Key result
Achieving normal blood pressure at one year, compared to remaining at elevated BP or stage 1 hypertension, was associated with a lower risk of incident heart failure (HR 0.89; 95% CI 0.85-0.94).
Why the study?
Few studies had evaluated how blood pressure changes in adults with ACC/AHA-defined elevated blood pressure or stage 1 hypertension relate to incident heart failure and other cardiovascular diseases.
Does achieving normal BP at one year reduce the risk of incident heart failure and other cardiovascular diseases in adults with elevated BP or stage 1 hypertension?
Cohort (n=616,483)
Does achieving normal BP at one year reduce the risk of incident heart failure and other cardiovascular diseases in adults with elevated BP or stage 1 hypertension?
Hazard Ratio: 0.89 (95% CI 0.85–0.94)
A one-year decline to normal blood pressure in individuals with elevated BP or stage 1 hypertension is associated with a significantly lower risk of incident heart failure, MI, angina, and stroke.
BP reduction to normal was associated with lower HF risk; leaves open need for prospective trials before practice change.
AIMS: Few studies have examined the relationship of blood pressure (BP) change in adults with elevated BP or stage 1 hypertension according to the American College of Cardiology (ACC)/American Heart Association (AHA) guideline with cardiovascular outcomes. We sought to identify the effect of BP change among individuals with elevated BP or stage 1 hypertension on incident heart failure (HF) and other cardiovascular diseases (CVDs). METHODS AND RESULTS: We conducted a retrospective cohort study including 616 483 individuals (median age 46 years, 73.7% men) with elevated BP or stage 1 hypertension based on the ACC/AHA BP guideline. Participants were categorized using BP classification at one-year as normal BP (n = 173 558), elevated BP/stage 1 hypertension (n = 367 454), or stage 2 hypertension (n = 75 471). The primary outcome was HF, and the secondary outcomes included (separately) myocardial infarction (MI), angina pectoris (AP), and stroke. Over a mean follow-up of 1097 ± 908 days, 10 544 HFs, 1317 MIs, 11 070 APs, and 5198 strokes were recorded. Compared with elevated BP/stage 1 hypertension at one-year, normal BP at one-year was associated with a lower risk of developing HF [hazard ratio (HR): 0.89, 95% CI:0.85-0.94], whereas stage 2 hypertension at one-year was associated with an elevated risk of developing HF (HR:1.43, 95% CI:1.36-1.51). This association was also present in other cardiovascular outcomes including MI, AP, and stroke. The relationship was consistent in all subgroups stratified by age, sex, baseline BP category, and overweight/obesity. CONCLUSION: A one-year decline in BP was associated with the lower risk of HF, MI, AP, and stroke, suggesting the importance of lowering BP in individuals with elevated BP or stage 1 hypertension according to the ACC/AHA guideline to prevent the risk of developing CVD.
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Kaneko et al. (2022) conducted a cohort in Elevated blood pressure or stage 1 hypertension (n=616,483). Normal blood pressure at one-year vs. Elevated BP/stage 1 hypertension at one-year was evaluated on Incident heart failure (HF) (HR 0.89, 95% CI 0.85-0.94). Achieving normal blood pressure at one year, compared to remaining at elevated BP or stage 1 hypertension, was associated with a lower risk of incident heart failure (HR 0.89; 95% CI 0.85-0.94).
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