Key Points
- To determine the association between prehypertension and the incidence of cardiovascular disease morbidity after adjusting for confounding cardiovascular risk factors.
- Systematic search of PubMed, EMBASE, Cochrane Library, and conference proceedings for prospective cohort studies assessing prehypertension and cardiovascular morbidity.
- Dual independent extraction of relative risks (RRs) and 95% confidence intervals (CIs) for cardiovascular disease (CVD), coronary heart disease (CHD), and stroke, alongside subgroup analyses.
- Across 18 prospective cohort studies (N=468,561), prehypertension significantly elevated the risk of CVD (RR = 1.55; 95% CI, 1.41 to 1.71), CHD (RR = 1.50; 95% CI, 1.30 to 1.74), and stroke (RR = 1.71; 95% CI, 1.55 to 1.89).
- Low-range prehypertension increased CVD risk compared with optimal blood pressure (RR = 1.46; 95% CI, 1.32 to 1.62), while high-range prehypertension conferred a significantly higher risk (RR = 1.80; 95% CI, 1.41 to 2.31; chi-square = 5.69, P = 0.02).
Structured PICO
Does prehypertension increase the risk of cardiovascular disease morbidity in the general adult population?
PPopulation468,561 participants from 18 prospective cohort studies, aged ≥18 years from the general population. 79.6% Asian.
IInterventionPrehypertension (blood pressure 120-139/80-89 mm Hg), including low-range (120-129/80-84 mm Hg) and high-range (130-139/85-89 mm Hg)
CComparatorOptimal blood pressure (<120/80 mm Hg)
OOutcomeComposited cardiovascular disease (CVD) morbidityhard clinical
Prehypertension, even in the low range (120-129/80-84 mm Hg), significantly elevates the risk of cardiovascular disease after adjusting for multiple cardiovascular risk factors.
Limitations
- No access to individual patient-level data
- Determination of prehypertension based on one single-day measurement, which may misclassify BP levels due to white coat effect or masked hypertension
- Potential for selection and publication bias