Prehypertension Is Not Associated with All-Cause Mortality: A Systematic Review and Meta-Analysis of Prospective Studies

Abstract

ObjectivesQuantitative associations between prehypertension or its two separate blood pressure (BP) ranges and cardiovascular disease (CVD) or all-cause mortality have not been reliably documented. In this study, we performed a comprehensive systematic review and meta-analysis to assess these relationships from prospective cohort studies.MethodsWe conducted a comprehensive search of PubMed (1966-June 2012) and the Cochrane Library (1988-June 2012) without language restrictions. This was supplemented by review of the references in the included studies and relevant reviews identified in the search. Prospective studies were included if they reported multivariate-adjusted relative risks (RRs) and corresponding 95% confidence intervals (CIs) of CVD or all-cause mortality with respect to prehypertension or its two BP ranges (low range: 120–129/80–84 mmHg; high range: 130–139/85–89 mmHg) at baseline. Pooled RRs were estimated using a random-effects model or a fixed-effects model depending on the between-study heterogeneity.ResultsThirteen studies met our inclusion criteria, with 870,678 participants. Prehypertension was not associated with an increased risk of all-cause mortality either in the whole prehypertension group (RR: 1.03; 95% CI: 0.91 to 1.15, P = 0.667) or in its two separate BP ranges (low-range: RR: 0.91; 95% CI: 0.81 to 1.02, P = 0.107; high range: RR: 1.00; 95% CI: 0.95 to 1.06, P = 0.951). Prehypertension was significantly associated with a greater risk of CVD mortality (RR: 1.32; 95% CI: 1.16 to 1.50, P<0.001). When analyzed separately by two BP ranges, only high range prehypertension was related to an increased risk of CVD mortality (low-range: RR: 1.10; 95% CI: 0.92 to 1.30, P = 0.287; high range: RR: 1.26; 95% CI: 1.13 to 1.41, P<0.001).ConclusionsFrom the best available prospective data, prehypertension was not associated with all-cause mortality. More high quality cohort studies stratified by BP range are needed.

Mortality Risk Along the Frailty Spectrum: Data from the National Health and Nutrition Examination Survey 1999 to 2004

“…Determining this association is important in clarifying prefrailty as an important diagnostic entity in itself versus another early disease state. Although some preconditions such as prehypertension have been well defined, no association has been found between prehypertension and overall mortality . This is unlike other precondition states such as prediabetes, for which a metaanalysis demonstrated an associated greater risk of all‐cause and cardiovascular mortality when defined according to fasting glucose as low as 5.6 mmol/L .…”

Update on the Hong Kong Reference Framework for Hypertension Care for Adults in Primary Care Settings—review of evidence on the definition of high blood pressure and goal of therapy

“…7 Meta-analyses of observational prospective studies suggested that people with SBP 120 to 139 mm Hg and/or DBP 80 to 89 mm Hg may also be at risk of cardiovascular events. [8][9][10][11][12][13][14][15][16][17] For this group of people, it was observed that the higher the BP was, the higher the cardiovascular risk was, in general. However, the risk was less significant and less clearly established in Asians, except for the risk of stroke which was shown to be lower, similar to, or even higher than that for non-Asians from different metaanalyses.…”

Pré-hipertensão, hipertensão arterial e fatores associados em pacientes odontológicos: estudo transversal na cidade de Santa Maria-RS, Brasil

“…A pré-hipertensão, como a própria denominação sugere, ocorre anteriormente à hipertensão e está associada com um risco aumentado de doenças cardiovasculares, principalmente para aqueles indivíduos classificados como pré-hipertensos em uma faixa mais elevada, chamada high-range prehypertension 25,26 , na qual a pressão arterial sistólica está entre 130 e 139 mmHg e a diastólica, entre 85 e 89 mmHg, o equivalente à pressão normal alta ou limítrofe da classificação brasileira 1 . Os desfechos fatais devido a doenças cardiovasculares aumentam de forma linear e contínua a partir de PAS 115 mmHg e de PAD 75 mmHg 1,13,25,26 .…”

“…Como recomendação primária, tem-se a abordagem não medicamentosa, que inclui mudanças no estilo de vida e a adoção de hábitos mais saudáveis, como a diminuição do consumo de álcool e da ingestão de sódio, a incorporação de atividades físicas e a eliminação do fumo 1 . Por outro lado, algumas pesquisas têm demonstrado eficácia suficiente e segura do tratamento anti-hipertensivo para pré-hipertensão, porém ainda não foi comprovado se os benefícios da terapia farmacológica superam os malefícios e não existem ainda evidências que justifiquem tal procedimento 25,27 .…”