Abstract
BackgroundProspective cohort studies of prehypertension and the incidence of cardiovascular disease (CVD) are controversial after adjusting for other cardiovascular risk factors. This meta-analysis evaluated the association between prehypertension and CVD morbidity.MethodsDatabases (PubMed, EMBASE and the Cochrane Library) and conference proceedings were searched for prospective cohort studies with data on prehypertension and cardiovascular morbidity. Two independent reviewers assessed the reports and extracted data. The relative risks (RRs) of CVD, coronary heart disease (CHD) and stroke morbidity were calculated and reported with 95% confidence intervals (95% CIs). Subgroup analyses were conducted on blood pressure, age, gender, ethnicity, follow-up duration, number of participants and study quality.ResultsPooled data included the results from 468,561 participants from 18 prospective cohort studies. Prehypertension elevated the risks of CVD (RR = 1.55; 95% CI = 1.41 to 1.71); CHD (RR = 1.50; 95% CI = 1.30 to 1.74); and stroke (RR = 1.71; 95% CI = 1.55 to 1.89). In the subgroup analyses, even for low-range prehypertension, the risk of CVD was significantly higher than for optimal BP (RR = 1.46, 95% CI = 1.32 to 1.62), and further increased with high-range prehypertension (RR = 1.80, 95% CI = 1.41 to 2.31). The relative risk was significantly higher in the high-range prehypertensive populations than in the low-range populations (χ2= 5.69, P = 0.02). There were no significant differences among the other subgroup analyses (P>0.05).ConclusionsPrehypertension, even in the low range, elevates the risk of CVD after adjusting for multiple cardiovascular risk factors.
Highlights
Prospective cohort studies of prehypertension and the incidence of cardiovascular disease (CVD) are controversial after adjusting for other cardiovascular risk factors
Studies were included if they met the following criteria: (1) prospective cohort studies of participants aged ≥18 years; (2) blood pressure (BP) and other cardiovascular risk factors were evaluated at baseline; (3) the follow-up duration was ≥2 years and the study assessed the incidence of composited CVD, coronary heart disease (CHD) or stroke morbidity; (4) they reported the multivariate-adjusted relative risks (RRs, including study-specific relative risk ratios or hazard ratios) and 95% confidence intervals (CIs) for events associated with prehypertension (BP 120 to 139/80 to 89 mm Hg) vs. reference or reported RRs and 95% CIs of low-range (BP 120 to 129/80 to 84 mm Hg) and high-range prehypertension (BP 130 to 139/ 85 to 89 mm Hg) vs. reference, respectively
Our final primary analysis included 19 articles [7,8,9,10,11,18,19,20,21,22,23,24,25,26,27,28,29,30,31], with a total of 468,561 participants, derived from 18 prospective cohort studies
Summary
Prospective cohort studies of prehypertension and the incidence of cardiovascular disease (CVD) are controversial after adjusting for other cardiovascular risk factors. This meta-analysis evaluated the association between prehypertension and CVD morbidity. Some studies have demonstrated that prehypertension is an independent risk factor for cardiovascular disease (CVD) [6,7,8,9], while others have not shown the same results after data were adjusted for baseline cardiovascular risk factors [10,11]. Arguments against using the term “prehypertension” include the fact that there is heterogeneity within this category, as the risk of progressing to hypertension and developing CVD is higher in individuals with BP 130 to 139/85 to 89 mm Hg than in those with BP 120 to 129/80 to 84 mm Hg [3,13]
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