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Long-Term Cardiovascular Risk Associated With Stage 1 Hypertension Defined by the 2017 ACC/AHA Hypertension Guideline

Yue Qi1, Xueyu Han1, Dong Zhao1

  • 1Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing, China; Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China; The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing, China; and the Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China.

Journal of the American College of Cardiology
|September 8, 2018
PubMed

Insights

Stage 1 hypertension significantly increases cardiovascular risk in middle-aged Chinese adults, but not in older adults. This highlights the importance of managing early hypertension for preventing cardiovascular events.

Area of Science:

  • Cardiology
  • Public Health
  • Epidemiology

Background:

  • Stage 1 hypertension, defined as 130-139/80-89 mm Hg by the 2017 ACC/AHA guidelines, requires risk assessment in China.
  • Understanding the cardiovascular risk associated with this blood pressure stratum is crucial for guideline adoption.

Purpose of the Study:

  • To evaluate the relative risk and population-attributable risk of cardiovascular disease (CVD) linked to stage 1 hypertension.
  • To investigate age-specific differences in CVD risk associated with stage 1 hypertension.

Main Methods:

  • A cohort of 21,441 Chinese adults aged ≥35 years, free of CVD at baseline, was followed for up to 20 years.
  • Adjusted hazard ratios (HR) and population-attributable risk for CVD were calculated for stage 1 hypertension.

Main Results:

  • Stage 1 hypertension affected 25.8% of the cohort. In adults aged 35-59 years, stage 1 hypertension showed HRs of 1.78 for CVD incidence, 1.77 for coronary heart disease, 1.79 for stroke, and 2.50 for CVD mortality compared to normal BP.
  • Attributable risks for CVD events and deaths were 13.4% and 26.5% respectively in the 35-59 age group. No increased risk was observed in adults aged ≥60 years.
  • Over 15 years, 65.0% of 35-59 year olds with stage 1 hypertension progressed to higher BP, facing a 3.01-fold increased CVD risk compared to those maintaining <130/<80 mm Hg.

Conclusions:

  • The 2017 ACC/AHA stage 1 hypertension definition is associated with increased cardiovascular risk in younger and middle-aged Chinese adults.
  • This association was not observed in Chinese adults aged 60 years and older.
  • Findings support the consideration of stage 1 hypertension management in younger Chinese populations to mitigate long-term cardiovascular risk.
Abstract

Keywords:
cardiovascular diseasecohort studyhypertensionincidencemortality

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