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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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Forest plot of comparison: prehypertension vs. optimal blood pressure, outcome: stroke.
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Figure 4: Forest plot of comparison: prehypertension vs. optimal blood pressure, outcome: stroke.

Mentions: Eleven (n = 292,026) and 12 studies (n = 406,539) reported multivariate-adjusted RRs and 95% CIs for CHD and stroke associated with prehypertension, respectively. We used the random-effects model on the pooled data from these studies and calculated a 50% increase in CHD incidence (RR = 1.50; 95% CI = 1.30 to 1.74, P <0.00001, I2 = 67%, Figure 3) and a 71% increase in stroke incidence (RR = 1.71; 95% CI = 1.55 to 1.89, P <0.00001, I2 = 26%, Figure 4). However, the difference between the incidence of CHD and stroke was not significant (χ2= 2.13, P = 0.14).


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)

Forest plot of comparison: prehypertension vs. optimal blood pressure, outcome: stroke.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: Forest plot of comparison: prehypertension vs. optimal blood pressure, outcome: stroke.
Mentions: Eleven (n = 292,026) and 12 studies (n = 406,539) reported multivariate-adjusted RRs and 95% CIs for CHD and stroke associated with prehypertension, respectively. We used the random-effects model on the pooled data from these studies and calculated a 50% increase in CHD incidence (RR = 1.50; 95% CI = 1.30 to 1.74, P <0.00001, I2 = 67%, Figure 3) and a 71% increase in stroke incidence (RR = 1.71; 95% CI = 1.55 to 1.89, P <0.00001, I2 = 26%, Figure 4). However, the difference between the incidence of CHD and stroke was not significant (χ2= 2.13, P = 0.14).

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