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Associations of blood pressure categories according to the 2017 American College of Cardiology/American Heart Association hypertension guideline and long-term blood pressure change with incident cardiovascular disease in middle-aged and elderly Chinese

the Dongfeng-Tongji cohort study

Ma, Lina,*; Guo, Wentinga,*; Yang, Lianglea; Lai, Xuefenga; Fang, Qina; Liu, Miaoa; Yang, Huihuaa; Zhou, Lvea; Wang, Haoa; Xiao, Yanga; He, Meiana; Guo, Huana; Wang, Chongjianb; Zhang, Xiaomina

doi: 10.1097/HJH.0000000000002137
ORIGINAL PAPERS: Epidemiology
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Objective: To assess the associations of newly defined blood pressure (BP) categories by the 2017 American College of Cardiology/American Heart Association guideline and changes in BP with the risk of cardiovascular disease (CVD) among the middle-aged and older Chinese.

Methods: Among 29 086 participants aged 61.6 years from the Dongfeng-Tongji (DFTJ) cohort, we estimated the hazard ratio for CVD using Cox proportional hazard models.

Results: As BP increased, we found a significant trend for greater risk of incident CVD, coronary heart disease (CHD) or stroke. Compared with the BP <120/<80 mmHg, those having stage 1 hypertension (BP of 130–139/80–89 mmHg) had an increased risk of CVD [hazard ratio of 1.29 (1.18–1.42)], CHD [hazard ratio of 1.27 (1.15–1.41)] and stroke [hazard ratio of 1.36 (1.10–1.70)], respectively. The effect of stroke was only presented in those aged at least 60 years, but not for those aged less than 60 years; whereas no age-specific association for CHD and CVD was found. Particularly, significantly increased risk of CVD (18%), CHD (14%) and stroke (37%) appeared even with elevated BP (120–129/<80 mmHg). Over a 5-year period, compared with individuals with stable BP less than 130/80 mmHg, those who maintained stage 1 hypertension had 43% increased risk for CVD, which was more prominent among those age at least 60 years. Relative to stable BP (−5 to 5 mmHg), a rise in SBP at least 15 mmHg and DBP at least 5 mmHg conferred 15 and 16% higher CVD risk; whereas the risk of CVD and CHD had 25 and 22% reduction with a decrease in SBP greater than15 mmHg, but not with DBP.

Conclusion: Newly defined stage 1 hypertension and elevated BP were associated with increased risk of incident CVD, whereas long-term changes of SBP and DBP had effects of varying degree on CVD incidence.

aDepartment of Occupational and Environmental Health, Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan

bDepartment of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China

Correspondence to Xiaomin Zhang, Department of Occupational and Environmental Health, Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan 430030, China. E-mail: mingxz117@163.com

Abbreviations: CHD, coronary heart disease; CI, confidence interval; CVD, cardiovascular disease; DFTJ, Dongfeng-Tongji

Received 11 February, 2019

Revised 25 March, 2019

Accepted 1 April, 2019

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