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Meta-Analysis
. 2013 Aug 2:11:177.
doi: 10.1186/1741-7015-11-177.

Prehypertension and incidence of cardiovascular disease: a meta-analysis

Yuli Huang  1 , Sheng Wang, Xiaoyan Cai, Weiyi Mai, Yunzhao Hu, Hongfeng Tang, Dingli Xu
Affiliations
Meta-Analysis

Prehypertension and incidence of cardiovascular disease: a meta-analysis

Yuli Huang et al. BMC Med. .

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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Figures

Figure 1
Figure 1
Flow of selection for studies through review. BP, blood pressure; CIs, confidence intervals; RRs indicates relative risks.* Only the latest of the published duplicate studies from the same cohort was included if they offered the same outcome messages. However, one of these studies offered additional messages for subgroup analysis according to BP and gender [6], which could not be derived from the primary included study [9], so it was re-included when performing the subgroup analyses. † Data were derived from 18 prospective cohort studies (two articles were from the Strong Heart Study and reported the risk factors for CHD [19] and stroke [24], respectively).
Figure 2
Figure 2
Forest plot of comparison: prehypertension vs. optimal blood pressure, outcome: cardiovascular morbidity.
Figure 3
Figure 3
Forest plot of comparison: prehypertension vs. optimal blood pressure, outcome: coronary heart disease.
Figure 4
Figure 4
Forest plot of comparison: prehypertension vs. optimal blood pressure, outcome: stroke.
See this image and copyright information in PMC

Comment in

References

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