jou nal o Ca diology
Recei ed da e: 23 May 2020
Re ised da e: 26 Sep embe 2020
Accep ed da e: 23 Oc obe 2020
Please ci e his a icle as: S. Ku l, S.Y. Jae, A. Vou ilainen, e al., Join e ec o blood
p essu e and C- eac i e p o ein and he isk o sudden ca diac dea h: A p ospec i e
coho s udy, In e na ional Jou nal o Ca diology (2020), h ps://doi.o g/10.1016/
j.ijca d.2020.10.071
This is a PDF ile o an a icle ha has unde gone enhancemen s a e accep ance, such
as he addi ion o a co e page and me ada a, and o ma ing o eadabili y, bu i is
no ye he de ini i e e sion o eco d. This e sion will unde go addi ional copyedi ing,
ypese ing and e iew be o e i is published in i s inal o m, bu we a e p o iding his
e sion o gi e ea ly isibili y o he a icle. Please no e ha , du ing he p oduc ion
p ocess, e o s may be disco e ed which could a ec he con en , and all legal disclaime s
ha apply o he jou nal pe ain.
© 2020 Published by Else ie .
Join E ec o Blood P essu e and C-Reac i e P o ein and he Risk o Sudden Ca diac
Dea h: A P ospec i e Coho S udy
Sudhi Ku la,b, Sae Y Jaec, A i Vou ilainena, Timo Mäkikalliod, Ja i A. Laukkanen a,e,
aIns i u e o Public Heal h and Clinical Nu i ion, Uni e si y o Eas e n Finland, Kuopio.
Finland.
bDepa men o Neu ology, Ins i u e o Clinical Medicine, Uni e si y o Eas e n Finland,
Kuopio. Finland. This au ho akes esponsibili y o all aspec s o he eliabili y and eedom
om bias o he da a p esen ed and hei discussed in e p e a ion.
cDepa men o Spo Science, Uni e si y o Seoul, Seoul, Republic o Ko ea; G adua e
School o U ban Public Heal h, Uni e si y o Seoul, Seoul, Republic o Ko ea. This au ho
akes esponsibili y o all aspec s o he eliabili y and eedom om bias o he da a
p esen ed and hei discussed in e p e a ion.
dDi ision o Ca diology, Depa men o In e nal Medicine, Oulu Uni e si y Hospi al, Oulu,
Finland. This au ho akes esponsibili y o all aspec s o he eliabili y and eedom om
bias o he da a p esen ed and hei discussed in e p e a ion.
eCen al Finland Heal Ca e Dis ic , Depa men o Medicine Jy äskylä, Finland. This
au ho akes esponsibili y o all aspec s o he eliabili y and eedom om bias o he da a
p esen ed and hei discussed in e p e a ion.
Facul y o Spo and Heal h Sciences, Uni e si y o Jy äskylä, Jy äskylä, Finland
Co espondence: Sudhi Ku l, Ins i u e o Public Heal h and Clinical Nu i ion, Uni e si y
o Eas e n Finland, P.O. Box 1627, 70211 KUOPIO, Finland, Tel +358-40-3552966, Fax
358-17-162936. e-mail: [email p o ec ed]i
Abs ac
Backg ound: Bo h blood p essu e and C- eac i e p o ein (CRP) a e each independen ly
ela ed o mo ali y isk. Howe e , he combined e ec o sys olic blood p essu e (SBP) and
CRP on sudden ca diac dea h (SCD) isk has no been s udied.
Pa ien s and Me hods: We s udied he join impac o SBP and CRP and he isk o SCD in
he Kuopio Ischemic Hea Disease p ospec i e coho s udy o 1953 men aged 42-61 yea s
wi h no his o y o ischemic hea disease. Baseline in es iga ions we e conduc ed be ween
Jou nal P e-p oo
Jou nal P e-p oo
Ma ch 1984 and Decembe 1989. SBP and CRP we e measu ed. SBP was di ided based on
median alues o low and high (median cu o s 132mm Hg) and CRP as low and high
(median cu -o 1.30 mg/L). Haza d a ios (HRs) wi h con idence in e als (CIs) we e
calcula ed a e mul i a ia e adjus men .
Resul s: Subjec s we e ollowed-up o 23.2 yea s, and 137 SCDs occu ed. In his s udy,
ele a ed SBP (>132mmHg) combined wi h ele a ed (CRP >1.30mg/L) we e associa ed wi h
SCD isk. Adjus men o age, examina ion yea , alcohol consump ion, BMI, ene gy
expendi u e du ing exe cise, o al choles e ol, HDL-choles e ol, ype 2 diabe es, smoking,
an ihype ension medica ion and aspi in use, he isk o SCD emained s a is ically signi ican
(HR, 2,73, 95% CI, 1.62-4.60, p <.001). Fu he adjus men o socio-economic s a us, yea s
o educa ion and his o y o ca dio ascula disease in a amily he esul s we e only sligh ly
changed (HR, 2.65, 95% CI, 1.57-4.49, p <.001).
Conclusions: In ou male coho s udy, he join e ec o high SBP oge he wi h inc eased
CRP le els is a isk p edic o o SCD compa ed wi h low SBP and CRP.
Keywo ds C- eac i e p o ein; Men; Sudden ca diac dea h; Sys olic blood p essu e
In oduc ion
Sudden ca diac dea h (SCD) may occu momen a ily a e he onse o he symp oms wi hou
ypical wa ning signs, hus lea ing e y limi ed ime o any ype o medical in e en ion (1).
Due o he wide-scale public heal h implica ions, p e en ion emains o be he mos iable
app oach o educe he isk o SCD in he gene al popula ion (2). Al hough he occu ence o
Jou nal P e-p oo
Jou nal P e-p oo
SCD is ela i ely low in he common popula ion, he absolu e numbe s a e high among
asymp oma ic subjec s.
Hype ension is an es ablished isk ac o o a ious ca dio ascula diseases including SCD.
Simila ly, C- eac i e p o ein (CRP), a ma ke o in lamma o y p ocess, and has also been
associa ed wi h a ious ca dio ascula e en s (3-6). Among subjec s wi h ele a ed blood
p essu e, inc eased CRP ha e been obse ed. Fu he mo e, i is known ha in lamma ion
plays a ole in he de elopmen o hype ension (6-11). Inc eased CRP le els a e linked o
educed ni ic oxide p oduc ion in endo helial cells (9-10) which may esul in excess
p oduc ion o endo helin and asocons ic ion (12-13). I has been assumed ha hype ension
may be in pa associa ed wi h in lamma o y diseases. Consis en ly, long- e m hype ension
may u he lead o ha m ul le en icula hype ophy (LVH), a known isk p edic o o
SCD (14). The e o e, his s udy was designed o de e mine i ele a ed blood p essu e
oge he wi h CRP is a isk p edic o o SCD in he Finnish male popula ion wi hou
diagnosed co ona y hea disease (CHD).
S udy Popula ion
The Kuopio Ischemic Hea Disease (KIHD) isk ac o s udy, is p ospec i e coho s udy
designed o s udy a he oscle o ic ca diac e en s in men om Finland. The subjec s included
42-61 yea s o age li ing in he ci y o Kuopio and i s su ounding communi ies. Baseline
in es iga ions we e pe o med be ween Ma ch 01, 1984, and Decembe 31, 1989. In all 2682
men we e included in he o e all s udy. Ou analysis included 1953 men wi h comple e da a
on SCD, co a ia es and no his o y o CHD. The s udy was app o ed by he Resea ch E hics
Commi ee o he Uni e si y o Eas e n Finland. Each pa icipan ga e a w i en in o med
consen o pa icipa e in he s udy.
Jou nal P e-p oo
Jou nal P e-p oo

Assessmen o isk ma ke s and biochemical measu emen s
The s anda d blood p essu e de ini ion was used o blood p essu e measu emen s. Blood
p essu e was assessed a 5, 10, and 15 minu es a e 15 minu es o supine es ; one s anding
blood p essu e measu emen was aken a e being o es o 1 minu e; 10 minu es o sea ed
es wi h BP measu ed a minu es 5 and 10 (15). The mean o hese alues was used as mean
blood p essu e. A p o essional nu se measu ed blood p essu e using a sphygmomanome e
(Hawksley, Uni ed Kingdom) in a es ing sea ed posi ion in a quie oom om 8:00 o 10:00
a.m (15). Hype ension a es was ei he hype ension con i med by he cu en use o
an ihype ensi e medica ion and/o SBP >140 mm Hg and/o DBP >90 mm Hg.
A baseline a ious examina ions including physical examina ions, collec ion o blood
samples and he collec ion o sel -adminis e ed ques ionnai es was done. Body mass index
(BMI) was calcula ed a e measu ing heigh and body weigh o he subjec s. Blood samples
we e aken acco ding o he p o ocol in he mo nings be ween 8 and 10 a.m. a e an
o e nigh as . Subjec s we e also asked o abs ain om alcohol consump ion o 3 days and
smoking o 12 hou s be o e blood collec ion. Collec ed se um samples we e ozen a −80
°C be o e analyses o lipids and biochemical analy es. Se um CRP was analyzed using an
immunome ic assay (Immuli e High Sensi i i y C-Reac i e P o ein Assay; DPC, Los
Angeles, CA, USA). Fas ing plasma glucose (FPG) was measu ed using he s anda d glucose
dehyd ogenase me hod (Me ck, Da ms ad , Ge many). Assessmen s o alcohol consump ion,
smoking, his o y o a ious heal h condi ions, educa ion, and socioeconomic s a us; subjec s
we e asked o comple e heal h and li es yle ques ionnai es (15-18). Physical ene gy
expendi u e o a ious physical ac i i ies we e assessed using he alida ed KIHD physical
Jou nal P e-p oo
Jou nal P e-p oo
ac i i y ques ionnai e. Le en icula hype ophy (Sokolow-Lyon index) was eco ded
om he elec oca diog am (ECG) a es .
Classi ica ion o Sudden Ca diac Dea h
All he in o ma ion on a al ca diac e en s used o classi ying we e in e iews, hospi al
documen s, dea h ce i ica es, au opsy epo s and medico-legal epo s and in e iews (18).
Dea hs ha occu ed ill he end o 2017 we e included a e checking heal h and hospi al
documen s including dea h ce i ica es.
SCD was classi ied as dea h ha occu ed ei he wi hin 1 hou a e he onse o symp oms o
wi hin 24 hou s a e sudden onse o a change in symp oms when au opsy epo e ealed a
non-ca diac cause o sudden dea h. Sudden ou -o -hospi al dea hs we e also de ined based on
all in o ma ion a disposal including in e iews (18). Non-ca diac como bidi ies, dea hs due
o ao ic aneu ysm up u e, pulmona y embolism, ca diac up u e o amponade, and cance
dea hs we e all excluded. The inal conclusions we e made using a ailable clinical da a such
as symp oms, in es iga i e and ECG indings, ca diac bioma ke s, au opsy indings, use o
medica ions and de ib illa o use and da a a ailable wi h he pa amedic s a . Comple e
in o ma ion was u he c oss-checked by wo physicians (18). Fo classi ica ion pu poses
independen e en s commi ee we e-blinded o he da a a ailable.
S a is ical analysis
We examined SBP and CRP and he o he isk ac o s o SCD by co a ia e analysis and he
isk o SCD wi h Cox p opo ional haza d modeling. To s udy he join associa ions o SBP
and CRP, wi h SCD isk, he median alues o SBP and CRP we e di ided in o ou
ca ego ies o low/high. Low SBP (<132mm Hg) and low CRP (<1.30mg/L) we e used as a
e e ence. We used h ee se s o co a ia es: Model (1) consis ed o age and examina ion yea ;
Jou nal P e-p oo
Jou nal P e-p oo
Model (2) consis ed o Model 1 oge he wi h ype 2 diabe es, BMI, alcohol consump ion,
ene gy expendi u e, o al choles e ol, se um HDL choles e ol, smoking, an ihype ensi e
medica ion and aspi in use; and Model (3) consis ed o Model 1and 2 oge he wi h
socioeconomic s a us, educa ion, and his o y o ca dio ascula diseases in he amily.
Fu he mo e, in ano he model we analyzed i CRP was less han 10 mg/L in ano he model.
Rela i e isk es ima es (HRs, haza d a ios) we e adjus ed o isk ac o s and es ima ed as
an iloga i hms o coe icien s om mul i a iable models. All es s o s a is ical signi icance
we e de ined as p- alues o <.05 and we e 2-sided. The Kaplan-Meie me hod was used o
assess he cumula i e su i al o SCD. S a is ical analysis was pe o med by using IBM,
SPSS S a is ics, e sion 25.0 o Windows (IBM A monk, New Yo k).
Resul s
Baseline cha ac e is ics
O e an a e age ollow-up o 23.2 yea s, 137 SCD cases we e documen ed. The baseline
cha ac e is ics o subjec s in he g oups a e p esen ed in Table 1. The mean age o men was
52 yea s, while SBP was 134mmHg (median 132 mmHg). Mean se um CRP le els we e 2.2
mg/L (median 1.3 mg/L) espec i ely. In model 3, a e u he adjus men SBP and CRP
le els, signi ican isk ma ke s o SCD we e age (p=.008), alcohol consump ion (p=.002),
smoking (p=.006) and alcohol consump ion (p<.001), and socioeconomic s a us (p=.010).
Among men wi h high SBP combined wi h high CRP (>132mmHg and >CRP o >1.30mg/L)
had high BMI, consumed mo e alcohol, had highe o al choles e ol, had mo e cases o ype 2
diabe es, used mo e o an ihype ensi e bu had lowe educa ion s a us as compa ed o o he
g oups.
Jou nal P e-p oo
Jou nal P e-p oo
Sys olic blood p essu e, C- eac i e p o ein, and sudden ca diac dea h
Ele a ed SBP combined wi h ele a ed CRP le els was ela ed he isk o SCD. In an age and
examina ion yea adjus ed model, when we compa ed high SBP combined wi h high CRP (
>132 mmHg and >1.30 mg/L) wi h combined low le els o SBP combined wi h CPR
(<132mmHg, <1.30 mg/L e e ence g oup) 4.0- old isk (95% CI 2.44-6.53, p<.001) was
obse ed. Fu he adjus men o alcohol consump ion, BMI, ene gy expendi u e du ing
exe cise, se um o al choles e ol, se um HDL-choles e ol, ype 2 diabe es, smoking,
an ihype ension medica ion and aspi in use, he isk o SCD emained s a is ically signi ican
(HR, 2,73, 95% CI, 1.62-4.60, p <.001) (Table 2). P og essi e adjus men (Model 3) o
socio-economic s a us, yea s o educa ion and his o y o ca dio ascula disease in a amily
he esul s we e only sligh ly changed (HR, 2.65, 95% CI, 1.57-4.49, p <.001). The Kaplan-
Meie cumula i e su i al cu es o SCD acco ding o he g oups o SBP and CRP le els
a e shown in Figu e 1.
The isk o SCD was also signi ican ly inc eased in he g oup o low SBP (<132mmHg)
combined wi h high CRP >1.30 mg/L, was (HR 1.73, 95% CI, 1.20-2.48, p=.003). Howe e ,
he espec i e isk was no inc eased in men wi h high SBP (>132mg Hg) combined wi h low
CRP o (<1.30mg/L) (HR 1.30, 95% CI, 0.89-1.91, p=.17).
Inc ease in sys olic blood p essu e, C- eac i e p o ein and sudden ca diac dea h
We in es iga ed he ole o inc eased SBP when CRP was less han 10 mg/L a baseline.
Subjec s we e di ided in o g oups depending on hei SBP. In he SCD isk analyses, men
wi h a mean SBP o 121 mmHg ( ange 121-132 mmHg) oge he wi h mean CRP o 1.52
mg/L ( ange 0.10-9.97 mg/L) was he e e ence g oup. Among men wi h mean SBP o 147
mmHg ( ange 132-203 mmHg) and mean CRP o 1.72mg/L ange (1.0-2.98 mg/L) he HR
o SCD was 2.12- old (95% CI, 1.26-3.56, p=.005) highe as compa ed o he e e ence
g oup a e adjus men o all used isk ac o s including an i-hype ensi e medica ion,
Jou nal P e-p oo
Jou nal P e-p oo
22. Siegel, D, Chei lin, MD, Black, DM, Seeley, D, Hea s , N, Hulley, SB. Risk o
en icula a hy hmias in hype ensi e men wi h le en icula hype ophy. Am J Ca diol.
1990; 65: 742–747
23. Biage i, MO. Quin ei o, RA. Gende di e ences in elec ical emodeling and
suscep ibili y o en icula a hy hmias in abbi s wi h le en icula hype ophy. Hea
Rhy hm. 2006; 3: 832–839
24. Laukkanen JA, La ie CJ, Khan H, Ku l S, Kunu so SK. Ca dio espi a o y i ness and he
isk o se ious en icula a hy hmias: A p ospec i e coho s udy. Mayo Clin P oc. 2019;94:
833-841
25. Laukkanen JA, Jennings JR, Kauhanen J, Mäkikallio TH, Ronkainen K, Ku l S. Rela ion
o sys emic blood p essu e o sudden ca diac dea h. Am J Ca diol. 2012; 110:378-82
26. An ony, I, Ni enbe g, A, Foul , JM, Ap eca , E. Co ona y asodila o ese e in un ea ed
and ea ed hype ensi e pa ien s wi h and wi hou le en icula hype ophy. J Am Coll
Ca diol. 1993; 22: 514–520.
27. Sesso HD, Wang L, Bu ing JE, Ridke PM, Gaziano JM. Compa ison o in e leukin-6 and
C- eac i e p o ein o he isk o de eloping hype ension in women. Hype ension. 2007;
49:304-10
28. Ridke PM, Cushman M, S amp e MJ, T acy RP, Hennekens CH. In lamma ion, aspi in,
and he isk o ca dio ascula disease in appa en ly heal hy men. N Engl J Med. 1997; 336:
973–979.
29.Jiménez-Pa ón D, B ellen hin AG, Lee DC, Sui X, Blai SN, La ie CJ. Role o Muscula
S eng h on he Risk o Sudden Ca diac Dea h in Men. Mayo Clin P oc. 2019; 94:2589-2591.
Jou nal P e-p oo
Jou nal P e-p oo

30. Ku l S, Laaksonen DE, Jae SY, e al. Me abolic synd ome and he isk o sudden ca diac
dea h in middle-aged men. In J Ca diol. 2016; 203:792-799.
Table 1. Baseline cha ac e is ics o middle-aged men wi h no his o y o ischemic hea disease. Values indica e mean ± SD
unless o he wise in o med.
Va iable
All
subjec s
SBP 132
mmHg
CRP <1.30
mg l-1
SBP 132
mmHg
CRP ≥1.30
mg/L
SBP >132
mmHg
CRP <1.30
mg/L
SBP >132
mmHg
CRP ≥1.30
mg/L
P- alue
Be ween
g oups
n
1953
545
427
431
550
SCD (n)
137
21
19
29
68
Age
52 ± 5.3
52 ± 5.5
52 ± 5.5
53 ± 5.2
53 ± 5.0
<.001
Yea o examina ion
1987 ±
1.7
1987 ± 1.6
1987 ± 1.6
1986 ± 1.7
1986 ± 1.7
.007
Yea s o educa ion
9.0 ± 3.6
9.6 ± 3.9
8.9 ± 3.6
8.9 ± 3.6
8.6 ± 3.3
<.001
Socioeconomic s a us
12 ± 5.1
11 ± 5.2
12 ± 5.2
11 ± 5.1
12 ± 4.9
<.001
BMI
27 ± 3.5
25 ± 2.7
27 ± 3.4
27 ± 3.0
28 ± 3.9
<.001
Alcohol consump ion (g
week-1)
74 ± 118
62 ± 102
73 ± 105
61 ± 122
98 ± 135
<.001
LTPA (kcal day-1)
138 ±
169
144 ± 166
119 ± 145
149 ± 160
138 ± 192
.051
Se um o al choles e ol
(mmol l-1)
5.9 ± 1.0
5.8 ± 1.0
5.8 ± 1.1
5.8 ± 1.0
6.0 ± 1.0
.002
HDL-choles e ol (mmol l-1)
1.3 ± 0.3
1.3 ± 0.3
1.3 ± 0.3
1.3 ± 0.3
1.3 ± 0.3
<.001
Diabe es (% o yes:
FPG >6.9 mmol l-1 o
medica ion)
4.7
1.7
4.4
4.6
7.8
<.001
Smoke (% o yes:
smoked less han a mon h
ago)
30
24
42
19
34
<.001
Uses d ugs o hype ension
(% o yes)
14
6.6
11
15
24
<.001
Uses ace ylsalicylic acid (%
o yes)
5.8
5.0
5.9
4.6
7.6
.162
CVD in amily (% o yes)
80
78
78
81
84
.103
Le en icula hype ophy
(% o yes)
0.9
0.4
0
1.1
1.8
.033
Jou nal P e-p oo
Jou nal P e-p oo
Abb e ia ions. SBP: Sys olic blood p essu e. CRP: Se um high-sensi i e C- eac i e p o ein. SCD: Sudden ca diac dea h.
BMI: Body mass index. LTPA: Leisu e- ime physical ac i i y. HDL: High-densi y lipop o ein. FPG: Fas ing plasma
glucose. CVD: Ca dio ascula disease including hype ension.
No es. The p- alues a e o he analysis o a iance o K uskal-Wallis es . Family e e s o mo he , a he , and siblings.
Table 2. Haza d a ios o Sudden Ca diac Dea h among Men wi h Sys olic blood p essu e
combined wi h C- eac i e p o ein
SBP combined wi h CRP
Haza ds
Ra io
95%
Con idence
in e al
P- alue
SBP <132mm hg and CRP <1.30 mg/L
1,02
0,54
1,93
,94
SBP <132mm hg and CRP ≥1.30 mg/L
1,46
0,82
2,60
,19
SBP >132mm hg and CRP <1.30 mg/L
2,73
1,62
4,59
<.001
Age, (yea s)
1,06
1,02
1,10
,003
Yea o examina ion
0,91
0,81
1,02
,113
Body mass index (kg/m2)
1,05
1,00
1,10
,050
Alcohol consump ion g ams/week
1,00
1,00
1,00
,001
Ene gy expendi u e (kcal/day)
1,00
0,99
1,00
,453
Se um o al choles e ol, (mmol/l)
1,15
0,98
1,34
,074
Se um HDLcholes e ol, (mmol/l)
0,76
0,40
1,42
,390
Type 2 diabe es melli us
1,68
0,90
3,14
,101
Ciga e e smoke s (pack-yea s)
1,75
1,21
2,54
,003
Use o an i-hype ensi e medica ion
1,36
0,89
2,08
,154
Use o ace ylsalicylic acid
0,81
0,35
1,84
,611
Abb e ia ions. SBP: Sys olic blood p essu e. CRP: Se um high-sensi i e C- eac i e p o ein. SCD: Sudden
ca diac dea h. BMI: Body mass index. LTPA: Leisu e- ime physical ac i i y. HDL: High-densi y lipop o ein..
CVD: Ca dio ascula disease including hype ension.
Figu e 1. The Kaplan-Meie cumula i e su i al cu es o sudden ca diac dea h acco ding o
median o sys olic blood p essu e and C- eac i e p o ein le els.
Jou nal P e-p oo
Jou nal P e-p oo
SBP was ca ego ized as low and high (median cu o 132mm Hg) and CRP as low and high
(median cu -o o 1.30 mg/L).
High ligh s:
 Li le is known abou he combined e ec o blood p essu e and C- eac i e p o ein on
acu e sudden ca diac dea h isk.
 This s udy shows ha he combined e ec o high sys olic blood p essu e and CRP is
associa ed inc eased isk o u u e sudden ca diac dea h compa ed wi h low SBP and
low CRP le els.
 The combined e ec o high sys olic blood p essu e and CRP is associa ed inc eased
isk o u u e sudden ca diac e en s and bo h he ac o s may help while s a ing he
he apy.
Jou nal P e-p oo
Jou nal P e-p oo
Figu e 1