Elsevier

American Heart Journal

Volume 167, Issue 2, February 2014, Pages 160-168.e1
American Heart Journal

Clinical Investigation
Hypertension
Association of all-cause and cardiovascular mortality with prehypertension: A meta-analysis

https://doi.org/10.1016/j.ahj.2013.10.023Get rights and content

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.

Section snippets

Search strategy and selection criteria

Electronic databases (PubMed, EMBASE, and the Cochrane Library) were searched to the third week of December 2012 using the following terms: “prehypertension,” “prehypertensive,” “pre-hypertension,” “pre-hypertensive,” “high normal blood pressure,” “optimal blood pressure,” or “borderline hypertension” and “mortality,” “death,” “deaths,” or “fatal.” There were no restrictions for language or publication form. In addition, conference proceedings (American College of Cardiology Meeting, American

Selected studies and characteristics

Of the initial 6,318 records, we determined that 50 articles qualified for full review (Figure 1). Our final primary analysis included data for 1,129,098 participants derived from 20 prospective cohort studies, 6, 7, 8, 9, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31 12 reported all-cause and cardiovascular mortality,6, 7, 8, 9, 17, 22, 23, 24, 25, 26, 27, 30 6 reported only cardiovascular mortality,16, 18, 19, 20, 21, 31 and 2 reported only all-cause mortality.28, 29

Discussion

These results show that after controlling for multiple cardiovascular risk factors, prehypertension is significantly associated with CVD mortality, largely driven by high-range prehypertension. The risk for stroke mortality is higher than CHD mortality. The PARs calculation indicated that 10.5% of CVD, 4.8% of CHD, and 14.6% of stroke death could be prevented if prehypertension was eliminated. However, prehypertension is not associated with all-cause mortality.

A previous meta-analysis also

Disclosures

Authorship: All authors had access to the data and played a role in writing this manuscript.

Competing interest: None declared.

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