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Prehypertension heightens risk for CVD, stroke mortality
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A new meta-analysis demonstrated that prehypertension is associated with CVD mortality, especially stroke mortality, but not with all-cause mortality.
Prehypertension is defined as systolic BP between 120 mm Hg and 139 mm Hg or diastolic BP between 80 mm Hg and 89 mm Hg, but the risk for CVD mortality was stronger for patients with high-range prehypertension, defined as systolic BP between 130 mm Hg and 139 mm Hg or diastolic BP between 85 mm Hg and 89 mm Hg, researchers reported.
“Studies of prehypertension and mortality are controversial after adjusting for other cardiovascular risk factors,” Yuli Huang, MD, of Nanfang Hospital, Southern Medical University, Guangzhou, China, and colleagues wrote.
The researchers conducted a meta-analysis of 20 studies with data on prehypertension and mortality (n=1,129,098). Twelve studies reported all-cause and CVD mortality, six reported CVD mortality only, and two reported all-cause mortality only. Seven of the studies reported data for CHD mortality and stroke mortality. Follow-up duration ranged from 5.1 years to 36 years.
After multivariate adjustment, prehypertension did not increase the risk for all-cause mortality (RR=1.03; 95% CI, 0.97-1.1). There was no relationship for any subgroup according to BP range, age, sex, ethnicity, follow-up duration or participant number.
However, prehypertension increased the risk for CVD mortality (RR=1.28; 95% CI, 1.16-1.4), CHD mortality (RR=1.12; 95% CI, 1.02-1.23) and stroke mortality (RR=1.41; 95% CI, 1.28-1.56), Huang and colleagues found. The difference between CHD mortality and stroke mortality was significant (P=.0009). No evidence of publication bias was found.
Participants with high-range prehypertension had an elevated risk for CVD mortality (RR=1.28; 95% CI, 1.16-1.41), but this association was not observed for those with low-range prehypertension (RR=1.08; 95% CI, 0.98-1.18).
Population-attributable risk calculation indicated that 10.5% of CVD death, 4.8% of CHD death and 14.6% of stroke death could be prevented if prehypertension were eliminated, according to the researchers.
“Our findings reaffirm the importance of the definition of ‘prehypertension’ rather than being ‘normal’ for individuals of 120-139/80-89 mm Hg,” Huang and colleagues wrote. “However, because of the significant difference in the risk for BP of 120-129/80-84 mm Hg and 130-139/85-89 mm Hg, we suggest that this category be subdivided into low- and high-range prehypertension and that lifestyle modification should be advocated earlier than usual in prehypertension.”
Disclosure: The researchers report no relevant financial disclosures.
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