Abstract
BackgroundTo explore the determinants of incident hypertension, and especially the impact of baseline blood pressure categories, in a representative Swedish population.MethodsA 10-year longitudinal study of residents aged 30–74. Blood pressures were measured and categorized according to ESH guidelines with optimal blood pressure < 120/80 mmHg, normal 120–129/80–84 mmHg, and high normal 130–139/85–89 mmHg. Incident hypertension was defined as ongoing treatment or three consecutive blood pressure readings ≥ 140/ ≥ 90 mmHg (one or both) at follow-up, while those with ≥ 140 and/or ≥ 90 mmHg at only one or two visits were labelled as unstable. After excluding subjects with hypertension, ongoing blood pressure lowering medication or a previous CVD event at baseline, 1099 remained for further analyses.ResultsSixteen (2.6%) subjects with optimal baseline blood pressure had hypertension at follow up. Corresponding numbers for subjects with normal, high normal and unstable blood pressure were 55 (19.4%), 50 (39.1%) and 46 (74.2%), respectively. Compared with subjects in optimal group those in normal, high normal and unstable blood pressure categories had significantly higher risk to develop manifest hypertension with odds ratios OR and (95% CI) of 7.04 (3.89–12.7), 17.1 (8.88–33.0) and 84.2 (37.4–190), respectively, with adjustment for age, BMI and family history for hypertension. The progression to hypertension was also independently predicted by BMI (p < 0.001), however, not by age.ConclusionsSubjects with high normal or unstable blood pressure should be identified in clinical practice, evaluated for global hypertension risk and offered personalized advice on lifestyle modification for early prevention of manifest hypertension and cardiovascular disease.
Highlights
Hypertension is a common condition, strongly associated with cardiovascular mortality and morbidity [1, 2] and 2010 established as the leading cause behind the world’s global burden of disease [2, 3], and as recently reviewed and put into a context of causal determinants by Fuchs and Whelton [3]
Subjects with high blood pressure, within the normal range, run an increased risk of developing hypertension compared to subjects with lower blood pressure [3] and there seems to be a sliding scale of elevated cardiovascular disease risk associated with blood pressures all the way down to a level of 115/75 mmHg [7]
Individuals diagnosed with hypertension or on anti-hypertensive medication at base-line were excluded in this study (n = 198), as were those with a previous CVD event (n = 25), and 5 participants lacking a complete series of blood pressure readings at follow-up, leaving 1099 individuals for the final analyses (Fig. 1)
Summary
Hypertension is a common condition, strongly associated with cardiovascular mortality and morbidity [1, 2] and 2010 established as the leading cause behind the world’s global burden of disease [2, 3], and as recently reviewed and put into a context of causal determinants by Fuchs and Whelton [3]. Subjects with high blood pressure, within the normal range, run an increased risk of developing hypertension compared to subjects with lower blood pressure [3] and there seems to be a sliding scale of elevated cardiovascular disease risk associated with blood pressures all the way down to a level of 115/75 mmHg [7]. While a presumptive cardiovascular risk factor in its own right, high normal blood pressure constitutes a risk factor for future hypertension and has sometimes even been referred to as prehypertension. Subjects of high normal blood pressure, especially in younger population strata, constitute a highly interesting and still rather poorly studied group. To explore the determinants of incident hypertension, and especially the impact of baseline blood pressure categories, in a representative Swedish population
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