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Prehypertension and incidence of cardiovascular disease: a meta-analysis.

Huang Y, Wang S, Cai X, Mai W, Hu Y, Tang H, Xu D - BMC Med (2013)

Bottom Line: Pooled data included the results from 468,561 participants from 18 prospective cohort studies.The relative risk was significantly higher in the high-range prehypertensive populations than in the low-range populations (χ2= 5.69, P = 0.02).There were no significant differences among the other subgroup analyses (P>0.05).

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Cardiology, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou 510515, China.

ABSTRACT

Background: Prospective cohort studies of prehypertension and the incidence of cardiovascular disease (CVD) are controversial after adjusting for other cardiovascular risk factors. This meta-analysis evaluated the association between prehypertension and CVD morbidity.

Methods: Databases (PubMed, EMBASE and the Cochrane Library) and conference proceedings were searched for prospective cohort studies with data on prehypertension and cardiovascular morbidity. Two independent reviewers assessed the reports and extracted data. The relative risks (RRs) of CVD, coronary heart disease (CHD) and stroke morbidity were calculated and reported with 95% confidence intervals (95% CIs). Subgroup analyses were conducted on blood pressure, age, gender, ethnicity, follow-up duration, number of participants and study quality.

Results: Pooled data included the results from 468,561 participants from 18 prospective cohort studies. Prehypertension elevated the risks of CVD (RR = 1.55; 95% CI = 1.41 to 1.71); CHD (RR = 1.50; 95% CI = 1.30 to 1.74); and stroke (RR = 1.71; 95% CI = 1.55 to 1.89). In the subgroup analyses, even for low-range prehypertension, the risk of CVD was significantly higher than for optimal BP (RR = 1.46, 95% CI = 1.32 to 1.62), and further increased with high-range prehypertension (RR = 1.80, 95% CI = 1.41 to 2.31). The relative risk was significantly higher in the high-range prehypertensive populations than in the low-range populations (χ2= 5.69, P = 0.02). There were no significant differences among the other subgroup analyses (P>0.05).

Conclusions: Prehypertension, even in the low range, elevates the risk of CVD after adjusting for multiple cardiovascular risk factors.

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Related in: MedlinePlus

Flow of selection for studies through review. BP, blood pressure; CIs, confidence intervals; RRs indicates relative risks.* Only the latest of the published duplicate studies from the same cohort was included if they offered the same outcome messages. However, one of these studies offered additional messages for subgroup analysis according to BP and gender [6], which could not be derived from the primary included study [9], so it was re-included when performing the subgroup analyses. † Data were derived from 18 prospective cohort studies (two articles were from the Strong Heart Study and reported the risk factors for CHD [19] and stroke [24], respectively).
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Figure 1: Flow of selection for studies through review. BP, blood pressure; CIs, confidence intervals; RRs indicates relative risks.* Only the latest of the published duplicate studies from the same cohort was included if they offered the same outcome messages. However, one of these studies offered additional messages for subgroup analysis according to BP and gender [6], which could not be derived from the primary included study [9], so it was re-included when performing the subgroup analyses. † Data were derived from 18 prospective cohort studies (two articles were from the Strong Heart Study and reported the risk factors for CHD [19] and stroke [24], respectively).

Mentions: The selection of studies for inclusion in the meta-analysis is shown in Figure 1. Of the initial 22,386 records, two reviewers determined independently that 42 required a review of the full manuscript. Our final primary analysis included 19 articles [7-11,18-31], with a total of 468,561 participants, derived from 18 prospective cohort studies (two articles were from the Strong Heart Study and reported the risk factors for CHD [19] and stroke [24], respectively). Eighteen of the primary papers were published in full and one was in abstract form [10]. However, study data from this abstract were acquired by correspondence with the main author. One article from the Framingham Heart Study was excluded for primary outcome analysis, because more recent data from the same cohort were available [9]. However, as this article offered additional messages for subgroup analyses according to BP and gender that could not be derived from the article included in the primary group [9], the study data were re-entered for subgroup analyses. Table 1 summarizes the key characteristics of the included studies. All prospective cohort studies were derived from the general population. Of the 18 studies 11 were from Asia (3 from China [7,25,29], 6 from Japan [18,23,26-28,31], and 2 from Iran [10,30]); 5 were from the United States [8,9,19-21,24]; and 1 each was from Turkey [22] and Germany [11]. The proportion of Asians was 79.6% (n = 372,927).


Prehypertension and incidence of cardiovascular disease: a meta-analysis.

Huang Y, Wang S, Cai X, Mai W, Hu Y, Tang H, Xu D - BMC Med (2013)

Flow of selection for studies through review. BP, blood pressure; CIs, confidence intervals; RRs indicates relative risks.* Only the latest of the published duplicate studies from the same cohort was included if they offered the same outcome messages. However, one of these studies offered additional messages for subgroup analysis according to BP and gender [6], which could not be derived from the primary included study [9], so it was re-included when performing the subgroup analyses. † Data were derived from 18 prospective cohort studies (two articles were from the Strong Heart Study and reported the risk factors for CHD [19] and stroke [24], respectively).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3750349&req=5

Figure 1: Flow of selection for studies through review. BP, blood pressure; CIs, confidence intervals; RRs indicates relative risks.* Only the latest of the published duplicate studies from the same cohort was included if they offered the same outcome messages. However, one of these studies offered additional messages for subgroup analysis according to BP and gender [6], which could not be derived from the primary included study [9], so it was re-included when performing the subgroup analyses. † Data were derived from 18 prospective cohort studies (two articles were from the Strong Heart Study and reported the risk factors for CHD [19] and stroke [24], respectively).
Mentions: The selection of studies for inclusion in the meta-analysis is shown in Figure 1. Of the initial 22,386 records, two reviewers determined independently that 42 required a review of the full manuscript. Our final primary analysis included 19 articles [7-11,18-31], with a total of 468,561 participants, derived from 18 prospective cohort studies (two articles were from the Strong Heart Study and reported the risk factors for CHD [19] and stroke [24], respectively). Eighteen of the primary papers were published in full and one was in abstract form [10]. However, study data from this abstract were acquired by correspondence with the main author. One article from the Framingham Heart Study was excluded for primary outcome analysis, because more recent data from the same cohort were available [9]. However, as this article offered additional messages for subgroup analyses according to BP and gender that could not be derived from the article included in the primary group [9], the study data were re-entered for subgroup analyses. Table 1 summarizes the key characteristics of the included studies. All prospective cohort studies were derived from the general population. Of the 18 studies 11 were from Asia (3 from China [7,25,29], 6 from Japan [18,23,26-28,31], and 2 from Iran [10,30]); 5 were from the United States [8,9,19-21,24]; and 1 each was from Turkey [22] and Germany [11]. The proportion of Asians was 79.6% (n = 372,927).

Bottom Line: Pooled data included the results from 468,561 participants from 18 prospective cohort studies.The relative risk was significantly higher in the high-range prehypertensive populations than in the low-range populations (χ2= 5.69, P = 0.02).There were no significant differences among the other subgroup analyses (P>0.05).

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Cardiology, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou 510515, China.

ABSTRACT

Background: Prospective cohort studies of prehypertension and the incidence of cardiovascular disease (CVD) are controversial after adjusting for other cardiovascular risk factors. This meta-analysis evaluated the association between prehypertension and CVD morbidity.

Methods: Databases (PubMed, EMBASE and the Cochrane Library) and conference proceedings were searched for prospective cohort studies with data on prehypertension and cardiovascular morbidity. Two independent reviewers assessed the reports and extracted data. The relative risks (RRs) of CVD, coronary heart disease (CHD) and stroke morbidity were calculated and reported with 95% confidence intervals (95% CIs). Subgroup analyses were conducted on blood pressure, age, gender, ethnicity, follow-up duration, number of participants and study quality.

Results: Pooled data included the results from 468,561 participants from 18 prospective cohort studies. Prehypertension elevated the risks of CVD (RR = 1.55; 95% CI = 1.41 to 1.71); CHD (RR = 1.50; 95% CI = 1.30 to 1.74); and stroke (RR = 1.71; 95% CI = 1.55 to 1.89). In the subgroup analyses, even for low-range prehypertension, the risk of CVD was significantly higher than for optimal BP (RR = 1.46, 95% CI = 1.32 to 1.62), and further increased with high-range prehypertension (RR = 1.80, 95% CI = 1.41 to 2.31). The relative risk was significantly higher in the high-range prehypertensive populations than in the low-range populations (χ2= 5.69, P = 0.02). There were no significant differences among the other subgroup analyses (P>0.05).

Conclusions: Prehypertension, even in the low range, elevates the risk of CVD after adjusting for multiple cardiovascular risk factors.

Show MeSH
Related in: MedlinePlus