Author + information
- Received April 16, 2018
- Revision received June 7, 2018
- Accepted June 12, 2018
- Published online September 3, 2018.
- Yue Qi, MD, PhD∗,
- Xueyu Han, MD∗,
- Dong Zhao, MD, PhD,
- Wei Wang, MD,
- Miao Wang, MD,
- Jiayi Sun, MD,
- Jun Liu, MD,
- Yan Li, MD,
- Shen Gao, MD,
- Yongchen Hao, PhD,
- Qiuju Deng, PhD and
- Jing Liu, MD, PhD∗ ()
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing, China; Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China; The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing, China; and the Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
- ↵∗Address for correspondence:
Dr. Jing Liu, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing 100029, China.
Background Systolic/diastolic blood pressure (BP) of 130 to 139/80 to 89 mm Hg has been recently defined as stage 1 hypertension by the 2017 American College of Cardiology/American Heart Association hypertension guideline. To what extent this BP stratum affects cardiovascular risk needs to be quantified in considering its adoption in China.
Objectives The purpose of this study was to assess the relative risk and population-attributable risk of cardiovascular disease (CVD) associated with stage 1 hypertension and age-specific differences.
Methods In total, 21,441 participants age ≥35 years and free of CVD at baseline were followed for up to 20 years in the Chinese Multi-provincial Cohort Study. The adjusted hazard ratio (HR) and population-attributable risk for CVD associated with stage 1 hypertension were calculated.
Results Participants with stage 1 hypertension accounted for 25.8% of the cohort. Among participants age 35 to 59 years, the HR comparing stage 1 hypertension to BP <120/<80 mm Hg for CVD incidence was 1.78 (95% confidence interval [CI]: 1.50 to 2.11), coronary heart disease incidence was HR: 1.77 (95% CI: 1.33 to 2.36), stroke incidence was HR: 1.79 (95% CI: 1.45 to 2.22), and CVD mortality was HR: 2.50 (95% CI: 1.66 to 3.77). The proportions of cardiovascular deaths and events attributable to stage 1 hypertension were 26.5% and 13.4% among participants age 35 to 59 years, respectively. Among participants age ≥60 years, however, stage 1 hypertension was not related to increased risk compared with BP <120/<80 mm Hg, and population-attributable risk associated with this stratum was not found. Over a 15-year period, 65.0% of participants age 35 to 59 years with stage 1 hypertension experienced an increase in BP to 140/90 mm Hg or higher, and they had a 3.01-fold increased cardiovascular risk compared with those who maintained BP <130/<80 mm Hg.
Conclusions The effect of 2017 American College of Cardiology/American Heart Association stage 1 hypertension on cardiovascular risk is evidenced in young and middle-aged Chinese adults, but not in those age ≥60 years.
↵∗ Drs. Qi and Han contributed equally to this work and are joint first authors.
This work was supported by the National Key Research and Development Program of China (grant 2016YFC0900902); the National Science & Technology Pillar Program (grants 2011BAI09B01, 2011BAI11B03, 2006BAI01A01, and 2006BAI01A02); and the capital health research and development of special (grant 2016-1-1051). The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 16, 2018.
- Revision received June 7, 2018.
- Accepted June 12, 2018.
- 2018 American College of Cardiology Foundation
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