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Stage 1 hypertension strongly predicts 10-year CVD events

19 May 2019

Stage 1 hypertension but not elevated blood pressure (BP) appears to be associated with a significant increase in the incidence of fatal and nonfatal cardiovascular disease (CVD) events over a 10-year follow-up, according to data from the ATTICA study.

The analysis involved 3,042 randomly selected Greek adults aged 18–89 years. Hypertension status was defined based on mean systolic/diastolic blood pressure and the most recent 2017 ACC/AHA guidelines: high normal blood pressure (HNBP; systolic, 120–139 mm Hg; diastolic, 80–89 mm Hg; no prior history of high blood pressure), elevated BP (systolic, 120–129 mm Hg; diastolic, <80 mm Hg) and stage 1 hypertension (systolic, 130–139 mm Hg; diastolic, 80–89 mm Hg).

In the cohort, the prevalence rates of HNBP, elevated BP and stage 1 hypertension were 44.6 percent (n=626), 29.0 percent (n=408) and 15.5 percent (n=218), respectively.

Incident fatal and nonfatal CVD events during follow-up of 10 years occurred in 98 patients (15.6 percent) in the HNBP group, 49 (12.0 percent) in the elevated BP group and 49 (22.5 percent) in the stage 1 hypertension group as compared with 49 (6.3 percent) in the normotension group (p<0.0001 for all).

Relative to normal BP, HNBP and stage 1 hypertension contributed to an increased risk of 10-year CVD. The risk increased by 1.5-fold with HNBP (adjusted hazard ratio [aHR], 1.49; 95 percent CI, 1.00–2.20) and by twofold with stage 1 hypertension (aHR, 1.90; 1.16–3.08). The risk increase was particularly pronounced in males (aHR, 2.03; 1.08–3.83).

On the other hand, elevated BP was not associated with an increased risk of developing 10-year CVD events (aHR, 1.28; 0.82–2.02).

In light of a notable increased risk of 10-year fatal and nonfatal CVD events associated with HNBP and stage 1 hypertension, researchers called for the implementation of targeted primary and secondary prevention interventions that may deter both CVD and related adverse health outcomes.

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