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Prognostic Factors of New-Onset Hypertension in New and Traditional Hypertension Definition in a Large Taiwanese
Yi-Hsueh Liu1,2,3, Szu-Chia Chen2,4, Wen-Hsien Lee2,3,4
1Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan.
Insights
Changing the hypertension definition impacts predictor associations. Older age, high blood pressure, heart rate, BMI, glucose, and triglycerides predict hypertension across definitions, but male sex, low cholesterol, and eGFR show definition-dependent significance.
Area of Science:
- Cardiology
- Hypertension Research
- Public Health
Background:
- The definition of hypertension has evolved, with a lower threshold (130/80 mmHg) now recommended by some guidelines.
- Understanding how this change affects the identification of individuals at risk for new-onset hypertension is crucial for clinical practice and public health strategies.
Purpose of the Study:
- To identify predictors of new-onset hypertension using both the traditional (≥140/90 mmHg) and a new (≥130/80 mmHg) definition.
- To compare the clinical and laboratory parameters associated with hypertension development under different diagnostic criteria.
Main Methods:
- Analysis of data from the Taiwan Biobank, including 17,072 participants in the new definition group and 21,293 in the traditional definition group.
- A mean follow-up of 3.9 years was conducted to ascertain new cases of hypertension.
- Multivariable analysis was employed to determine significant predictors for each definition group.
Main Results:
- Older age, male sex, high systolic blood pressure (SBP), high diastolic blood pressure (DBP), high heart rate, high body mass index (BMI), high fasting glucose, and high triglycerides were significant predictors in the new definition group.
- In the traditional definition group, older age, high SBP, high DBP, high heart rate, high BMI, high fasting glucose, low cholesterol, high triglycerides, and low estimated glomerular filtration rate (eGFR) were significant predictors.
- Male sex was a significant predictor only in the new definition group, while low cholesterol and low eGFR were significant only in the traditional definition group.
Conclusions:
- Key predictors like older age, elevated SBP/DBP, heart rate, BMI, fasting glucose, and triglycerides are consistent across both hypertension definitions.
- The shift in definition alters the predictive value of certain factors, notably male sex, cholesterol levels, and eGFR.
- These findings highlight the significant impact of changing diagnostic criteria on hypertension risk prediction and underscore the need for tailored approaches.
Abstract:
The aim of this study was to determine the predictors of new-onset hypertension when the definition of hypertension is changed from the traditional definition (140/90 mmHg) to a new definition (130/80 mmHg). Using data from the Taiwan Biobank, a total of 17,072 and 21,293 participants in the new and traditional definition groups were analyzed, respectively. During a mean follow-up period of 3.9 years, 3641 and 3002 participants developed hypertension in the new and traditional definition groups, respectively. After multivariable analysis, older age (OR, 1.035; 95% CI, 1.030 to 1.039; p < 0.001), male sex (OR, 1.332; 95% CI, 1.194 to 1.486; p < 0.001), high systolic blood pressure (SBP) (OR, 1.067; 95% CI, 1.062 to 1.073; p < 0.001), high diastolic blood pressure (DBP) (OR, 1.048; 95% CI, 1.040 to 1.056; p < 0.001), high heart rate (OR, 1.007; 95% CI, 1.002 to 1.012; p = 0.004), high body mass index (BMI) (OR, 1.091; 95% CI, 1.077 to 1.106; p < 0.001), high fasting glucose (OR, 1.004; 95% CI, 1.001 to 1.006; p = 0.002), and high triglycerides (OR, 1.001; 95% CI, 1.000 to 1.001; p = 0.004) were significantly associated with new-onset hypertension in the new definition group. In the traditional definition group, the predictors of new-onset hypertension were older age (OR, 1.038; 95% CI, 1.032 to 1.043; p < 0.001), high SBP (OR, 1.078; 95% CI, 1.072 to 1.084; p < 0.001), high DBP (OR, 1.039; 95% CI, 1.031 to 1.046; p < 0.001), high heart rate (OR, 1.005; 95% CI, 1.000 to 1.010; p = 0.032), high BMI (OR, 1.072; 95% CI, 1.058 to 1.087; p < 0.001), high fasting glucose (OR, 1.003; 95% CI, 1.000 to 1.005; p = 0.020), low cholesterol (OR, 0.998; 95% CI, 0.997 to 0.999; p = 0.004), high triglycerides (OR, 1.001; 95% CI, 1.000 to 1.001; p = 0.001), and low estimated glomerular filtration rate (eGFR) (OR, 0.995; 95% CI, 0.993 to 0.997; p < 0.001). In conclusion, older age, high SBP and DBP, high heart rate, high BMI, high fasting glucose, and high triglycerides were useful predictors of new-onset hypertension in both the new and traditional definition groups. However, male sex was a significant predictor of new-onset hypertension only in the new definition group, and low cholesterol and low eGFR were significant predictors of new-onset hypertension only in the traditional definition group. Hence, changing the diagnostic cut-off value for hypertension may have a significant impact on the association of some clinical and laboratory parameters with new-onset hypertension.
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