Associations Of Blood Pressure Classification According To The 2017 ACC/AHA Hypertension Guideline And Their Changes With Risk Of Incident Cardiovascular Disease:a Prospective Study

Cardiovascular disease(CVD)is still the chief diseases affecting people’s health all over the world and the number of deaths due to CVD is the highest among all kinds of diseases every year.The prevention and treatment of CVD has become a serious public health challenge throughout the world.Hypertension is a well-established risk factor for CVD as well as the most common chronic disease.In 2017,the American College of Cardiology/American Heart Association(ACC/AHA)released an updated guideline with a new criteria for hypertension,defining hypertension as systolic blood pressure(SBP)/diastolic BP(DBP)of 130/80 mm Hg or more.However,it is unknown to what extent newly defined BP stages affect CVD risk in the Chinese and its adoption in China needs to be further quantified.In addition,BP level at a single time point might not well characterize risk of disease prediction.Focusing on longterm changes in BP can help screening of hypertension and early intervention in hypertension.Thus,we aimed to investigate the association of newly defined BP stages,different BP components as well as their changes with the risk of CVD incidence in the Dongfeng-Tongji cohort.Objective: To assess the associations of BP classification using 2017 ACC/AHA guideline and their changes with the risk of CVD among the middle-aged and older Chinese.Methods: A total of 29086 participants free of coronary heart disease(CHD),stroke,cancer,severely abnormal electrocardiogram at baseline,loss to follow-up,missing values for BP and covariates from the Dongfeng-Tongji(DFTJ)cohort were enrolled.The epidemiological information of the subjects was collected through questionnaires and physical examinations.Cox proportional hazard models were conducted to calculate the hazard ratio(HR)and 95% confidence interval(CI)for CVD,CHD and stroke.Furthermore,13765 participants who had participated in both surveys were included to estimate the association between change of different BP components and risk of CVD,CHD and stroke using Cox proportional hazard models.Results: Overall,during a mean follow-up of 5.9 years,5260 incident CVD cases were documented among 29086 participants.Compared to the normal BP of <120/<80 mm Hg,elevated BP(120-129/<80 mm Hg)was significantly associated with 18% increased risk of CVD,the effect of CVD was only presented in those age ≥60 years.Those having stage 1 hypertension(130-139/80-89 mm Hg),stage 2 hypertension(140-149/90-99 mm Hg),above stage 2 hypertension(≥160/80 mm Hg)had an 29%,47% and 59% increased risk of CVD,respectively,and these effects were presented in both group of age<60 and ≥60 years.Baseline SBP,DBP,PP and MAP were associated,in a dose-dependent manner,with increased risk of CVD incidence.After controlling for potential covariates,SBP is the most significant determinant associated with the risk of CVD and CHD,HRs for the risk of CVD and CHD incidence were 1.16(1.13,1.19)and 1.11(1.07,1.14)for 1 SD increment for SBP;while MAP is the strongest factor for stroke,HR for the risk of stroke was 1.36(1.28,1.44)for 1 SD increment for MAP.Among 4246 participants with baseline BP of 130-139/80-89 mm Hg,723(21.5%)maintained at the same stratum and 1789(53.2%)progressed to hypertension over a 5-year follow up period.Compared with individuals with stable BP <130/80 mm Hg,those who maintained 130-139/80-89 mm Hg had 43% increased risk for CVD,which was more prominent among those age ≥60 years.Moreover,participants experienced an increase in BP from 130-139/80-89 mm Hg to ≥140/≥90 mm Hg or sustained exposure to BP ≥140/≥90 had 70% and 73% increased risk of CVD.Over a 5-year period,changes of different BP components had effects of varying degree on CVD incidence.Relative to stable BP(-5 to 5 mm Hg),a rise in SBP ≥ 15 mm Hg and DBP ≥ 5 mm Hg conferred higher CVD risk;while the risk of CVD and CHD had a reduction with a decrease in SBP >15mm Hg,but not with DBP.When a reduction in PP from baseline by 5-15 mm Hg predicted a lower risk of CHD.A rise in MAP from baseline by 15 mm Hg increased the risk of stroke,while a reduction in MAP from baseline by 15 mm Hg predicted a lower risk of CHD.Conclusions: Elevated BP and stage 1 hypertension,defined by 2017 ACC/AHA hypertension guideline,were associated with increased risk of incident CVD.Sustained exposure to BP of 130-139/80-89 mmHg increases the risk of CVD incidence.Regular monitoring of BP and early control of stage 1 hypertension may gain significant public health benefits by prevention of CVD.SBP screening may be more conducive to the prevention of CHD risk,while MAP could provide more information on the prediction of stroke risk.