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Stage 1 hypertension, but not elevated blood pressure, predicts 10-year fatal and non-fatal CVD events in healthy adults: the ATTICA Study

Journal of Human Hypertension volume 33, pages 308–318 (2019)Cite this article

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Abstract

The study evaluated the extent to which high normal blood pressure (HNBP), elevated BP, and Stage 1 hypertension predict 10-year incidence of cardiovascular disease (CVD). A population-based, prospective cohort study was conducted among 3042 randomly selected Greek adults, aged 18–89 years. Following 10-years follow-up (2002–2012), incidence of non-fatal and fatal CVD (ICD-10) was achieved in 2020 participants. The analytic sample (n = 1403) excluded hypertensive patients. At baseline, the prevalence rate of HNBP, elevated BP, and Stage 1 hypertension was 44.6% (n = 626), 29.0% (n = 408), and 15.5% (n = 218), respectively. During follow-up, the 10-year combined (fatal or non-fatal) CVD incidence rates in HNBP, elevated BP, and Stage 1 hypertensive individuals were 15.6% (n = 98), 12.0% (n = 49), and 22.5% (n = 49), respectively, as compared to 6.3% (n = 49) in normotensives (all p’s < 0.0001). As compared to normotensives (and following the adjustment for known demographic, lifestyle and clinical confounding factors), HNBP participants had a 1.5-fold (Adjusted Hazard Ratio, Adj. HR: 1.49; 95% CI: 1.00–2.20) increased risk of 10-year CVD events. Similarly, Stage 1 hypertensive participants had an approximately twofold (Adj. HR: 1.90; 95% CI: 1.16–3.08) increased risk for 10-year CVD, particularly among males (Adj. HR: 2.03; 95% CI: 1.08–3.83). However, individuals with elevated BP did not exhibit a differential risk for developing 10-year CVD events (Adj. HR: 1.28; 95% CI: 0.82–2.02). Therefore, since HNBP and Stage 1 hypertension individuals exhibit a notable increased risk of 10-year fatal and non-fatal CVD, the implementation of targeted primary and secondary prevention interventions may deter both CVD and related adverse health outcomes.

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Acknowledgements

We would like to thank the field investigators of the study: M. Toutouza (biochemical evaluation), I. Papaioannou (physical examination), E. Tsetsekou (physical examination), A. Zeimbekis (physical examination), K. Masoura (physical examination), A. Katinioti (physical examination), S. Vellas (physical examination), E. Kambaxis (nutritional evaluation), K. Paliou (nutritional evaluation), C. Tselika (technical support), S. Poulopoulou (technical support), M. Koukoura (technical support), K. Vassiliadou (genetic evaluation) and M. Toutouza (data management).

Funding

The Hellenic Cardiology Society, the Hellenic Atherosclerosis Society, the Graduate Program in Applied Nutrition and Dietetics of Harokopio University and the Coca-Cola SA funded this study by research grants (KE252/ELKE/HUA). The ATTICA Study is funded by research grants from the Hellenic Society of Cardiology (grant–1, 2002).

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Authors and Affiliations

  1. Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 70 El. Venizelou Avenue, 176 71, Athens, Greece

    Elena Critselis, Natasa Kollia, Ekavi N. Georgousopoulou & Demosthenes B. Panagiotakos

  2. First Cardiology Clinic, School of Medicine, University of Athens, Athens, Greece

    Christina Chrysohoou, Dimitrios Tousoulis & Christos Pitsavos

  3. Faculty of Health, University of Canberra, Canberra, ACT, Australia

    Ekavi N. Georgousopoulou & Demosthenes B. Panagiotakos

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  1. Elena Critselis
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Correspondence to Demosthenes B. Panagiotakos.

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Critselis, E., Chrysohoou, C., Kollia, N. et al. Stage 1 hypertension, but not elevated blood pressure, predicts 10-year fatal and non-fatal CVD events in healthy adults: the ATTICA Study. J Hum Hypertens 33, 308–318 (2019). https://doi.org/10.1038/s41371-019-0169-z

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