Blood pressure and 10-year all-cause mortality: Findings from the PERU MIGRANT Study

Q: What are the key findings of this study?

Hypertension defined by JNC-7 (HR 3.45) and ACC/AHA 2017 stage 2 (HR 3.48) increased 10-year all-cause mortality risk compared to normal blood pressure in Peruvian adults.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Hypertension / Blood pressure levels (n=976). Intervention: Hypertension / Elevated blood pressure categories (JNC-7 and ACC/AHA 2017 definitions) vs. Normal blood pressure (SBP <120 mm Hg and DBP <80 mm Hg without medication). Primary outcome: 10-year all-cause mortality (HR 3.45, 95% CI 1.62-7.33, p=<0.05).

Q: What does this research mean for the field?

Hypertension defined under either JNC-7 or ACC/AHA 2017 guidelines is associated with an approximately 3.5-fold increased risk of 10-year all-cause mortality compared to normal blood pressure in Peruvian adults. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate the association between blood pressure categories and 10-year all-cause mortality using the JNC-7 and ACC/AHA 2017 guideline definitions.

Aida Hidalgo-Benites; Valeria Senosain-Leon; Rodrigo M. Carrillo‐Larco; Andrea Ruíz-Alejos; Robert H. Gilman; Liam Smeeth; J. Jaime Miranda; Antonio Bernabé‐Ortiz

doi:10.12688/f1000research.73900.2

January 17, 2023F1000ResearchOpen Access

Blood pressure and 10-year all-cause mortality: Findings from the PERU MIGRANT Study

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Key result

Hypertension is linked to ~3.5-fold higher 10-year all-cause mortality versus normal blood pressure.

HR 3.45
95% CI 1.62-7.33
P<0.05
n=976

Why the study?

Proposed changes in hypertension cut-offs prompted reassessment of the long-term impact of elevated blood pressure on mortality outcomes.

Are blood pressure categories defined by the JNC-7 and ACC/AHA 2017 guidelines associated with 10-year all-cause mortality in a Peruvian cohort?

Key Points

To evaluate the association between blood pressure categories and 10-year all-cause mortality using the JNC-7 and ACC/AHA 2017 guideline definitions.
Prospective cohort analysis of 976 participants (mean age 60.4 years [SD: 11.4], 513 [52.6%] women) enrolled in the PERU MIGRANT Study.
Blood pressure exposures were classified according to JNC-7 and ACC/AHA 2017 guidelines.
All-cause mortality was tracked over a 10-year follow-up (9992.6 person-years) and analyzed using log-rank tests, Kaplan-Meier curves, and Cox regression models adjusting for confounders.
Baseline hypertension prevalence was 16.0% (95% CI 13.7%–18.4%) under JNC-7 and nearly doubled to 31.3% (95% CI 28.4%–34.3%) using ACC/AHA 2017 criteria.
A total of 63 (6.4%) participants died during follow-up, equating to an overall mortality rate of 3.6 (95% CI 2.4–4.7) per 1000 person-years.
Under JNC-7, pre-hypertension and hypertension were associated with a 2-fold and 3.5-fold increased risk of death versus normal blood pressure, with similar effect sizes observed for ACC/AHA 2017 stage 1 and stage 2 hypertension.

Study Design

Type

Cohort (n=976)

Multicenter

Yes

Structured PICO

Are blood pressure categories defined by the JNC-7 and ACC/AHA 2017 guidelines associated with 10-year all-cause mortality in a Peruvian cohort?

P

Population

976 Peruvian adults aged ≥30 years (mean age 60.4, 52.6% female) from rural, rural-to-urban migrant, and urban groups, followed for 10 years.

E

Exposure

Elevated blood pressure / hypertension categories according to JNC-7 (pre-hypertension: SBP 120-139 or DBP 80-89 mm Hg without therapy; hypertension: SBP ≥140 or DBP ≥90 mm Hg or prior diagnosis/treatment) and ACC/AHA 2017 guidelines (elevated BP: SBP 120-129 and DBP <80 mm Hg; stage 1 hypertension: SBP 130-139 or DBP 80-89 mm Hg; stage 2 hypertension: SBP ≥140 or DBP ≥90 mm Hg or prior diagnosis/treatment)

C

Comparator

Normal blood pressure (SBP <120 mm Hg and DBP <80 mm Hg without anti-hypertensive medication)

O

Outcome

10-year all-cause mortality (time in years from baseline assessment in 2007-2008 to death or censorship in 2018 via the National Record of Identification and Civil Status [RENIEC])hard clinical

Main Result

Hazard Ratio: 3.45 (95% CI 1.62–7.33)

Absolute Event Rate: 18.6% vs 2.2%

p-value: p=<0.05

Limitations

Analysed all-cause mortality instead of cardiovascular mortality due to data availability
Diet patterns and salt consumption were not included in models as they were unavailable
Left truncation possible as subjects <30 years were excluded
Did not assess the potential effect of anti-hypertensive drugs on mortality due to limited sample size
Diet patterns and salt consumption were not available to be included as confounders
Potential left truncation as subjects <30 years were excluded

Implication

Applying ACC/AHA 2017 guidelines in a Peruvian cohort nearly doubles hypertension prevalence compared to JNC-7 (31.3% vs 16.0%) and identifies stage 1 and stage 2 hypertension patients at significantly higher 10-year mortality risk, posing resource challenges for LMIC health systems.

Abstract

<ns3:p> <ns3:bold>Background</ns3:bold> </ns3:p> <ns3:p>The long-term impact of elevated blood pressure on mortality outcomes has been recently revisited due to proposed changes in cut-offs for hypertension. This study aimed at assessing the association between high blood pressure levels and 10-year mortality using the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) and the American College of Cardiology and the American Heart Association (ACC/AHA) 2017 blood pressure guidelines.</ns3:p> <ns3:p> <ns3:bold>Methods</ns3:bold> </ns3:p> <ns3:p>Data of the PERU MIGRANT Study, a prospective ongoing cohort, was used. The outcome of interest was 10-year all-cause mortality, and exposures were blood pressure categories according to the JNC-7 and ACC/AHA 2017 guidelines. Log-rank test, Kaplan-Meier and Cox regression models were used to assess the associations of interest controlling for confounders. Hazard ratios (HR) and 95% confidence intervals (95% CI) were estimated.</ns3:p> <ns3:p> <ns3:bold>Results</ns3:bold> </ns3:p> <ns3:p>A total of 976 records, mean age of 60.4 (SD: 11.4), 513 (52.6%) women, were analyzed. Hypertension prevalence at baseline almost doubled from 16.0% (95% CI 13.7%–18.4%) to 31.3% (95% CI 28.4%–34.3%), using the JNC-7 and ACC/AHA 2017 definitions, respectively. Sixty-three (6.4%) participants died during the 10-year follow-up, equating to a mortality rate of 3.6 (95% CI 2.4–4.7) per 1000 person-years. Using JNC-7, and compared to those with normal blood pressure, those with pre-hypertension and hypertension had 2-fold and 3.5-fold increased risk of death, respectively. Similar mortality effect sizes were estimated using ACC/AHA 2017 for stage 1 and stage 2 hypertension.</ns3:p> <ns3:p> <ns3:bold>Conclusions</ns3:bold> </ns3:p> <ns3:p>Blood pressure levels under two different definitions increased the risk of 10-year all-cause mortality. Hypertension prevalence doubled using ACC/AHA 2017 compared to JNC-7. The choice of blood pressure cut-offs to classify hypertension categories need to be balanced against the patients benefit and the capacities of the health system to adequately handle a large proportion of new patients.</ns3:p>

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Cite This Study

Hidalgo-Benites et al. (2023) conducted a cohort in Hypertension / Blood pressure levels (n=976). Hypertension / Elevated blood pressure categories (JNC-7 and ACC/AHA 2017 definitions) vs. Normal blood pressure (SBP <120 mm Hg and DBP <80 mm Hg without medication) was evaluated on 10-year all-cause mortality (HR 3.45, 95% CI 1.62-7.33, p=<0.05). Hypertension defined by JNC-7 (HR 3.45) and ACC/AHA 2017 stage 2 (HR 3.48) increased 10-year all-cause mortality risk compared to normal blood pressure in Peruvian adults.

synapsesocial.com/papers/6a799cdf4c448619ca0dcf56 https://doi.org/10.12688/f1000research.73900.2

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Blood pressure and 10-year all-cause mortality: Findings from the PERU MIGRANT Study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Blood pressure and 10-year all-cause mortality: Findings from the PERU MIGRANT Study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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