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. 2023 Nov 20:10:1134.
doi: 10.12688/f1000research.73900.4. eCollection 2021.

Blood pressure and 10-year all-cause mortality: Findings from the PERU MIGRANT Study

Aida Hidalgo-Benites  1 , Valeria Senosain-Leon  1 , Rodrigo M Carrillo-Larco  2   3 , Andrea Ruiz-Alejos  3 , Robert H Gilman  3   4 , Liam Smeeth  5 , J Jaime Miranda  3   6 , Antonio Bernabé-Ortiz  3   7
Affiliations

Blood pressure and 10-year all-cause mortality: Findings from the PERU MIGRANT Study

Aida Hidalgo-Benites et al. F1000Res. .

Abstract

Background: The long-term impact of elevated blood pressure on mortality outcomes has been recently revisited due to proposed changes in cut-offs for hypertension. This study aimed at assessing the association between high blood pressure levels and 10-year mortality using the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) and the American College of Cardiology and the American Heart Association (ACC/AHA) 2017 blood pressure guidelines.

Methods: Data analysis of the PERU MIGRANT Study, a prospective ongoing cohort, was used. The outcome of interest was 10-year all-cause mortality, and exposures were blood pressure categories according to the JNC-7 and ACC/AHA 2017 guidelines. Log-rank test, Kaplan-Meier and Cox regression models were used to assess the associations of interest controlling for confounders. Hazard ratios (HR) and 95% confidence intervals (95% CI) were estimated.

Results: A total of 976 records, mean age of 60.4 (SD: 11.4), 513 (52.6%) women, were analyzed. Hypertension prevalence at baseline almost doubled from 16.0% (95% CI 13.7%-18.4%) to 31.3% (95% CI 28.4%-34.3%), using the JNC-7 and ACC/AHA 2017 definitions, respectively. Sixty-three (6.4%) participants died during the 10-year follow-up, equating to a mortality rate of 3.6 (95% CI 2.4-4.7) per 1000 person-years. Using JNC-7, and compared to those with normal blood pressure, those with pre-hypertension and hypertension had 2.1-fold and 5.1-fold increased risk of death, respectively. Similar mortality effect sizes were estimated using ACC/AHA 2017 for stage-1 and stage-2 hypertension.

Conclusions: Blood pressure levels under two different definitions increased the risk of 10-year all-cause mortality. Hypertension prevalence doubled using ACC/AHA 2017 compared to JNC-7. The choice of blood pressure cut-offs to classify hypertension categories need to be balanced against the patients benefit and the capacities of the health system to adequately handle a large proportion of new patients.

Keywords: Hypertension; blood pressure; mortality; pre-hypertension.

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Conflict of interest statement

No competing interests were disclosed.

Figures

Figure 1.
Figure 1.. Kaplan-Meier function using (A) JNC-7 and (B) ACC/AHA definitions.
HT = Hypertension.
See this image and copyright information in PMC

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