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Risk analysis of blood pressure changes on cardiovascular disease in Chinese population
1School of Public Health, Inner Mongolia Medical University, Hohhot, China.
Insights
Changes in blood pressure significantly impact cardiovascular event risk in Chinese adults. Persistent high blood pressure increases risk, while returning to normal levels may decrease it.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Cardiovascular disease (CVD) remains a leading cause of mortality globally.
- Understanding the impact of blood pressure (BP) fluctuations on CVD risk is crucial for prevention strategies.
- The 2017 ACC/AHA hypertension guidelines provide a framework for defining BP status.
Purpose of the Study:
- To evaluate the association between changes in blood pressure status and the incidence of cardiovascular events.
- To assess the risk of CVD associated with different baseline BP levels and BP changes over time in a Chinese population.
- To investigate the impact of persistent hypertension and BP normalization on CVD risk.
Main Methods:
- A cohort study involving 33,179 Chinese participants (≥35 years, 57.1% women) without baseline CVD.
- Blood pressure status categorized using 2017 ACC/AHA hypertension guidelines.
- Analysis of BP changes: stable <130/80 mmHg, <130/80 to ≥130/80 mmHg, ≥130/80 to <130/80 mmHg, and persistent ≥130/80 mmHg.
- Cox proportional hazards and Fine-Gray models used to estimate hazard ratios (HR) for incident CVD over a median follow-up of 3.17 years.
Main Results:
- Baseline BP levels of 120-129/<80 mmHg (HR=1.66), 130-139/80-89 mmHg (HR=1.35), and ≥140/90 mmHg (HR=2.46) were associated with increased CVD risk compared to <120/80 mmHg.
- Compared to stable BP <130/80 mmHg, persistent BP ≥130/80 mmHg showed a significantly higher CVD risk (HR=1.88).
- A decrease in BP to <130/80 mmHg from a higher category was associated with a reduced CVD risk (HR=1.40).
Conclusions:
- Elevated blood pressure categories, including 120-129/<80 mmHg, are linked to a higher risk of cardiovascular events in the Chinese population.
- Sustained high blood pressure (≥130/80 mmHg) significantly elevates CVD risk over time.
- Achieving normal blood pressure levels (<130/80 mmHg) from a hypertensive state can mitigate cardiovascular risk.
Abstract:
The study aimed to assess the impact of changes in blood pressure on cardiovascular events in the Chinese population. It enrolled 33 179 Chinese participants aged ≥35 years (57.1% women) without CVD at baseline. BP status was defined according to the 2017 ACC/AHA hypertension guidelines. The type of BP change was defined as change in BP status from baseline to the end of follow-up, included stable BP <130/80, <130/80 to ≥130/80, ≥130/80 to <130/80 mm Hg, persistent BP ≥130/80 mm Hg. The hazard ratio (HR) of incident CVD by change in BP category was estimated using Cox proportional hazards and Fine-Gray models. During median follow-up of 3.17 years, 2023 CVD events occurred. Compared with BP <120/80, 120-129/<80 mm Hg at baseline (HR = 1.66, 95% CI: 1.09-2.53), 130-139/80-89 mm Hg (HR = 1.35, 95% CI: 0.94-1.95), and ≥140/90 mm Hg (HR = 2.46, 95% CI: 1.78-3.40) were risk factors for CVD. Compared with the group with stable BP <130/80 mm Hg, the risk of CVD was 1.88 (95% CI: 1.40-2.53) in the group with persistent BP ≥130/80 mm Hg and 1.40 (95% CI: 1.01-1.94) in the group of BP decreased to <130/80 mm Hg. These results showed that BP 120-129/<80, 130-139/80-89, and ≥140/90 mm Hg were associated with a high risk of CVD. Over time, persistent BP ≥130/80 mm Hg increased the risk of CVD, but a return to <130/80 mm Hg from hypertension decreased the risk of CVD.
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