Skip to content

Associations of mortality with own blood pressure using son’s blood pressure as an instrumental variable

Research output: Contribution to journalArticle

Original languageEnglish
JournalScientific Reports
DateAccepted/In press - 28 May 2019


High 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.

Download statistics

No data available



  • Full-text PDF (accepted author manuscript)

    Accepted author manuscript, 352 KB, PDF-document

    Embargo ends: 1/01/99

    Request copy

  • Supplementary information PDF

    Accepted author manuscript, 2 MB, PDF-document

    Embargo ends: 1/01/99

    Request copy

  • Fig2_dbp

    Accepted author manuscript, 41 KB, application/postscript

  • Fig3_chd

    Accepted author manuscript, 150 KB, application/postscript

  • Fig_4

    Accepted author manuscript, 91 KB, image/tiff

View research connections

Related faculties, schools or groups