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Prehypertension and risk of cardiovascular diseases: a meta-analysis of 47 cohort studies
Minghui Han1, Quanman Li1, Leilei Liu1
1Department of Epidemiology and Health Statistics.
Insights
Prehypertension significantly increases the risk of cardiovascular diseases (CVDs), including heart attack and stroke. Managing prehypertension can prevent over 10% of CVD cases.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Prehypertension, defined as systolic blood pressure (SBP) 120-139 mmHg and/or diastolic blood pressure (DBP) 80-89 mmHg, is a precursor to hypertension.
- Understanding the association between prehypertension and cardiovascular outcomes is crucial for preventative strategies.
Purpose of the Study:
- To assess the association between prehypertension and the risk of total cardiovascular diseases (CVDs), coronary heart disease (CHD), myocardial infarction (MI), and stroke.
- To differentiate risks associated with low-range and high-range prehypertension.
Main Methods:
- A systematic literature search was conducted on PubMed, Embase, and Web of Science up to November 2018.
- Meta-analysis of 27 articles (47 studies, 491,666 participants) using fixed-effects models to pool risk ratios (RRs) and 95% confidence intervals (CIs).
- Meta-regression was employed to analyze heterogeneity among subgroups.
Main Results:
- Prehypertension was significantly associated with increased risk of total CVDs (RR 1.40), CHD (RR 1.40), MI (RR 1.86), and stroke (RR 1.66).
- High-range prehypertension (SBP 130-139/DBP 85-89 mmHg) showed a greater risk increase for total CVDs (RR 1.81), CHD (RR 1.65), MI (RR 1.99), and stroke (RR 1.99) compared to normal blood pressure.
- The population-attributable risk for prehypertension was substantial, particularly for MI (24.60%) and stroke (19.15%).
Conclusions:
- Prehypertension, especially the high-range, is a significant risk factor for major cardiovascular events.
- Effective management and control of prehypertension are essential public health strategies that could prevent a considerable proportion of CVD cases.
Objective:
To assess the association of prehypertension (SBP 120-139 mmHg and/or DBP 80-89 mmHg) and total cardiovascular diseases (CVDs), coronary heart disease (CHD), myocardial infarction (MI), and stroke.
Methods:
PubMed, Embase, and Web of Science were searched for articles published up to 7 November 2018. Normal range BP was considered SBP less than 120 mmHg and DBP less than 80 mmHg. RRs and 95% CIs were pooled using fixed-effects models. Meta-regression was conducted to estimate the heterogeneity among subgroups.
Results:
We included 27 articles (47 studies including 491 666 study participants) in the analysis. Prehypertension was associated with total CVDs (RR 1.40, 95% CI 1.34-1.46), CHD (1.40, 1.28-1.52), MI (1.86, 1.50-2.32), and stroke (1.66, 1.56-1.76). Risk of total CVDs, MI, and stroke was increased with low-range prehypertension (low-range: SBP 120-129 mmHg and/or DBP 80-84 mmHg) versus normal BP - RR 1.42 (95% CI 1.29-1.55), 1.43 (1.10-1.86), and 1.52 (1.27-1.81), respectively - and risk of total CVDs, CHD, MI, and stroke was increased with high-range prehypertension (high-range: SBP 130-139 mmHg and/or DBP 85-89 mmHg) - RR 1.81 (95% CI 1.56-2.10), 1.65 (1.13-2.39), 1.99 (1.59-2.50), and 1.99 (1.68-2.36), respectively. The population-attributable risk for the association of total CVDs, CHD, MI, and stroke with prehypertension was 12.09, 13.26, 24.60, and 19.15%, respectively.
Conclusion:
Prehypertension, particularly high-range, is associated with increased risk of total CVDs, CHD, MI, and stroke. Effective control of prehypertension could prevent more than 10% of CVD cases.
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