A longitudinal analysis of the progression from normal blood pressure to stage 2 hypertension: A 12-year Korean cohort

Abstract

BackgroundThe study aimed to estimate the incidence of and period of progression to stage 2 hypertension from normal blood pressure.MethodsWe selected a total of 21,172 normotensive individuals between 2003 and 2004 from the National Health Insurance Service-Health Screening and followed them up until 2015. The criteria for blood pressure were based on the American College of Cardiology/American Heart Association 2017 guideline (normal BP: SBP <120 and DBP <80mmHg, elevated BP: SBP 120-129 and DBP <80mmHg, stage 1 hypertension: SBP 130-139 or DBP 80-89mmHg, stage 2 hypertension: SBP <greater than or equal to>140 or DBP >= 90mmHg). We classified the participants into four courses (Course A: normal BP -> elevated BP -> stage 1 hypertension -> stage 2 hypertension, Course B: normal BP -> elevated BP -> stage 2 hypertension, Course C: normal BP -> stage 1 hypertension -> stage 2 hypertension, Course D: normal BP -> stage 2 hypertension) according to their progression from normal blood pressure to stage 2 hypertension.ResultsDuring the median 12.23years of follow-up period, 52.8% (n= 11,168) and 23.6% (n=5004) of the participants had stage 1 and stage 2 hypertension, respectively. In particular, over 60years old had a 2.8-fold higher incidence of stage 2 hypertension than 40-49years old. After the follow-up period, 77.5% (n=3879) of participants with stage 2 hypertension were found to be course C (n= 2378) and D (n=1501). After the follow-up period, 77.5% (n=3879) of participants with stage 2 hypertension were found to be course C (n= 2378) and D (n=1501). The mean years of progression from normal blood pressure to stage 2 hypertension were 8.72.6years (course A), 6.1 +/- 2.9years (course B), 7.5 +/- 2.8years (course C) and 3.2 +/- 2.0years, respectively.Conclusions This study found that the incidence of hypertension is associated with the progression at each stage. We suggest that the strategies necessary to prevent progression to stage 2 hypertension need to be set differently for each target course.