Key result
Stage 1 hypertension linked to ~20% higher risk of major cardiovascular events.
Why the study?
The updated ACC/AHA hypertension definition represents a paradigm shift, prompting the need to evaluate its association with CVD risk and potential modification by cardiovascular health metrics.
Does achieving ideal cardiovascular health metrics mitigate the risk of major cardiovascular events in adults with newly defined stage 1 and stage 2 hypertension?
Cohort (n=91,204)
Yes
Does achieving ideal cardiovascular health metrics mitigate the risk of major cardiovascular events in adults with newly defined stage 1 and stage 2 hypertension?
Hazard Ratio: 1.2 (95% CI 1.05–1.37)
Absolute Event Rate: 4.85% vs 3.44%
The increased cardiovascular risk conferred by newly defined stage 1 hypertension can be substantially mitigated by achieving ideal cardiovascular health metrics, particularly in younger adults.
Stage 1 hypertension may inform risk assessment in Chinese adults; leaves open whether ideal CVH metrics modify outcomes in prospective trials.
Background The updated definition of hypertension by the American College of Cardiology (ACC) and the American Heart Association (AHA) is an important paradigm shift and has lead to extensive discussion. We aimed to examine the association between the updated blood pressure (BP) categories and the risk of cardiovascular diseases (CVDs) with potential modifications from other cardiovascular health metrics (CVHMs). Methods This prospective study included 91,204 participants ≥40 years recruited from 20 community sites across mainland China. Participants were followed up during 2010-2016 for CVD events including nonfatal myocardial infarction, stroke, heart failure, and cardiovascular death. BP categories were defined according to the 2017 ACC/AHA guideline and CVHMs included smoking, physical activity, diet, body-mass index, total cholesterol, and fasting glucose. Findings Overall, 1,985 major CVD events occurred during a mean follow-up of 3.7 years. Having more ideal CVHMs significantly reduced the risk of CVD events in both stage 1 and stage 2 hypertension. Compared with participants without hypertension, participants having ≥4 ideal CVHMs were no longer associated with an increased CVD risk in stage 1 hypertension (HR=1·04; 95% CI=0·83-1·31), but less so in stage 2 hypertension (HR=1·90, 95% CI=1·70-2·13). Such pattern of association was more evident in participants aged <60 years ( P for interaction <0·05). Interpretation Stage 1 hypertension defined by the ACC/AHA identifies individuals at increased CVD risk, which can be attenuated by achieving more preferable cardiovascular health, especially in adults aged <60 years. Funding Funding National Key R&D Program of China.
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Wu et al. (2022) conducted a cohort in Hypertension (2017 ACC/AHA guidelines) (n=91,204). Stage 1 and Stage 2 hypertension (2017 ACC/AHA guidelines) vs. Participants without hypertension (blood pressure <130/80 mmHg) was evaluated on Major cardiovascular events (nonfatal myocardial infarction, stroke, heart failure, and cardiovascular death) (HR 1.20, 95% CI 1.05-1.37). Stage 1 hypertension defined by the 2017 ACC/AHA guidelines was associated with a 20% increased risk of major cardiovascular events (HR 1.20) compared to individuals without hypertension.
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