Cardiovascular Diseases and All‐Cause Mortality Risk in Patients With Prehypertension and Noncommunicable Diseases: Results From the Kailuan Study

It remains unclear whether prehypertension combined with noncommunicable diseases (NCDs) is associate with higher risks of cardiovascular diseases (CVD) and all-cause mortality. The study aimed to investigate the associations of prehypertension with CVD and all-cause mortality in individuals with or without NCDs. The prospective cohort study included 56 114 participants from the Kailuan Study. Participants were divided into four groups: optimal blood pressure (BP) without NCDs, prehypertension without NCDs, optimal BP with NCDs and prehypertension with NCDs. CVD events and all-cause mortality were followed up until December 31, 2018. Cox proportional hazards models and Kaplan-Meier survival curves were used to assess the associations of prehypertension with the risk of CVD and all-cause mortality among patients with or without NCDs. Sensitivity and stratified analysis were performed to verify the robustness of the results. During a median follow-up of 9.04 years, 3367 CVD events and 5754 all-cause mortality had occurred. Compared with optimal BP alone, the multivariable adjusted hazard ratios (HRs) and 95% confidence interval (CI) for CVD were 1.36(1.23-1.51) for prehypertension alone, 1.82(1.55-2.14) for optimal BP and NCDs and 2.33(2.10-2.58) for prehypertension and NCDs (all P < 0.001). For all-cause mortality, the corresponding HRs (95%CI) were 1.13(1.04-1.21), 2.07(1.85-2.32) and 1.85(1.72-2.00) (all P < 0.001). Results were consistent in sensitivity and stratified analysis. Notably, females with prehypertension and NCDs showed the highest all-cause mortality risk. Prehypertension significantly increased CVD risk in patients with NCDs. However, a paradoxical all-cause mortality association was seen, with higher risk among NCDs patients with optimal BP versus prehypertension.