Abstract
BackgroundAlthough the high disease burden that results from cardiovascular complications of hypertension, factors related to the progression to hypertension in the normotensive population are not actively reported. The purpose of this study was to estimate the rate of the progression to hypertension and to reveal the associated risk factors.MethodsThe study included normotensive participants from the National Health Insurance Service-National Health Screening Cohort, and contained a 10% sample of all adults who received a national health screening test in either 2002 or 2003. At the end of the study in 2015, the patients were divided into two groups based on whether or not they progressed to hypertension. Cox proportional hazard modeling was performed to identify risk factors for progression. Subgroup analysis using logistic regression was employed to reveal factors influencing the different natural history of the progression.ResultsAmong the 75,335 included participants, the progression rate to hypertension was 66.39% (50,013), with an adjusted incidence rate of 8.62 per 100 person-year in the aged 40–64 group and 12.68 in the aged 65 or above group. Age, BMI, hemoglobin, and family history of hypertension and other diseases were related to the progression. Among the progression group, 78.21% (39,116) participants skipped a pre-hypertensive status; this group consisted of older females with lower pulse pressure and more alcohol consumption compared to people who had pre-hypertensive status before the progression.ConclusionSubstantial risk factors for the progression to hypertension should be carefully managed even in normotensive participants who receive health screening tests.
Highlights
Hypertension is the leading component of global disease burden and acts as a major cause of cardiovascular diseases [1]; a higher mortality in hypertensive population is well known in many countries through national level studies [2,3,4]
Anyone can the high disease burden that results from cardiovascular complications of hypertension, factors related to the progression to hypertension in the normotensive population are not actively reported
78.21% (39,116) participants skipped a pre-hypertensive status; this group consisted of older females with lower pulse pressure and more alcohol consumption compared to people who had pre-hypertensive status before the progression
Summary
Hypertension is the leading component of global disease burden and acts as a major cause of cardiovascular diseases [1]; a higher mortality in hypertensive population is well known in many countries through national level studies [2,3,4]. The definition of hypertension changed in the 2017 American College of Cardiology/American Heart Association (ACC/AHA) hypertension guidelines [10], which caused confusion in the diagnosis and treatment of patients with stage 1 hypertension, previously referred to as prehypertension [11]. In this complex situation, and due to the dynamic nature of blood pressure, it is difficult to measure blood pressure in a consistent way [12] and classify the blood pressure status in the general population. The purpose of this study was to estimate the rate of the progression to hypertension and to reveal the associated risk factors
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