What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Prehypertension (n=12498). Intervention: Prehypertension (Systolic BP 120-139 mm Hg) vs. Normal blood pressure (Systolic BP 3.0 mg/L) (OR 1.36, 95% CI 1.14-1.62, p=<0.05).

October 1, 2004Open Access

Elevation of C‐Reactive Protein in People With Prehypertension

Q: What are the key findings of this study?

Prehypertensive individuals with a systolic blood pressure of 120-139 mm Hg had a significantly higher likelihood of elevated C-reactive protein compared to normotensive individuals (OR 1.36).

DKDana E. KingAmerican Academy of Family Physicians BEBrent M. EganPreventive Cardiology AMArch G. MainousGeneral / Preventive / Lipids

Key Result

Prehypertensive individuals with a systolic blood pressure of 120-139 mm Hg had a significantly higher likelihood of elevated C-reactive protein compared to normotensive individuals (OR 1.36).

Study Design

Type

Cross-Sectional (n=12,498)

Multicenter

Yes

Structured PICO

Does prehypertension associate with elevated C-reactive protein in adults without diagnosed hypertension?

Population

12,498 US adults aged 17 and older without a prior diagnosis of hypertension, evaluated for the relationship between blood pressure categories and elevated C-reactive protein.

Exposure

Prehypertension (systolic blood pressure 120-139 mm Hg or diastolic blood pressure 80-89 mm Hg)

Comparator

Normal blood pressure (systolic blood pressure <120 mm Hg and diastolic blood pressure <80 mm Hg)

Outcome

Elevated C-reactive protein (CRP >3.0 mg/L)surrogate

Prehypertension is independently associated with elevated C-reactive protein levels, suggesting a potential inflammatory mechanism for the increased cardiovascular risk observed in this population.

Main Result

Odds Ratio: 1.36 (95% CI 1.14–1.62)

Absolute Event Rate: 27.4% vs 19.8%

p-value: p=<0.05

Limitations

Self-report was used for the diagnosis of hypertension, which may lead to miscategorization.
Blood pressure readings were obtained on only one occasion rather than multiple repeat measures.
CRP was analyzed using a categorical method comparing high to low levels, rather than as a continuous variable.

Abstract

The objective of this study was to determine the relationship of C-reactive protein (CRP) and blood pressure (BP) across the range of BP categories including prehypertension. The Third National Health and Nutrition Examination Survey (NHANES III) data collected from 1988 to 1994 were analyzed. In unadjusted analyses, there was a step-wise increase in the probability of elevated CRP across a wide range of BP categories. Prehypertensive participants had a higher prevalence of elevated CRP than normotensive people (27.4% vs. 19.8%; p<05). After adjustment for age, gender, race, smoking, body mass index, exercise, diabetes, and medication usage, participants with systolic BP 120-139 mm Hg or diastolic BP 80-89 mm Hg were more likely to have elevated CRP than people with systolic BP <120 (odds ratio, 1.36; 95% confidence interval, 1.14-1.62; odds ratio, 1.20; 95% confidence interval, 1.02-1.41, respectively). CRP and BP are positively related across a wide range of BP categories. A substantial proportion of prehypertensive individuals have elevated CRP independent of multiple confounders.

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