New 2019 JSH guidelines and the risk of incident cardiovascular disease: The Suita Study

Area of Science:

• Cardiology
• Public Health
• Epidemiology

Background:

• Hypertension is a primary risk factor for cardiovascular disease (CVD).
• Current guidelines for hypertension diagnosis and management vary.
• There is a need to identify optimal blood pressure (BP) targets for CVD prevention.

Purpose of the Study:

• To investigate the association between blood pressure categories defined by the 2019 Japanese Society of Hypertension (JSH) guidelines and the risk of CVD, stroke, and coronary heart disease (CHD).
• To determine if CVD preventive interventions should commence at lower BP thresholds than currently recommended.

Main Methods:

• Utilized data from 7,643 participants (aged 30-84 years) from the Suita Study.
• Followed participants for a median of 16.6 years (113,838 person-years).
• Analyzed the association between BP levels (normal, high-normal, elevated, hypertension) and the incidence of CVD, stroke, and CHD.

Main Results:

• Compared to normal BP (<120/80 mmHg), elevated BP (130-139/80-89 mmHg) and hypertension (≥140/90 mmHg) were significantly associated with increased risks of CVD, stroke, and CHD.
• High-normal BP (120-129/<80 mmHg) was also associated with a higher risk of CVD and CHD.
• A total of 690 CVD events occurred, including 411 strokes and 279 CHDs.

Conclusions:

• The findings indicate that cardiovascular disease and its subtypes (stroke, CHD) risks are elevated even at BP levels below the hypertension threshold defined by the 2019 JSH guidelines.
• CVD preventive strategies should be initiated earlier, targeting individuals with high-normal and elevated blood pressure.
• Current JSH guidelines may not identify all individuals at high risk for CVD, suggesting a need for revised BP targets for prevention.