Key result
Over a 12-year follow-up, adults aged 60 years and older had a 2.8-fold higher incidence of progressing from normal blood pressure to stage 2 hypertension compared to those aged 40-49 years.
Why the study?
The study was conducted to estimate the incidence of and period of progression to stage 2 hypertension from normal blood pressure.
Cohort (n=21,172)
Normotensive individuals can progress rapidly to stage 2 hypertension, often skipping intermediate blood pressure stages, highlighting the need for frequent screening especially in older adults.
Answers are grounded in this paper and cite their sources.
Provides incidence and progression estimates in normotensives; hypothesis-generating and should not yet change practice.
BACKGROUND: The study aimed to estimate the incidence of and period of progression to stage 2 hypertension from normal blood pressure. METHODS: We selected a total of 21,172 normotensive individuals between 2003 and 2004 from the National Health Insurance Service-Health Screening and followed them up until 2015. The criteria for blood pressure were based on the American College of Cardiology/American Heart Association 2017 guideline (normal BP: SBP < 120 and DBP < 80 mmHg, elevated BP: SBP 120-129 and DBP < 80 mmHg, stage 1 hypertension: SBP 130-139 or DBP 80-89 mmHg, stage 2 hypertension: SBP ≥140 or DBP ≥ 90 mmHg). We classified the participants into four courses (Course A: normal BP → elevated BP → stage 1 hypertension→ stage 2 hypertension, Course B: normal BP → elevated BP → stage 2 hypertension, Course C: normal BP → stage 1 hypertension → stage 2 hypertension, Course D: normal BP → stage 2 hypertension) according to their progression from normal blood pressure to stage 2 hypertension. RESULTS: During the median 12.23 years of follow-up period, 52.8% (n= 11,168) and 23.6% (n=5004) of the participants had stage 1 and stage 2 hypertension, respectively. In particular, over 60 years old had a 2.8-fold higher incidence of stage 2 hypertension than 40-49 years old. After the follow-up period, 77.5% (n=3879) of participants with stage 2 hypertension were found to be course C (n= 2378) and D (n=1501). After the follow-up period, 77.5% (n=3879) of participants with stage 2 hypertension were found to be course C (n= 2378) and D (n=1501). The mean years of progression from normal blood pressure to stage 2 hypertension were 8.7±2.6 years (course A), 6.1±2.9 years (course B), 7.5±2.8 years (course C) and 3.2±2.0 years, respectively. CONCLUSIONS: This study found that the incidence of hypertension is associated with the progression at each stage. We suggest that the strategies necessary to prevent progression to stage 2 hypertension need to be set differently for each target course.
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Yu et al. (2021) conducted a cohort in Normal blood pressure progressing to hypertension (n=21,172). Older age (≥60 years) vs. Age 40-49 years was evaluated on Incidence of stage 2 hypertension (2.8-fold higher incidence, p=<0.01). Over a 12-year follow-up, adults aged 60 years and older had a 2.8-fold higher incidence of progressing from normal blood pressure to stage 2 hypertension compared to those aged 40-49 years.
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