Modifiable factors of 20-year blood pressure trajectories among normotensives and their associations with hypertension : a prospective study

Abstract

Little is known about the impact of modifiable risk factors on blood pressure (BP) trajectories and their associations with hypertension (HTN). We aimed to identify BP trajectories in normotensive Chinese adults and explore their influencing factors and associations with HTN. We used data from 3,436 adults with at least four BP measurements between 1989 and 2018 in the China Health and Nutrition Survey, an ongoing cohort study. We measured BP using mercury sphygmomanometers with appropriate cuff sizes in all surveys. We used group-based trajectory modeling to identify BP trajectories between 1989 and 2009 and multiple logistic and Cox regression models to analyze their influencing factors and associations with HTN in 2011-2018. We identified five systolic blood pressure (SBP) trajectories, ‘Low-increasing(LI)’, ‘Low–stable(LS)’, ‘Moderate-increasing(MI)’, ‘High-stable(HS)’, and ‘Moderate-decreasing(MD)’; and four diastolic blood pressure (DBP) trajectories classified as ‘Low-increasing(LI)’, ‘Moderate–stable(MS)’, ‘Low-stable(LS)’ and ‘High-increasing(HI)’. People with higher physical activity (PA) levels and lower waist circumferences (WCs) were less likely to be in the SBP LI, MI, HS, and MD groups (P < 0.05). People with higher fruit and vegetable intakes, lower WCs and salt intakes, and higher PA levels were less likely to be in the DBP LI, MS, and HI groups (P < 0.05). Participants in the SBP HS group (hazard ratio [HR] 2.01) or the DBP LI, MS, and HI groups (HRs 1.38, 1.40, 1.71, respectively) had higher risks of HTN (P < 0.05). This study suggests that BP monitoring is necessary to prevent HTN in the Chinese population.

Blood Pressure Trajectories From Childhood to Youth and Arterial Stiffness in Adulthood: A 30-Year Longitudinal Follow-Up Study

“…and other modifiable risk factors (e.g., salt intake, education level and physical activity, etc.) (7,18,19,28,31,(34)(35)(36)(37). More perspective studies are needed to confirm these findings.…”

Associations of traditional cardiovascular risk factors with 15-year blood pressure change and trajectories in Chinese adults: a prospective cohort study

“…Another study used data from the China Health and Nutrition Survey (CHNS) between 1989 and 2009 to identify 20-year blood pressure trajectories in normotensive adults. Compared with stable low blood pressure levels, the risk of moderate to high increasing trajectories increased by 8–11% for SBP and 5–8% for DBP per 1 cm larger WC, respectively [22]. The present study included both normotensive and hypertensive participants.…”

“…Compared with stable low blood pressure levels, the risk of moderate to high increasing trajectories increased by 8–11% for SBP and 5–8% for DBP per 1 cm larger WC, respectively. [ 22 ] The present study included both normotensive and hypertensive participants. We found that the SD, ARV, cumBP, and occurrence of high-risk trajectories in both SBP and DBP increased with higher BMI or WC.…”