Abstract
The time at which hypertension treatment should be initiated for different age groups and sexes remains controversial. We aimed to determine whether the association between blood pressure (BP) and major adverse cardiovascular events (MACE) varies with age and sex. This study enrolled 327,328 subjects who had not taken antihypertensive medication in the Korean National Health Service-National Health Screening Cohort between 2002 and 2003. Participants were categorized into four groups according to 2017 American College of Cardiology/American Heart Association hypertension guideline. Primary outcome was MACE characterized by cardiovascular mortality, myocardial infarction, unstable angina, and stroke. During a 10-year follow-up, a significant increase in MACE risk was observed from the stage 1 hypertension group (hazard ratio [HR], 1.23; 95% CI 1.15–1.32; P < 0.001) in time-varying Cox analysis. This relationship was persistent in subjects aged < 70 years, but increased MACE risk was observed only in the stage 2 hypertension group in ≥ 70 years (HR, 1.52; 95% CI 1.32–1.76, P < 0.001). When categorized as per sex, both men and women showed significant MACE risk from stage 1 hypertension. However, on comparing the sexes after stratifying by age, a significantly increased risk of MACE was shown from stage 1 hypertension in men aged < 50 years, but from stage 2 hypertension in men aged ≥ 50 years. Meanwhile, increased MACE risk was observed from stage 2 hypertension in women aged < 60 years, but from stage 1 hypertension in women aged ≥ 60 years. Thus, young male subjects had higher MACE risk than young female subjects, but this difference gradually decreased with age and there was no difference between sexes in subjects aged ≥ 70 years. Therefore, our results suggest that hypertension treatment initiation may need to be individualized depending on age and sex.
Highlights
The time at which hypertension treatment should be initiated for different age groups and sexes remains controversial
When we classified the participants based on their baseline blood pressure (BP), 99,290 (30.3%) individuals were in the normal BP group and 30,745 (9.4%) were in the elevated BP group; 111,240 (34.0%) had stage 1 HTN and 86,053 (26.3%) had stage 2 HTN
The crude incidence rate (CIR) for major adverse cardiovascular events (MACE) in the normal BP group was 1.67 per 1000 person-years, which gradually increased with an increase in BP stage (Table 2)
Summary
The time at which hypertension treatment should be initiated for different age groups and sexes remains controversial. During a 10-year follow-up, a significant increase in MACE risk was observed from the stage 1 hypertension group (hazard ratio [HR], 1.23; 95% CI 1.15–1.32; P < 0.001) in time-varying Cox analysis. Hypertension (HTN) has been defined as systolic blood pressure (SBP) ≥ 140 mmHg or diastolic blood pressure (DBP) ≥ 90 mmHg. several meta-analyses conducted based on large observational studies have continuously reported that pre-HTN stage is associated with increased cardiovascular disease (CVD) risk[1,2,3,4]. Recent Systolic Blood Pressure Intervention Trial (SPRINT) showed that intensive BP control at < 120 mmHg resulted in significantly lower rates of CVD compared with standard BP control[5] Based on this evidence, 2017 American College of Cardiology/American Heart Association (ACC/AHA) guideline suggested to lower the threshold and newly defined HTN as SBP ≥ 130 mmHg or DBP ≥ 80 mmHg6. CVD risk according to BP was evaluated in subgroups of age and sex
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