Abstract
Little is known about the natural progression and regression of blood pressure status, even though such knowledge would help determine the best intervention strategies. Our study aimed to explore natural changes in blood pressure status in a middle-aged Chinese population. A total of 6,129 Chinese men and women, aged 35 to 59 years at baseline, from the China Multi-center Collaborative Study of Cardiovascular Epidemiology, were reexamined 6 years later to determine the probability of progression (from non-hypertension to hypertension) and regression (from hypertension to non-hypertension). The majority (80%) of non-hypertensives among the respondents in this study remained normal or pre-hypertensive; about two-thirds of stage 1 hypertensives either stayed at the same stage or regressed to non-hypertension. However, only 9% of stage 2 hypertensives regressed to non-hypertension. Multi-variable logistic regression analysis showed that the stage 1 hypertension group had a 5-fold chance of regressing to non-hypertension in comparison with the stage 2 hypertension group (odds ratio [OR]=0.2, 95% confidence interval [CI]: 0.1−0.3), whereas the pre-hypertension group had a 4-fold likelihood of progressing to hypertension compared with normotensive subjects (OR=4.4, 95% CI: 3.7−5.3). After excluding participants ever on drug treatment in either examinations, the OR of regression for stage 2 hypertension was over twice that for stage 1 hypertension (OR=0.5, 95% CI: 0.3−0.7), and the possibility of progression decreased, though very slightly (OR=4.3, 95% CI: 3.6−5.1). Weight change significantly influenced progression and regression. Alcohol drinking affected progression significantly. In conclusion, the present findings support the strategy of intensively treating stage 2 hypertension and moderately treating stage 1 hypertension. Persons with pre-hypertension should be monitored for progression and advice on lifestyle modifications should be used.
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Lawes CM, Hoorn SV, Law MR, Elliott P, Macmahon S, Rodgers A : Blood pressure and the global burden of disease 2000. Part II: Estimates of attributable burden. J Hypertens 2006; 24: 423–430.
Jiang He, Dongfeng Gu, Xigui Wu, et al: Major causes of death among men and women in China. N Engl J Med 2005; 353: 1124–1135.
Chobanian AV, Bakris GL, Black HR, et al: Seventh report of the Joint National Committee on Prevention, Dectection, Evaluation, and Treatment of High Blood Pressure. Hypertension 2003; 42: 1206–1252.
European Society of Hypertension−European Society of Cardiology Guidelines Committee : 2003 European Society of Hypertension−European Society of Cardiology guidelines for the management of arterial hypertension. J Hypertens 2003; 21: 1011–1053.
Sagie A, Martin G, Larson SD, et al: The natural history of borderline isolated systolic hypertension. N Engl J Med 1993; 329: 1912–1917.
Vasan RS, Larson MG, Leip EP, et al: Assessment of frequency of progression to hypertension in non-hypertensive participants in the Framingham Heart Study: a cohort study. Lancet 2001; 358: 1682–1686.
Leitschuh M, Cupples LA, Kannel W, Gagnon D, Chobanian A : High-normal blood pressure progression to hypertension in the Framingham Heart Study. Hypertension 1991; 17: 22–27.
Winegarden CR : From “prehypertension” to hypertension? Additional evidence. Ann Epidemiol 2005; 15: 720–725.
Bakx JC, Van den Hoogen HJM, van den Bosch WJHM, et al: Development of blood pressure and the incidence of hypertension in men and women over an 18-year period: results of the Nijmegen cohort study. J Clin Epidemiol 1999; 52: 531–538.
Chiu YH, Wu SC, Tseng CD, Yen MF, Chen THH : Progression of pre-hypertension, stage 1 and 2 hypertension (JNC 7): a population-based study in Keelung, Taiwan (Keelung Community-based Integrated Screening No. 9). J Hypertens 2006; 24: 821–828.
Zhang H, Thijs L, Kuznetsova T, Fagard RH, Li X, Staessen AJ : Progression to hypertension in the non-hypertensive participants in the Flemish Study on Environment, Genes and Health Outcomes. J Hypertens 2006; 24: 1719–1727.
Zhou BF, Zhang HY, Wu YF, et al: Ecological analysis of the association between incidence and risk factors of coronary heart disease and stroke in Chinese populations. CVD Prevention 1998; 1: 207–216.
Wang Z, Wu Y, Zhao L, Li Y, Yang J, Zhou B, Cooperative Research Group of the Study on Trends of Cardiovascular Diseases in China and Preventive Strategy for the 21st Century: Trends in prevalence, awareness, treatment and control of hypertension in the middle-aged population of China, 1992−1998. Hypertens Res 2004; 27: 703–709.
Wu YF : Survey methods for the risk factors of cardiovascular disease, in Zhou BF, Wu XG (eds): Handbook for the Methods of Study in Cardiovascular Epidemiology. Beijing, Joint Publishing House of Beijing Medical University and Peking Union Medical University, 1997, pp 64–76.
Julius S, Nesbitt SD, Egan BM, et al, the Trial of Preventing Hypertension [TROPHY] Study Investigators : Feasibility of treating prehypertension with an angiotensin-receptor blocker. N Engl J Med 2006; 354: 1685–1697.
Whelton PK, He J, Appel LJ, et al: Primary prevention of hypertension: clinical and public health advisory from the National High Blood Pressure Education Program. JAMA 2002; 288: 1882–1888.
Brunner E, Thorogood M, Rees K, Hewitt G : Dietary advice for reducing cardiovascular risk. Cochrane Database Syst Rev 2005; Oct 19; ( 4): CD002128.
Aldana SG, Greenlaw RL, Diehl HA, et al: The behavioral and clinical effects of therapeutic lifestyle change on middle-aged adults. Prev Chronic Dis 2006; 3: A05.
Stevens VJ, Obarzanek E, Cook NR, et al: Long-term weight loss and changes in blood pressure: results of the Trials of Hypertension Prevention, phase II. Ann Intern Med 2001; 134: 1–11.
Appel LJ, Champagne CM, Harsha DW, et al: Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER clinical trial. Writing Group of the PREMIER Collaborative Research Group. JAMA 2003; 289: 2083–2093.
Medical Research Council Working Party on Mild-to-Moderate Hypertension : Adverse reactions to bendofluazide and propranolol for the treatment of mild hypertension. Lancet 1981; 2 ( 8246): 539–543.
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Hu, J., Wu, Y., Zhao, L. et al. Natural Variances in Blood Pressure Category among Chinese Adults. Hypertens Res 31, 905–911 (2008). https://doi.org/10.1291/hypres.31.905
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DOI: https://doi.org/10.1291/hypres.31.905