ASSOCIATION OF HIGH NORMAL BLOOD PRESSURE DEFINED BY DIFFERENT CRITERIA WITH ALL-CAUSE AND CARDIOVASCULAR MORTALITY

Abstract

Objective: To evaluate the association of the all-cause and cardiovascular mortality with the guideline-based classification criteria and systolic blood pressure (SBP)-based classification for high normal blood pressure. Design and method: We collected data from the NHANES Database,which is a large, serial, cross-sectional survey designed to be nationally representative of the civilian adult population in the United States Inclusion Criteria: SBP > 90mmHg; Without any antihypertensive treatment; Having complete record for a history of major cardiovascular-related disease including hypertension, coronary heart disease, myocardial infarction, heart failure, stroke, diabetes and hyperlipemia. All the participants were divided into 3 groups according to the latest guidelines or systolic blood pressure. Group1: Normotensivel; Group2: High normal blood pressure; Group3: Hypertension Results: By grouping population according to guideline definition, in terms of all-cause mortality and cardiovascular death, there was no significant difference between population with normal blood pressure (NT) and with high normal blood pressure (HNBP). But both groups had significantly lower risk compared with hypertension group (HTN). Multivariate Cox regression results indicated the lowest risk of all-cause mortality in the HNBP group and no difference in risk of all-cause mortality between the NT and HTN groups, which was illogical and inconsistent with real-world clinical practice. By grouping population according to SBP, we found that the grouping better distinguished all-cause and cardiovascular mortality among groups. Multivariate COX regression analysis found that NT and HNBP groups had no difference in risk of all-cause and cardiovascular death. The restricted cubic spline curve of DBP showed the lowest HR were found when DBP was between 83 and 95 mmHg, which were defined as high normal blood pressure or hypertension according to guideline-directed classification. This result may be the primary reason for the difference between guideline and SBP-directed classification. Conclusions: In this study, our analysis showed that the blood pressure based on SBP had a higher association with both all-cause mortality and cardiovascular mortality than the guide-directed definition. DBP inclusion could be a confounding factor for the classification. People with high normal blood pressure did not show a worse prognosis than those with normal blood pressure.