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Open Access Research article

Prehypertension and incidence of cardiovascular disease: a meta-analysis

Yuli Huang1, Sheng Wang1, Xiaoyan Cai2, Weiyi Mai3, Yunzhao Hu2, Hongfeng Tang2 and Dingli Xu1*

Author Affiliations

1 Department of Cardiology, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou 510515, China

2 Clinical Medicine Research Center, the Affiliated Hospital at Shunde, Southern Medical University (the First People’s Hospital of Shunde), Foshan, China

3 Department of Cardiology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China

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BMC Medicine 2013, 11:177  doi:10.1186/1741-7015-11-177

Published: 2 August 2013

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.

Keywords:
Prehypertension; Cardiovascular diseases; Morbidity; Meta-analysis