Prehypertension increases risk of cardiovascular disease

26 February 2007

Prehypertension is common among postmenopausal women, and associated with increased risk of myocardial infarction (MI), stroke, heart failure (HF), and cardiovascular death, US researchers have found.

These findings support current recommendations aimed at reducing blood pressure at an earlier stage of cardiovascular disease, the authors write in the journal Circulation.

The Joint Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure defines prehypertension as systolic blood pressure between 120 and 139 mmHg, or diastolic pressure between 80 and 89 mmHg.

To determine the extent to which prehypertension increases the risk of cardiovascular disease, Judith Hsia (George Washington University, Washington, DC) and colleagues followed-up 60,785 postmenopausal women, with a mean age of 62.8 years, over a period of 7.7 years.

Women with prehypertension had adjusted hazard ratios of 1.58 for cardiovascular death, 1.76 for MI, 1.93 for stroke, 1.36 for HF, and 1.66 for any cardiovascular event, compared with normotensive women.

Prehypertension was present at baseline in 39.5%, 32.1%, 42.6%, 38.7%, and 40.3% of White, Black, Hispanic, American Indian, and Asian women, respectively. Nevertheless, hazard ratios for cardiovascular risk did not differ significantly among the different ethnic groups.

Age, body mass index, and prevalence of diabetes mellitus and hypercholesterolemia correlated with blood pressure (all p<0.0001), whereas smoking was more prevalent among normotensive (10.0%) than prehypertensive women (7.4%).

Hsia and co-workers note that "the clustering of conventional risk factors with prehypertension raises the possibility that the increased cardiovascular risk was not due entirely to blood pressure."

They say: "Prospective trials are needed to evaluate the efficacy, feasibility, and cost-effectiveness of global primordial cardiovascular risk reduction."

Circulation 2007; 115: 855-860