Key result
Among adults <60 years, stage I systolic diastolic hypertension was associated with an increased risk of incident CVD (HR 1.42; 95% CI 1.04-1.94) compared to normal blood pressure.
Why the study?
The study evaluated associations of cardiovascular disease outcomes with elevated BP and 2017 ACC/AHA stage I hypertension phenotypes among Tehranian adults.
Do elevated blood pressure and stage I hypertension phenotypes defined by the 2017 ACC/AHA guidelines increase the risk of incident CVD in adults without baseline CVD?
Cohort (n=7,068)
No
Do elevated blood pressure and stage I hypertension phenotypes defined by the 2017 ACC/AHA guidelines increase the risk of incident CVD in adults without baseline CVD?
Answers are grounded in this paper and cite their sources.
Age significantly modifies the association between 2017 ACC/AHA stage I hypertension and CVD risk, with stage I IDH not indicating increased risk regardless of baseline CVD risk.
OBJECTIVES: To evaluate the associations of cardiovascular disease (CVD) outcomes with elevated blood pressure (BP), stage I of isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), and systolic diastolic hypertension (SDH), defined by 2017 ACC/AHA guidelines among the Tehranian adult population. METHOD: We enrolled 7068 residents of Tehran (district No. 13) aged at least 30 years, who were free of CVD and not taking antihypertensive medications at baseline. Participants were categorized into eight categories: normal BP (reference group), elevated BP, stage I IDH, stage I ISH, stage I SDH, and all stage II phenotypes. Significant interactions were found between age groups (<60 versus ≥60 years) and BP categories (P value: 0.017); hence, the analysis was performed in each age group, separately. We used multivariable Cox proportional regression analysis to evaluate the association of different BP categories with incident CVD. RESULTS: During 18years of follow-up, 1053 CVD events occurred. In the younger group, stage I of IDH and SDH were associated with increased CVD risk with hazard ratios (HRs) of 1.23 (95% confidence interval: 0.99-1.52) and 1.42 (1.04-1.94), respectively. In the older group, stage I of IDH had a lower risk for coronary heart disease (CHD) [HR 0.53 (0.29-0.96)]. As a sensitivity analysis, among high CVD risk individuals (10-year risk ≥10%), we found a higher risk for CVD among those with elevated BP and stage I of SDH. For individuals with 10-year risk less than 10%, all BP parameters, except stage I of IDH, were associated with increased CVD risk. Although there was no significant interaction between sex and BP categories, elevated BP and stage I of SDH significantly increased the risk of CVD only among men. CONCLUSION: Age is an important potential modifier in the association between stage I of hypertension and CVD/CHD risk. Stage I of IDH was not an alarming status for CVD development, whether the participants had a high CVD risk or not.
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A 2022 study conducted a cohort in Hypertension (n=7,068). Stage I systolic diastolic hypertension (SDH) vs. Normal blood pressure was evaluated on Incident cardiovascular disease (CVD) (HR 1.42, 95% CI 1.04-1.94). Among adults <60 years, stage I systolic diastolic hypertension was associated with an increased risk of incident CVD (HR 1.42; 95% CI 1.04-1.94) compared to normal blood pressure.
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