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Prehypertension and mortality in a nationally representative cohort
Arch G Mainous1, Charles J Everett, Heather Liszka
1Department of Family Medicine, Medical University of South Carolina, Charleston, South Carolina, USA. mainouag@musc.edu
The American Journal of Cardiology
|December 14, 2004
Summary
Prehypertension increases mortality risk, but this risk disappears when other cardiovascular disease factors are considered. Lifestyle interventions targeting multiple risk factors are recommended for prevention.
Area of Science:
- Cardiovascular Health
- Epidemiology
- Public Health
Background:
- Prehypertension is defined as 120-139 mm Hg systolic or 80-89 mm Hg diastolic blood pressure.
- Prehypertension is a known risk factor for hypertension.
- The independent risk of prehypertension for mortality is not well understood.
Purpose of the Study:
- To analyze the independent risk of prehypertension for all-cause and cardiovascular disease (CVD) mortality.
- To evaluate the impact of co-existing cardiovascular risk factors on this association.
Main Methods:
- Analysis of a nationally representative cohort (n=9,087) from the National Health and Nutrition Examination Survey (NHANES II) and NHANES II Mortality Study.
- Cox proportional-hazards models were used to assess mortality risks.
- Adjustments were made for the presence of other cardiovascular disease risk factors.
Main Results:
- Unadjusted analyses showed increased all-cause (HR 1.27) and CVD (HR 1.66) mortality risk for prehypertension.
- After adjusting for other CVD risk factors, the increased mortality risk for prehypertension was no longer significant (all-cause HR 0.82, CVD HR 1.00).
- No significant independent mortality risk was found for prehypertension in individuals aged 55 years or older.
Conclusions:
- Prehypertension's independent risk for mortality appears minimal when other cardiovascular disease risk factors are accounted for.
- Lifestyle interventions addressing multiple risk factors, including blood pressure, are likely the most effective prevention strategy.