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Xiaoyan Cai - One of the best experts on this subject based on the ideXlab platform.
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Prehypertension and the risk of coronary heart disease in asian and western populations a meta analysis
Journal of the American Heart Association, 2015Co-Authors: Yuli Huang, Xiaoyan Cai, Changhua Liu, Dingji Zhu, Jinghai Hua, Jian PengAbstract:Background The results of studies on the association between Prehypertension (blood pressure 120 to 139/80 to 89 mm Hg) and coronary heart disease (CHD) remain controversial. Furthermore, it is unclear whether Prehypertension affects the risk of CHD in Asian and Western populations differently. This meta‐analysis evaluated the risk of CHD associated with Prehypertension and its different subgroups. Methods and Results The PubMed and Embase databases were searched for prospective cohort studies with data on Prehypertension and the risk of CHD. Studies were included if they reported multivariate‐adjusted relative risks (RRs) with 95% CIs of CHD from Prehypertension. A total of 591 664 participants from 17 prospective cohort studies were included. Prehypertension increased the risk of CHD (RR 1.43, 95% CI 1.26 to 1.63, P <0.001) compared with optimal blood pressure (<120/80 mm Hg). The risk of CHD was higher in Western than in Asian participants (Western: RR 1.70, 95% CI 1.49 to 1.94; Asian: RR 1.25, 95% CI 1.12 to 1.38; ratio of RRs 1.36, 95% CI 1.15 to 1.61). The population‐attributable risk indicated that 8.4% of CHD in Asian participants was attributed to Prehypertension, whereas this proportion was 24.1% in Western participants. Conclusions Prehypertension, even at the low range, is associated with an increased risk of CHD. This risk is more pronounced in Western than in Asian populations. These results supported the heterogeneity of target‐organ damage caused by Prehypertension and hypertension among different ethnicities and underscore the importance of prevention of CHD in Western patients with Prehypertension.
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Prevalence and risk factors associated with Prehypertension in Shunde District, southern China.
BMJ open, 2014Co-Authors: Yuli Huang, Changhua Liu, Dingji Zhu, Jinghai Hua, Wenke Qiu, Xiaoyan CaiAbstract:Objective To explore the prevalence and combined cardiovascular risk factors of Prehypertension in southern China. Design A retrospective study; the logistic regression model was used to find the risk factors of Prehypertension. Setting The study was conducted in Shunde District, southern China, using the community-based health check-up information. Participants Participants aged ≥35 years with complete health check-up information data between January 2011 and December 2013 were enrolled and divided into hypertension, Prehypertension and optimal blood pressure (BP) groups. Prehypertension was further divided into low-range (BP 120–129/80–84 mm Hg) and high-range (BP 130–139/85–89 mm Hg) subgroups. Outcome measures The prevalence of Prehypertension and the combined cardiovascular risk factors within the prehypertensive subgroups. Results Of the 5362 initially reviewed cases (aged ≥35 years), 651 were excluded because of missing data. The proportions of optimal BP, Prehypertension and hypertension were 39.1%, 38.6% and 22.3%, respectively. The average age, proportion of male sex, overweight, impaired fasting glucose (IFG), dyslipidaemia and hyperuricaemia were significantly higher in the Prehypertension group than in the optimal BP group (all p Conclusions Prehypertension is highly prevalent in southern China. Prehypertensive individuals presented with many other cardiovascular risk factors. There was heterogeneity of combined risk factors within the prehypertensive subgroups.
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Prehypertension and the risk of stroke A meta-analysis
Neurology, 2014Co-Authors: Yuli Huang, Xiaoyan Cai, Weiyi Mai, Sheng WangAbstract:Objective: In this meta-analysis, we sought to evaluate the association between Prehypertension and the risk of stroke. Methods: We searched PubMed and EMBASE databases for studies with data on Prehypertension and stroke. Two independent reviewers assessed the reports and extracted data. Prospective studies were included if they reported multivariate-adjusted relative risks (RRs) with 95% confidence intervals (CIs) for the associations between stroke and Prehypertension or its 2 subranges (low-range Prehypertension: 120–129/80–84 mm Hg; high-range Prehypertension: 130–139/85–89 mm Hg). We conducted subgroup analyses according to blood pressure ranges, stroke type, endpoint, age, sex, ethnicity, and study characteristics. Results: Pooled data included the results of 762,393 participants from 19 prospective cohort studies. Prehypertension increased the risk of stroke (RR 1.66; 95% CI 1.51–1.81) compared with optimal blood pressure ( p 0.001). There were no significant differences in any of the subgroup analyses (all p > 0.05). Conclusions: After adjusting for multiple cardiovascular risk factors, Prehypertension is associated with stroke morbidity. Although the increased risk is largely driven by high-range Prehypertension, the risk is also increased in people with low-range Prehypertension.
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association of all cause and cardiovascular mortality with Prehypertension a meta analysis
American Heart Journal, 2014Co-Authors: Yuli Huang, Xiaoyan Cai, Weiyi Mai, Sheng Wang, Hongfeng TangAbstract:Background Studies of Prehypertension and mortality are controversial after adjusting for other cardiovascular risk factors. This meta-analysis sought to evaluate the association of Prehypertension with all-cause and cardiovascular disease (CVD) mortality. Methods The PubMed, EMBASE, Cochrane Library databases, and conference proceedings were searched for studies with data on Prehypertension and mortality. The relative risks (RRs) of all-cause, CVD, coronary heart disease (CHD), and stroke mortality were calculated and presented with 95% CIs. Subgroup analyses were conducted according to blood pressure, age, gender, ethnicity, follow-up duration, participant number, and study characteristics. Results Data from 1,129,098 participants were derived from 20 prospective cohort studies. Prehypertension significantly increased the risk of CVD, CHD, and stroke mortality (RR 1.28, 95% CI 1.16-1.40; RR 1.12, 95% CI 1.02-1.23; and RR 1.41, 95% CI 1.28-1.56, respectively), but did not increase the risk of all-cause mortality after multivariate adjustment (RR 1.03, 95% CI 0.97-1.10). The difference between CHD mortality and stroke mortality was significant ( P Conclusion Prehypertension is associated with CVD mortality, especially with stroke mortality, but not with all-cause mortality. The risk for CVD mortality is largely driven by high-range Prehypertension.
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Prehypertension and Incidence of ESRD: A Systematic Review and Meta-analysis
American journal of kidney diseases : the official journal of the National Kidney Foundation, 2013Co-Authors: Yuli Huang, Xiaoyan Cai, Weiyi Mai, Sheng Wang, Jianyu Zhang, Hao RenAbstract:Background Studies of the association of Prehypertension with the incidence of end-stage renal disease (ESRD) after adjusting for other cardiovascular risk factors have shown controversial results. Study Design Systematic review and meta-analysis of prospective cohort studies. Setting & Population Adults with Prehypertension. Selection Criteria for Studies Studies evaluating the association of Prehypertension with the incidence of ESRD identified by searches in PubMed, EMBASE, and Cochrane Library databases and conference proceedings, without language restriction. Predictor Prehypertension. Outcomes The relative risks (RRs) of ESRD were calculated and reported with 95% CIs. Subgroup analyses were conducted according to blood pressure (BP), age, sex, ethnicity, and study characteristics. Results Data from 1,003,793 participants were derived from 6 prospective cohort studies. Compared with optimal BP, Prehypertension significantly increased the risk of ESRD (RR, 1.59; 95% CI, 1.39-1.91). In subgroup analyses, Prehypertension significantly predicted higher ESRD risk across age, sex, ethnicity, and study characteristics. Even low-range (BP, 120-129/80-84mm Hg) Prehypertension increased the risk of ESRD compared with optimal BP (RR, 1.44; 95% CI, 1.19-1.74), and the risk increased further with high-range (BP, 130-139/85-89mm Hg) Prehypertension (RR, 2.02; 95% CI, 1.70-2.40). The RR was significantly higher in the high-range compared with the low-range prehypertensive population ( P =0.01). Limitations No access to individual patient-level data. Conclusions Prehypertension is associated with incident ESRD. The increased risk is driven largely by high-range Prehypertension.
Yuli Huang - One of the best experts on this subject based on the ideXlab platform.
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Prehypertension and the risk of coronary heart disease in asian and western populations a meta analysis
Journal of the American Heart Association, 2015Co-Authors: Yuli Huang, Xiaoyan Cai, Changhua Liu, Dingji Zhu, Jinghai Hua, Jian PengAbstract:Background The results of studies on the association between Prehypertension (blood pressure 120 to 139/80 to 89 mm Hg) and coronary heart disease (CHD) remain controversial. Furthermore, it is unclear whether Prehypertension affects the risk of CHD in Asian and Western populations differently. This meta‐analysis evaluated the risk of CHD associated with Prehypertension and its different subgroups. Methods and Results The PubMed and Embase databases were searched for prospective cohort studies with data on Prehypertension and the risk of CHD. Studies were included if they reported multivariate‐adjusted relative risks (RRs) with 95% CIs of CHD from Prehypertension. A total of 591 664 participants from 17 prospective cohort studies were included. Prehypertension increased the risk of CHD (RR 1.43, 95% CI 1.26 to 1.63, P <0.001) compared with optimal blood pressure (<120/80 mm Hg). The risk of CHD was higher in Western than in Asian participants (Western: RR 1.70, 95% CI 1.49 to 1.94; Asian: RR 1.25, 95% CI 1.12 to 1.38; ratio of RRs 1.36, 95% CI 1.15 to 1.61). The population‐attributable risk indicated that 8.4% of CHD in Asian participants was attributed to Prehypertension, whereas this proportion was 24.1% in Western participants. Conclusions Prehypertension, even at the low range, is associated with an increased risk of CHD. This risk is more pronounced in Western than in Asian populations. These results supported the heterogeneity of target‐organ damage caused by Prehypertension and hypertension among different ethnicities and underscore the importance of prevention of CHD in Western patients with Prehypertension.
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Prevalence and risk factors associated with Prehypertension in Shunde District, southern China.
BMJ open, 2014Co-Authors: Yuli Huang, Changhua Liu, Dingji Zhu, Jinghai Hua, Wenke Qiu, Xiaoyan CaiAbstract:Objective To explore the prevalence and combined cardiovascular risk factors of Prehypertension in southern China. Design A retrospective study; the logistic regression model was used to find the risk factors of Prehypertension. Setting The study was conducted in Shunde District, southern China, using the community-based health check-up information. Participants Participants aged ≥35 years with complete health check-up information data between January 2011 and December 2013 were enrolled and divided into hypertension, Prehypertension and optimal blood pressure (BP) groups. Prehypertension was further divided into low-range (BP 120–129/80–84 mm Hg) and high-range (BP 130–139/85–89 mm Hg) subgroups. Outcome measures The prevalence of Prehypertension and the combined cardiovascular risk factors within the prehypertensive subgroups. Results Of the 5362 initially reviewed cases (aged ≥35 years), 651 were excluded because of missing data. The proportions of optimal BP, Prehypertension and hypertension were 39.1%, 38.6% and 22.3%, respectively. The average age, proportion of male sex, overweight, impaired fasting glucose (IFG), dyslipidaemia and hyperuricaemia were significantly higher in the Prehypertension group than in the optimal BP group (all p Conclusions Prehypertension is highly prevalent in southern China. Prehypertensive individuals presented with many other cardiovascular risk factors. There was heterogeneity of combined risk factors within the prehypertensive subgroups.
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Prehypertension and the risk of stroke A meta-analysis
Neurology, 2014Co-Authors: Yuli Huang, Xiaoyan Cai, Weiyi Mai, Sheng WangAbstract:Objective: In this meta-analysis, we sought to evaluate the association between Prehypertension and the risk of stroke. Methods: We searched PubMed and EMBASE databases for studies with data on Prehypertension and stroke. Two independent reviewers assessed the reports and extracted data. Prospective studies were included if they reported multivariate-adjusted relative risks (RRs) with 95% confidence intervals (CIs) for the associations between stroke and Prehypertension or its 2 subranges (low-range Prehypertension: 120–129/80–84 mm Hg; high-range Prehypertension: 130–139/85–89 mm Hg). We conducted subgroup analyses according to blood pressure ranges, stroke type, endpoint, age, sex, ethnicity, and study characteristics. Results: Pooled data included the results of 762,393 participants from 19 prospective cohort studies. Prehypertension increased the risk of stroke (RR 1.66; 95% CI 1.51–1.81) compared with optimal blood pressure ( p 0.001). There were no significant differences in any of the subgroup analyses (all p > 0.05). Conclusions: After adjusting for multiple cardiovascular risk factors, Prehypertension is associated with stroke morbidity. Although the increased risk is largely driven by high-range Prehypertension, the risk is also increased in people with low-range Prehypertension.
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association of all cause and cardiovascular mortality with Prehypertension a meta analysis
American Heart Journal, 2014Co-Authors: Yuli Huang, Xiaoyan Cai, Weiyi Mai, Sheng Wang, Hongfeng TangAbstract:Background Studies of Prehypertension and mortality are controversial after adjusting for other cardiovascular risk factors. This meta-analysis sought to evaluate the association of Prehypertension with all-cause and cardiovascular disease (CVD) mortality. Methods The PubMed, EMBASE, Cochrane Library databases, and conference proceedings were searched for studies with data on Prehypertension and mortality. The relative risks (RRs) of all-cause, CVD, coronary heart disease (CHD), and stroke mortality were calculated and presented with 95% CIs. Subgroup analyses were conducted according to blood pressure, age, gender, ethnicity, follow-up duration, participant number, and study characteristics. Results Data from 1,129,098 participants were derived from 20 prospective cohort studies. Prehypertension significantly increased the risk of CVD, CHD, and stroke mortality (RR 1.28, 95% CI 1.16-1.40; RR 1.12, 95% CI 1.02-1.23; and RR 1.41, 95% CI 1.28-1.56, respectively), but did not increase the risk of all-cause mortality after multivariate adjustment (RR 1.03, 95% CI 0.97-1.10). The difference between CHD mortality and stroke mortality was significant ( P Conclusion Prehypertension is associated with CVD mortality, especially with stroke mortality, but not with all-cause mortality. The risk for CVD mortality is largely driven by high-range Prehypertension.
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Prehypertension and Incidence of ESRD: A Systematic Review and Meta-analysis
American journal of kidney diseases : the official journal of the National Kidney Foundation, 2013Co-Authors: Yuli Huang, Xiaoyan Cai, Weiyi Mai, Sheng Wang, Jianyu Zhang, Hao RenAbstract:Background Studies of the association of Prehypertension with the incidence of end-stage renal disease (ESRD) after adjusting for other cardiovascular risk factors have shown controversial results. Study Design Systematic review and meta-analysis of prospective cohort studies. Setting & Population Adults with Prehypertension. Selection Criteria for Studies Studies evaluating the association of Prehypertension with the incidence of ESRD identified by searches in PubMed, EMBASE, and Cochrane Library databases and conference proceedings, without language restriction. Predictor Prehypertension. Outcomes The relative risks (RRs) of ESRD were calculated and reported with 95% CIs. Subgroup analyses were conducted according to blood pressure (BP), age, sex, ethnicity, and study characteristics. Results Data from 1,003,793 participants were derived from 6 prospective cohort studies. Compared with optimal BP, Prehypertension significantly increased the risk of ESRD (RR, 1.59; 95% CI, 1.39-1.91). In subgroup analyses, Prehypertension significantly predicted higher ESRD risk across age, sex, ethnicity, and study characteristics. Even low-range (BP, 120-129/80-84mm Hg) Prehypertension increased the risk of ESRD compared with optimal BP (RR, 1.44; 95% CI, 1.19-1.74), and the risk increased further with high-range (BP, 130-139/85-89mm Hg) Prehypertension (RR, 2.02; 95% CI, 1.70-2.40). The RR was significantly higher in the high-range compared with the low-range prehypertensive population ( P =0.01). Limitations No access to individual patient-level data. Conclusions Prehypertension is associated with incident ESRD. The increased risk is driven largely by high-range Prehypertension.
William F Clark - One of the best experts on this subject based on the ideXlab platform.
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elevated blood pressure in relation to overweight and obesity among children in a rural canadian community
Pediatrics, 2008Co-Authors: Marina I Salvadori, Jessica M Sontrop, Amit X Garg, Jennifer T Truong, Rita S Suri, Farid H Mahmud, Jennifer J Macnab, William F ClarkAbstract:OBJECTIVE. Childhood overweight and obesity may result in premature onset of cardiovascular risk factors such as hypertension. Rural populations in North America may be at increased risk for overweight. We evaluated whether overweight and obesity were associated with Prehypertension and hypertension in a well-characterized population of children in rural Canada. METHODS. The study population for this cross-sectional study was composed of children (aged 4–17 years) who were participants of the Walkerton Health Study (Canada) in 2004. Prehypertension and hypertension were defined on the basis of percentiles from the average of 3 blood pressure measures taken on a single occasion. Percentiles for BMI and blood pressure were calculated by using the 2000 Centers for Disease Control and Prevention growth charts. Multinomial logistic regression was used to evaluate the odds for Prehypertension and hypertension resulting from overweight and obesity. RESULTS. Of 675 children (98.7% white), 122 (18.1%) were overweight and 77 (11.4%) were obese. Prehypertension and hypertension were detected in 51 (7.6%) and 50 (7.4%), respectively. After adjustment for family history of hypertension and kidney disease, obesity was associated with both Prehypertension and hypertension. Overweight was associated with hypertension but not Prehypertension. These associations were observed across the genders and children aged CONCLUSIONS. In this population of children who lived in a rural community in Canada, overweight and obesity were strongly associated with elevated blood pressure. Whether blood pressure normalizes with improvements in diet, physical activity, and environment is an area for additional study.
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elevated blood pressure in relation to overweight and obesity among children in a rural canadian community
Pediatrics, 2008Co-Authors: Marina I Salvadori, Jessica M Sontrop, Amit X Garg, Jennifer T Truong, Rita S Suri, Farid H Mahmud, Jennifer J Macnab, William F ClarkAbstract:OBJECTIVE: Childhood overweight and obesity may result in premature onset of cardiovascular risk factors such as hypertension. Rural populations in North America may be at increased risk for overweight. We evaluated whether overweight and obesity were associated with Prehypertension and hypertension in a well-characterized population of children in rural Canada. METHODS: The study population for this cross-sectional study was composed of children (aged 4-17 years) who were participants of the Walkerton Health Study (Canada) in 2004. Prehypertension and hypertension were defined on the basis of percentiles from the average of 3 blood pressure measures taken on a single occasion. Percentiles for BMI and blood pressure were calculated by using the 2000 Centers for Disease Control and Prevention growth charts. Multinomial logistic regression was used to evaluate the odds for Prehypertension and hypertension resulting from overweight and obesity. RESULTS: Of 675 children (98.7% white), 122 (18.1%) were overweight and 77 (11.4%) were obese. Prehypertension and hypertension were detected in 51 (7.6%) and 50 (7.4%), respectively. After adjustment for family history of hypertension and kidney disease, obesity was associated with both Prehypertension and hypertension. Overweight was associated with hypertension but not Prehypertension. These associations were observed across the genders and children aged or=13 years, except that overweight was not associated with hypertension among girls. CONCLUSIONS: In this population of children who lived in a rural community in Canada, overweight and obesity were strongly associated with elevated blood pressure. Whether blood pressure normalizes with improvements in diet, physical activity, and environment is an area for additional study.
M Renuka - One of the best experts on this subject based on the ideXlab platform.
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Prevalence of Prehypertension in a Rural District of Southern India
International journal of preventive medicine, 2015Co-Authors: Marinayakanakoppalu R Ravi, N C Ashok, M RenukaAbstract:Background: Estimating the prevalence of Prehypertension and its risk factors in a population becomes important to design preventive measures and hence reduce the burden of hypertension.The aim of this study was to estimate the prevalence of Prehypertension and determine the factors associated with hypertension. Methods: This is a cross-sectional study and was carried out in a rural population. The study included 402 participants. Data regarding basic demographic characteristics were collected along with anthropometric measurements including height and weight. Information regarding smoking alcohol intake, dietary habits were collected. Prehypertension was defined as systolic blood pressure 120-139 mm Hg and/or diastolic blood pressure 80-89 mm Hg. Chi-square-test was used to find the association of various risk factors; t-test was used to compare the means. Multiple linear regression analysis was used to know the relationship of various risk factors. Results: Prevalence of Prehypertension was estimated to be 28.8%. Factors such as salt intake, tobacco consumption, alcohol consumption, stress, family history of hypertension, history of diabetes mellitus had a significant association with Prehypertension (P Conclusions: The prevalence of Prehypertension was found to be high among the rural population. Early intervention is needed to decrease the burden of hypertension and its complications in future.
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BRIEF COMMUNICATION: PREVALENCE OF Prehypertension IN A RURAL DISTRICT OF SOUTHERN INDIA
2015Co-Authors: R Ravi Marinayakanakoppalu, C Ashok Nagaralu, M RenukaAbstract:Background: Estimating the prevalence of Prehypertension and its risk factors in a population becomes important to design preventive measures and hence reduce the burden of hypertension. The aim of this study was to estimate the prevalence of Prehypertension and determine the factors associated with hypertension. Methods: This is a cross‐sectional study and was carried out in a rural population. The study included 402 participants. Data regarding basic demographic characteristics were collected along with anthropometric measurements including height and weight. Information regarding smoking alcohol intake, dietary habits were collected. Prehypertension was defined as systolic blood pressure 120–139 mm Hg and/or diastolic blood pressure 80–89 mm Hg. Chi‐square‐test was used to find the association of various risk factors; t‐test was used to compare the means. Multiple linear regression analysis was used to know the relationship of various risk factors. Results: Prevalence of Prehypertension was estimated to be 28.8%. Factors such as salt intake, tobacco consumption, alcohol consumption, stress, family history of hypertension, history of diabetes mellitus had a significant association with Prehypertension (P < 0.05). Conclusions: The prevalence of Prehypertension was found to be high among the rural population. Early intervention is needed to decrease the burden of hypertension and its complications in future.
Brent M. Egan - One of the best experts on this subject based on the ideXlab platform.
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Prehypertension prevalence health risks and management strategies
Nature Reviews Cardiology, 2015Co-Authors: Brent M. Egan, Sean StevensfabryAbstract:Prehypertension (blood pressure 120-139/80-89 mmHg) affects ~25-50% of adults worldwide, and increases the risk of incident hypertension. The relative risk of incident hypertension declines by ~20% with intensive lifestyle intervention, and by 34-66% with single antihypertensive medications. To prevent one case of incident hypertension in adults with Prehypertension and a 50% 5-year risk of hypertension, 10 individuals would need to receive intensive lifestyle intervention, and four to six patients would need to be treated with antihypertensive medication. The relative risk of incident cardiovascular disease (CVD) is greater with 'stage 2' (130-139/85-89 mmHg) than 'stage 1' (120-129/80-84 mmHg) Prehypertension; only stage 2 Prehypertension increases cardiovascular mortality. Among individuals with Prehypertension, the 10-year absolute CVD risk for middle-aged adults without diabetes mellitus or CVD is ~10%, and ~40% for middle-aged and older individuals with either or both comorbidities. Antihypertensive medications reduce the relative risk of CVD and death by ~15% in secondary-prevention studies of Prehypertension. Data on primary prevention of CVD with pharmacotherapy in Prehypertension are lacking. Risk-stratified, patient-centred, comparative-effectiveness research is needed in Prehypertension to inform an acceptable, safe, and effective balance of lifestyle and medication interventions to prevent incident hypertension and CVD.
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Prehypertension—prevalence, health risks, and management strategies
Nature reviews. Cardiology, 2015Co-Authors: Brent M. Egan, Sean Stevens-fabryAbstract:Prehypertension (blood pressure 120-139/80-89 mmHg) affects ~25-50% of adults worldwide, and increases the risk of incident hypertension. The relative risk of incident hypertension declines by ~20% with intensive lifestyle intervention, and by 34-66% with single antihypertensive medications. To prevent one case of incident hypertension in adults with Prehypertension and a 50% 5-year risk of hypertension, 10 individuals would need to receive intensive lifestyle intervention, and four to six patients would need to be treated with antihypertensive medication. The relative risk of incident cardiovascular disease (CVD) is greater with 'stage 2' (130-139/85-89 mmHg) than 'stage 1' (120-129/80-84 mmHg) Prehypertension; only stage 2 Prehypertension increases cardiovascular mortality. Among individuals with Prehypertension, the 10-year absolute CVD risk for middle-aged adults without diabetes mellitus or CVD is ~10%, and ~40% for middle-aged and older individuals with either or both comorbidities. Antihypertensive medications reduce the relative risk of CVD and death by ~15% in secondary-prevention studies of Prehypertension. Data on primary prevention of CVD with pharmacotherapy in Prehypertension are lacking. Risk-stratified, patient-centred, comparative-effectiveness research is needed in Prehypertension to inform an acceptable, safe, and effective balance of lifestyle and medication interventions to prevent incident hypertension and CVD.
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Prehypertension and cardiovascular morbidity
Annals of Family Medicine, 2005Co-Authors: Heather A. Liszka, Dana E. King, Charles J. Everett, Arch G. Mainous, Brent M. EganAbstract:PURPOSE The Seventh Report of the Joint National Commission (JNC 7) on High Blood Pressure established Prehypertension (120 to 139 mm Hg systolic or 80 to 89 mm Hg diastolic) as a new risk category. We aim to determine the risk of major cardiovascular events associated with blood pressure in the prehypertensive range in a longitudinal, population-based cohort. METHODS Analyses were conducted on participants in the National Health and Nutrition Examination Survey I (1971–1975) observed for 18 years for major cardiovascular disease events. Cox proportional hazard ratios were calculated to assess relative risk of cardiovascular disease, including stroke, myocardial infarction, and heart failure, in participants with Prehypertension and normal blood pressure (<120/80 mm Hg). RESULTS Prehypertension was associated with increased risk for cardiovascular disease (1.79 [95% confidence interval (CI) 1.40–2.24]) in unadjusted analysis. After adjustment for cardiovascular risk factors, the relationship of Prehypertension to cardiovascular disease was diminished but persisted (1.32 [95% CI 1.05–1.65]). Ninety-three percent of prehypertensive individuals had at least 1 cardiovascular risk factor. Low Prehypertension (120–129/80–84 mm Hg) was associated with increased cardiovascular disease in unadjusted analyses (1.56 [95% CI 1.23–1.98]) but was not statistically significant in adjusted analyses (1.24 [95% CI 0.96–1.59]). High-normal blood pressure (130–139/85–89 mm Hg) remained a predictor of cardiovascular disease in unadjusted (2.13 [95% CI 1.64–2.76]) and adjusted (1.42 [95% CI 1.09–1.84]) analyses. CONCLUSIONS In a longitudinal, population-based, US cohort, Prehypertension was associated with increased risk of major cardiovascular events independently of other cardiovascular risk factors. These findings, along with the presence of cardiovascular risk factors in the majority of participant sample with Prehypertension, support recommendations for physicians to actively target lifestyle modifications and multiple risk reduction in their prehypertensive patients.
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Prehypertension and mortality in a nationally representative cohort
The American journal of cardiology, 2004Co-Authors: Arch G. Mainous, Dana E. King, Charles J. Everett, Heather A. Liszka, Brent M. EganAbstract:The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure 7 recommendations include early identification of Prehypertension (120 to 139 mm Hg systolic or 80 to 89 mm Hg diastolic). Although Prehypertension is a risk factor for hypertension, little is known of Prehypertension's independent risk for mortality. We conducted an analysis of a nationally representative cohort in the second National Health and Nutrition Examination Survey 1976 to 1980 (NHANES II) and the NHANES II Mortality Study, 1992. The cohort included 9,087 patients aged 30 to 74 years at baseline, who represented nearly 95 million Americans. Cox proportional-hazards models were conducted for both cardiovascular disease (CVD) and all-cause mortality. The unadjusted relative risk of both all-cause (hazard ratio [HR] 1.27, 95% confidence interval [CI] 1.02 to 1.58) and CVD (HR 1.66, 95% CI 1.21 to 2.26) mortality is increased for patients with Prehypertension over patients with normal blood pressure (BP). Almost all patients with hypertension (93%), Prehypertension (90%), and normal BP (85%) have other CVD risk factors. When the presence of any CVD risk factor is adjusted for in the survival analysis, the adjusted relative risk of both all-cause (HR 0.82, 95% CI 0.64 to 1.04) and CVD (HR 1.00, 95% CI 0.72 to 1.39) mortality is no longer increased for patients with Prehypertension. Similarly, in analyses of patients aged ≥55 years, there is no significant independent mortality risk for Prehypertension. Lifestyle interventions targeting multiple risk factors including BP may be the most effective prevention strategy.