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Atasoy, S. ; Johar, H.* ; Peters, A. ; Ladwig, K.-H.

Association of hypertension cut-off values with 10-year cardiovascular mortality and clinical consequences: A real-world perspective from the prospective MONICA/KORA study.

Eur. Heart J. 40, 732-738 (2019)

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Aims To investigate the clinical value of a lower blood pressure (BP) cut-off for Stage 1 (S1) hypertension (130-139mmHg systolic or 80-89mmHg diastolic) in comparison to the currently established Stage 2 (S2) cut-off (140/90mmHg) in a population-based cohort.Methods and results We assessed the hypertension prevalence and associated cardiovascular disease (CVD) events in a sample of 11603 participants (52% men, 48% women; mean 47.6years) from the MONICA/KORA prospective study. The implementation of the new S1 cut-off increased the prevalence of hypertension from 34% to 63%. Only 24% of S2 hypertension patients were under treatment. Within a follow-up period of 10years (70148 person-years), 370 fatal CVD events were observed. The adjusted CVD-specific mortality rate per 1000 persons was 1.61 [95% confidence interval (CI) 1.10-2.25] cases in S2 and 1.07 (95% CI 0.71-1.64) cases in S1 hypertension in comparison to normal BP. Cox proportional regression models were significant for the association of S2 and CVD mortality (1.54, 95% CI 1.04-2.28, P = 0.03), also in the presence of competing risks (1.47, P = 0.05). However, statistical significance for S1 hypertension was not reached (0.93, 95% CI 0.61-1.44, P = 0.76). Among S2 participants, there was a significantly higher prevalence of depressed-mood in treated patients (47%) in comparison to non-treated patients (33%) (P < 0.0001).Conclusion The lower BP cut-off substantially increased hypertension prevalence, while capturing a population with lower CVD mortality. Additionally, participants under treatment were more likely to have depressed-mood in comparison to non-treated participants, which might reflect a negative labelling effect.

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