Article
American Journal of Hypertension (2008) 21 17–22; doi:10.1038/ajh.2007.19
Relationship Between the Metabolic Syndrome and the Development of Hypertension in the Hong Kong Cardiovascular Risk Factor Prevalence Study-2 (CRISPS2)
Bernard M.Y Cheung1, Nelson M.S Wat1, Y. B Man1, Sidney Tam2, C. H Cheng1, Gabriel M Leung3, Jean Woo4, Edward D Janus5, C. P Lau1, T. H Lam3 and Karen S.L Lam1
- 1Department of Medicine, University of Hong Konga, Hong Kong
- 2Clinical Biochemistry Unit, Queen Mary Hospital, Hong Kong
- 3Department of Community Medicine, University of Hong Kong, Hong Kong
- 4Department of Medicine and Therapeutics, Chinese University of Hong Kong, Shatin, Hong Kong
- 5Department of General Medicine, University of Melbourne, Western Hospital, Footscray, Australia
Correspondence: Bernard M.Y.Cheung, (b.cheung@bham.ac.uk)
Received 5 June 2007; First Decision 5 July 2007; Accepted 26 July 2007.
Abstract
Background
The metabolic syndrome is a predictor of diabetes and coronary events. We hypothesized that it also predicts hypertension.
Methods
A total of 1,944 subjects (901 men and 1,043 women; age 46 
12 years) from the Hong Kong Cardiovascular Risk Factor Prevalence Survey were recruited in 1995–1996 and restudied in 2000–2004. The prevalence of hypertension and factors predicting its development were determined.
Results
In 2000–2004, hypertension was found in 23.2% of the men and 17.2% of the women. Of the 1,602 subjects who were normotensive at baseline, 258 subjects developed hypertension after a median interval of 6.4 years. According to the National Cholesterol Education Program (NCEP) and International Diabetes Federation (IDF) criteria, the hazard ratios associated with the metabolic syndrome were 1.89 (95% confidence interval (CI): 1.41–2.54) and 1.72 (95% CI: 1.24–2.39), respectively. The positive and negative predictive values of the metabolic syndrome for identifying subjects who will develop hypertension in this population were 34.7 and 85.4% (NCEP criteria), and 33.1 and 85.5% (IDF criteria), respectively. The development of hypertension was related to the number of components of the metabolic syndrome (other than raised blood pressure), present in men (P = 0.003) and in women (P = 0.001). Using multivariate analysis, age, baseline systolic blood pressure (SBP), body mass index (BMI), and the triglycerides/high-density lipoprotein (HDL) ratio were found to be significant predictors of the development of hypertension. Compared with optimal blood pressure, the hazards of developing hypertension associated with normal or high-normal blood pressure were 2.31 (95% CI: 1.68–3.17) and 3.48 (95% CI: 2.52–4.81), respectively.
Conclusions
Blood pressure, when not optimal, is the predominant predictor of hypertension. The metabolic syndrome contributes to the risk, especially when blood pressure is optimal.
American Journal of Hypertension (2008) 21 17–22; doi:10.1038/ajh.2007.19
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