PP.01.11] DEVELOPMENT OF HYPERTENSION OVER 10 YEARS DEPENDING ON BASELINE BLOOD PRESSURE CATEGORIES IN A SWEDISH POPULATION

Abstract

Objective: To explore the relationship between blood pressure categories at baseline and incident hypertension at follow-up in a representative Swedish population. Design and method: A longitudinal study over 10 years in a Swedish population. Main measures were anthropometric data, blood pressure, fasting glucose, LDL, CRP, eGFR, current smoking, leisure time physical activity and medical history. Blood pressures were measured and categorized according to ESH guidelines with optimal blood pressure defined as < 120 mmHg systolic and < 80 mmHg diastolic, normal as 120–129/80–84 mmHg, high normal as 130–139/85–89 mmHg, and unstable as >=140 and/or >=90 mmHg at one or two visits but not on three. Hypertension was defined as ongoing treatment or readings of >=140 and/or >= 90 mmHg at three consecutive visits. Subjects with hypertension at baseline were excluded. Data were analyzed with multivariate binary logistics regression. Results: Among the 1129 participating subjects the proportion with optimal blood pressure at the baseline survey was 56.1% (n=633), normal blood pressure 25.9% (n = 292), high normal blood pressure 12.5% (n = 141), and unstable blood pressure 5.6% (n = 63), respectively. Of those with optimal blood pressure at baseline 18 (2.8%), converted to hypertension during follow up. Corresponding numbers for subjects with normal, high normal and unstable blood pressure were 58 (19.9%), 56 (39.7%) and 47 (74.6%) respectively. Both normal, high normal and unstable baseline blood pressure were associated with an increased risk of development to manifest hypertension compared to optimal blood pressure, with odds ratios (OR (95% CI)) of 5.4 (CI 2.9–9.9), 12.5 (CI 6.3–25) and 88 (CI 33–231), respectively, independent of age and other main cardiovascular risk factors. A trend test showed that the OR for incident hypertension per unit of baseline blood pressure category was 3.8 (CI 2.9–5.0). The progression to hypertension was also independently predicted by age, BMI and heredity for hypertension. Conclusions: Subjects with high normal or unstable blood pressure should be identified in clinical practice and evaluated for global risk accounting for family history of hypertension. Measures should be taken to avoid or postpone the development of hypertension and its complications.