Progression of pre-hypertension, stage 1 and 2 hypertension (JNC 7): a population-based study in Keelung, Taiwan (Keelung Community-based Integrated Screening No. 9)

OBJECTIVE: To investigate the prevalence and progression of, and identify risk factors for, pre-hypertension, stage 1 and 2 hypertension in a population-based study. DESIGN: A prospective cohort study. SETTING: An integrated community-based multiple screening program in Keelung, Taiwan. PARTICIPANTS: A total of 67 011 individuals aged 20-79 years between 1999 and 2003 were included. Of these, 22 111 re-attended, yielding 53 689 repeated recordings of blood pressure, including movement between normal and pre-hypertension and progression from pre-hypertension to stage 1 or stage 2 hypertension. MAIN OUTCOME MEASURES: Blood pressure was defined and classified according to the JNC 7 Report as normal, pre-hypertension, stage 1, and stage 2 hypertension. RESULTS: Below 50 years of age, males had a higher progression rate, particularly from normal to pre-hypertension, than females. Annual regression rates from pre-hypertension to normal were higher in the young age group than in the old age group, particularly for females. Factors associated with the occurrence of pre-hypertension were old age, male gender, high waist circumference, abnormal blood lipids, smoking, chewing betel nuts, lack of exercise, and having parents with hypertension. Factors associated with regression from pre-hypertension to normal were body mass index, fasting glucose, high-density lipoprotein level, smoking, and parents with hypertension. Progression from pre-hypertension to stage 1 hypertension was positively related to male gender, higher waist circumference, and having parents with hypertension. CONCLUSIONS: The rates of progression and regression of hypertension vary with age and gender, anthropometric and biochemical measurements, and family history.