Long-Term Cardiovascular Risk Associated With Stage 1 Hypertension Defined by the 2017 ACC/AHA Hypertension Guideline.
BACKGROUND
Systolic/diastolic blood pressure (BP) of 130 to 139/80 to 89 mm Hg has been recently defined as stage 1 hypertension by the 2017 American College of Cardiology/American Heart Association hypertension guideline. To what extent this BP stratum affects cardiovascular risk needs to be quantified in considering its adoption in China.


OBJECTIVES
The purpose of this study was to assess the relative risk and population-attributable risk of cardiovascular disease (CVD) associated with stage 1 hypertension and age-specific differences.


METHODS
In total, 21,441 participants age ≥35 years and free of CVD at baseline were followed for up to 20 years in the Chinese Multi-provincial Cohort Study. The adjusted hazard ratio (HR) and population-attributable risk for CVD associated with stage 1 hypertension were calculated.


RESULTS
Participants with stage 1 hypertension accounted for 25.8% of the cohort. Among participants age 35 to 59 years, the HR comparing stage 1 hypertension to BP <120/<80 mm Hg for CVD incidence was 1.78 (95% confidence interval [CI]: 1.50 to 2.11), coronary heart disease incidence was HR: 1.77 (95% CI: 1.33 to 2.36), stroke incidence was HR: 1.79 (95% CI: 1.45 to 2.22), and CVD mortality was HR: 2.50 (95% CI: 1.66 to 3.77). The proportions of cardiovascular deaths and events attributable to stage 1 hypertension were 26.5% and 13.4% among participants age 35 to 59 years, respectively. Among participants age ≥60 years, however, stage 1 hypertension was not related to increased risk compared with BP <120/<80 mm Hg, and population-attributable risk associated with this stratum was not found. Over a 15-year period, 65.0% of participants age 35 to 59 years with stage 1 hypertension experienced an increase in BP to 140/90 mm Hg or higher, and they had a 3.01-fold increased cardiovascular risk compared with those who maintained BP <130/<80 mm Hg.


CONCLUSIONS
The effect of 2017 American College of Cardiology/American Heart Association stage 1 hypertension on cardiovascular risk is evidenced in young and middle-aged Chinese adults, but not in those age ≥60 years.
['Qi|Yue|Y|', 'Han|Xueyu|X|', 'Zhao|Dong|D|', 'Wang|Wei|W|', 'Wang|Miao|M|', 'Sun|Jiayi|J|', 'Liu|Jun|J|', 'Li|Yan|Y|', 'Gao|Shen|S|', 'Hao|Yongchen|Y|', 'Deng|Qiuju|Q|', 'Liu|Jing|J|']
D000328:Adult D002681:China D015331:Cohort Studies D003327:Coronary Disease D016757:Death, Sudden, Cardiac D005260:Female D006801:Humans D006973:Hypertension D008137:Longitudinal Studies D008297:Male D008875:Middle Aged D009203:Myocardial Infarction D017410:Practice Guidelines as Topic D012306:Risk D020521:Stroke
hypertension cardiovascular disease cohort study incidence mortality