| Objective: Mainly based on the Systolic Blood Pressure Intervention Trial(SPRINT)and several meta-analyses,American College of Cardiology and American Heart Association(ACC/AHA)redefined stage 1 hypertension to systolic blood pressure(SBP)130-139 mm Hg or diastolic blood pressure(DBP)80-89 mm Hg in 2017. However,patients in SPRINT were restricted to more than 50 years and other multiple meta-analyses also aimed at the aged population.At present,there is still a lack of research on the association of blood pressure classification,especially stage 1hypertension with adverse events.Therefore,we investigated the association between blood pressure classification,especially stage 1 hypertension defined by the 2017 ACC/AHA guidelines and the risk of adverse events among adults aged <50 years.Methods: A total of 20,072 adults aged 35-49 years,without history of cardiovascular diseases(CVD)at baseline were included in the present study.According to 2017 ACC/AHA guideline,the participants were classified into four categories: normal BP(SBP<120mm Hg and DBP<80mm Hg),elevated BP(120mm Hg≤SBP≤129mm Hg and DBP<80mm Hg),stage 1 hypertension(130mm Hg≤SBP≤139mm Hg or 80≤DBP≤89mm Hg)and stage 2 hypertension(SBP≥140mm Hg/DBP≥90 mm Hg or taking antihypertensive medications).The present study outcomes were adverse events,including all-cause mortality,CVD mortality,stroke incidence and myocardial infarction(MI)incidence.The hazard ratios(HRs)and 95% confidence interval(CI)were calculated with the group of normal BP as the reference.Three models were established: model 1 was unadjusted;model 2 was adjusted for sex,age,ethnicity and education levels;and model 3 was adjusted for baseline BMI,current smoking,current drinking,antihypertensive treatment,physical activity,history of diabetes and hyperlipidemia,and family history of hypertension on the basis of model 2.Results: During a median follow-up period of 12.5 years,the results indicated that 777 subjects of all-cause deaths and 299 subjects were attributable to CVD.Meanwhile,830 subjects involved in incident stroke and 141 subjects in MI.Compared with blood pressure(BP)<120/<80 mm Hg,compared with normal blood pressure,elevated blood pressure was not associated with all-cause death,CVD death,stroke and MI.In unadjusted model,HR(95%CI)was 0.88(0.67,1.16),0.96(0.58,1.58),1.18(0.87,1.60)and 0.71(0.34,1.47)respectively.Stage 1 hypertension had a HR(95% CI)of 1.38(1.13-1.70)for all-cause mortality,1.74(1.20-2.53)for CVD mortality,1.78 for(1.40-2.26)for stroke incidence,and 1.63(0.99-2.71)for MI incidence,respectively.The result showed that after the adjustment for sex,age,and other potential CVD factors,stage 1 hypertension was associated with higher risk of stroke.(HR and 95% CI: 1.53,1.20-1.95).Stage 1 hypertension was not associated with all-cause mortality,CVD mortality and MI.After analyzing the subtypes of stroke,it was found that stage1 hypertension was associated with ischemic stroke and hemorrhagic stroke.Conclusion: The stage 1 hypertension defined by the 2017 ACC/AHA Hypertension Guidelines was associated with an increased risk of stroke.People with stage 1hypertension should pay attention to their own blood pressure to reduce the risk of stroke. |
