Association of high-normal blood pressure defined by the 2023 European Society of Hypertension guideline with mortality in the Chinese population: a nationwide, population-based, prospective study of 3.6 million adults
Zhiwei Li,
Mengmeng Liu,
Bowang Chen,
Yuelin Wu,
Hui Jia,
Ruirui Geng,
Yixiao Wang,
Xiaoyan Zhang,
Yang Yang,
Jianlan Cui,
Jiapeng Lu,
Zhiping Guo,
Xi Li,
Weili Zhang
Affiliations
Zhiwei Li
National Clinical Research Center of Cardiovascular Diseases, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
Mengmeng Liu
Central China Subcenter of National Center for Cardiovascular Diseases, Henan Cardiovascular Disease Center, Fuwai Central-China Cardiovascular Hospital, Central China Fuwai Hospital of Zhengzhou University
Bowang Chen
National Clinical Research Center of Cardiovascular Diseases, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
Yuelin Wu
National Clinical Research Center of Cardiovascular Diseases, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
Hui Jia
Central China Subcenter of National Center for Cardiovascular Diseases, Henan Cardiovascular Disease Center, Fuwai Central-China Cardiovascular Hospital, Central China Fuwai Hospital of Zhengzhou University
Ruirui Geng
Central China Subcenter of National Center for Cardiovascular Diseases, Henan Cardiovascular Disease Center, Fuwai Central-China Cardiovascular Hospital, Central China Fuwai Hospital of Zhengzhou University
Yixiao Wang
National Clinical Research Center of Cardiovascular Diseases, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
Xiaoyan Zhang
National Clinical Research Center of Cardiovascular Diseases, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
Yang Yang
National Clinical Research Center of Cardiovascular Diseases, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
Jianlan Cui
National Clinical Research Center of Cardiovascular Diseases, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
Jiapeng Lu
National Clinical Research Center of Cardiovascular Diseases, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
Zhiping Guo
Central China Subcenter of National Center for Cardiovascular Diseases, Henan Cardiovascular Disease Center, Fuwai Central-China Cardiovascular Hospital, Central China Fuwai Hospital of Zhengzhou University
Xi Li
National Clinical Research Center of Cardiovascular Diseases, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
Weili Zhang
National Clinical Research Center of Cardiovascular Diseases, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
Abstract Background The relationship between high-normal blood pressure (BP) and mortality lacks high-quality evidence based on large population cohorts. This study aims to comprehensively investigate the association of high-normal BP and its trajectory with all-cause and cause-specific mortality. Methods In this community-based population cohort from the China Health Evaluation And risk Reduction Through nationwide teamwork (ChinaHEART) project, 3,598,940 participants aged 35–75 years with data for baseline BP were included. High-normal BP was defined as a systolic BP (SBP) of 130–139 mmHg and/or a diastolic BP (DBP) of 85–89 mmHg at baseline. Overall, 78,130 participants with three or more BP measurements were included in the trajectory pattern analysis during the follow-up. Four BP change trajectory patterns were identified. Results For the baseline BP analysis, compared with the optimal BP group (SBP < 120 mmHg and DBP < 80 mmHg [18.1%]), participants with high-normal BP (18.7%) had an increase of 4% in all-cause mortality risk (hazard ratio [HR] 1.04, 95% confidence interval [CI] 1.01–1.07) and an increase of 28% in cardiovascular disease (CVD) mortality risk (HR 1.28, 95% CI 1.21–1.34), with the greatest increase in mortality risk observed for hemorrhagic stroke (HR 1.75, 95% CI 1.55–1.98). Among the BP trajectory patterns, compared with participants with optimal-stable BP, those with high-normal-increasing BP had an increase of 35% in all-cause mortality risk (HR 1.35, 95% CI 1.07–1.70) and an increase in CVD mortality risk of 57% (HR 1.57, 95% CI 1.11–2.24), with the greatest increase in mortality risk also observed for hemorrhagic stroke (HR 3.75, 95% CI 1.50–9.34). Approximately 0.7% and 1.6% of all-cause mortality was attributable to high-normal BP at baseline and the high-normal-increasing BP trajectory pattern, respectively. Conclusions Individuals with high-normal BP at baseline exhibited a significantly elevated mortality risk and especially for risk of hemorrhagic stroke mortality during the follow-up. This positive association may be mainly attributed to the “high-normal-increasing” BP change over time.
