Stage 1 hypertension, but not elevated blood pressure, predicts 10-year fatal and non-fatal CVD events in healthy adults: the ATTICA Study

J Hum Hypertens. 2019 Apr;33(4):308-318. doi: 10.1038/s41371-019-0169-z. Epub 2019 Feb 11.

Abstract

The study evaluated the extent to which high normal blood pressure (HNBP), elevated BP, and Stage 1 hypertension predict 10-year incidence of cardiovascular disease (CVD). A population-based, prospective cohort study was conducted among 3042 randomly selected Greek adults, aged 18-89 years. Following 10-years follow-up (2002-2012), incidence of non-fatal and fatal CVD (ICD-10) was achieved in 2020 participants. The analytic sample (n = 1403) excluded hypertensive patients. At baseline, the prevalence rate of HNBP, elevated BP, and Stage 1 hypertension was 44.6% (n = 626), 29.0% (n = 408), and 15.5% (n = 218), respectively. During follow-up, the 10-year combined (fatal or non-fatal) CVD incidence rates in HNBP, elevated BP, and Stage 1 hypertensive individuals were 15.6% (n = 98), 12.0% (n = 49), and 22.5% (n = 49), respectively, as compared to 6.3% (n = 49) in normotensives (all p's < 0.0001). As compared to normotensives (and following the adjustment for known demographic, lifestyle and clinical confounding factors), HNBP participants had a 1.5-fold (Adjusted Hazard Ratio, Adj. HR: 1.49; 95% CI: 1.00-2.20) increased risk of 10-year CVD events. Similarly, Stage 1 hypertensive participants had an approximately twofold (Adj. HR: 1.90; 95% CI: 1.16-3.08) increased risk for 10-year CVD, particularly among males (Adj. HR: 2.03; 95% CI: 1.08-3.83). However, individuals with elevated BP did not exhibit a differential risk for developing 10-year CVD events (Adj. HR: 1.28; 95% CI: 0.82-2.02). Therefore, since HNBP and Stage 1 hypertension individuals exhibit a notable increased risk of 10-year fatal and non-fatal CVD, the implementation of targeted primary and secondary prevention interventions may deter both CVD and related adverse health outcomes.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Blood Pressure*
  • Cardiovascular Diseases / diagnosis
  • Cardiovascular Diseases / epidemiology*
  • Cardiovascular Diseases / mortality
  • Cardiovascular Diseases / physiopathology
  • Cause of Death
  • Female
  • Greece / epidemiology
  • Humans
  • Hypertension / diagnosis
  • Hypertension / epidemiology*
  • Hypertension / mortality
  • Hypertension / physiopathology
  • Incidence
  • Male
  • Middle Aged
  • Prevalence
  • Prognosis
  • Prospective Studies
  • Risk Assessment
  • Risk Factors
  • Young Adult