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Am Heart J. 2014 Feb;167(2):160-168.e1. doi: 10.1016/j.ahj.2013.10.023. Epub 2013 Nov 6.

Association of all-cause and cardiovascular mortality with prehypertension: a meta-analysis.

Author information

1
Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
2
Clinical Medicine Research Center, the First People's Hospital of Shunde, Foshan, China.
3
Department of Cardiology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
4
Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China. Electronic address: dinglixu@fimmu.com.

Abstract

BACKGROUND:

Studies of prehypertension and mortality are controversial after adjusting for other cardiovascular risk factors. This meta-analysis sought to evaluate the association of prehypertension with all-cause and cardiovascular disease (CVD) mortality.

METHODS:

The PubMed, EMBASE, Cochrane Library databases, and conference proceedings were searched for studies with data on prehypertension and mortality. The relative risks (RRs) of all-cause, CVD, coronary heart disease (CHD), and stroke mortality were calculated and presented with 95% CIs. Subgroup analyses were conducted according to blood pressure, age, gender, ethnicity, follow-up duration, participant number, and study characteristics.

RESULTS:

Data from 1,129,098 participants were derived from 20 prospective cohort studies. Prehypertension significantly increased the risk of CVD, CHD, and stroke mortality (RR 1.28, 95% CI 1.16-1.40; RR 1.12, 95% CI 1.02-1.23; and RR 1.41, 95% CI 1.28-1.56, respectively), but did not increase the risk of all-cause mortality after multivariate adjustment (RR 1.03, 95% CI 0.97-1.10). The difference between CHD mortality and stroke mortality was significant (P < .001). Subgroup analyses showed that CVD mortality was significantly increased in high-range prehypertension (RR 1.28, 95% CI 1.16-1.41) but not in low-range prehypertension (RR 1.08, 95% CI 0.98-1.18).

CONCLUSION:

Prehypertension is associated with CVD mortality, especially with stroke mortality, but not with all-cause mortality. The risk for CVD mortality is largely driven by high-range prehypertension.

PMID:
24439976
DOI:
10.1016/j.ahj.2013.10.023
[Indexed for MEDLINE]

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