Prehypertension and Cardiovascular Disease Risk in the Women’s Health Initiative

TLDR

Prehypertension is common and linked to higher vascular mortality, but its impact on nonfatal myocardial infarction, stroke, and congestive heart failure remains uncertain. The study assessed 60,785 postmenopausal women over 7.7 years, estimating prehypertension prevalence, its association with other risk factors, and incident cardiovascular events using time‑dependent Cox regression models. Prehypertension, present in about 40 % of women across ethnicities, was associated with 1.58‑ to 1.93‑fold increased hazards for cardiovascular death, myocardial infarction, stroke, heart failure, and overall cardiovascular events, with no ethnic‑group differences, underscoring the need for primordial prevention trials.

Abstract

Background— Prehypertension is common and is associated with increased vascular mortality. The extent to which it increases risk of nonfatal myocardial infarction, stroke, and congestive heart failure is less clear. Methods and Results— We determined the prevalence of prehypertension, its association with other coronary risk factors, and the risk for incident cardiovascular disease events in 60 785 postmenopausal women during 7.7 years of follow-up using Cox regression models that included covariates as time-dependent variables. Prehypertension was present at baseline in 39.5%, 32.1%, 42.6%, 38.7%, and 40.3% of white, black, Hispanic, American Indian, and Asian women, respectively ( P <0.0001 across ethnic groups). Age, body mass index, and prevalence of diabetes mellitus and hypercholesterolemia increased across blood pressure categories, whereas smoking decreased (all P <0.0001). Compared with normotensive women (referent), adjusted hazard ratios for women with prehypertension were 1.58 (95% confidence interval [CI], 1.12 to 2.21) for cardiovascular death, 1.76 (95% CI, 1.40 to 2.22) for myocardial infarction, 1.93 (95% CI, 1.49 to 2.50) for stroke, 1.36 (95% CI, 1.05 to 1.77) for hospitalized heart failure, and 1.66 (95% CI, 1.44 to 1.92) for any cardiovascular event. Hazard ratios for the composite outcome with prehypertension did not differ between ethnic groups ( P =0.71 for interaction), although the numbers of events among Hispanic and Asian women were small. Conclusions— Prehypertension is common and was associated with increased risk of myocardial infarction, stroke, heart failure, and cardiovascular death in white and nonwhite postmenopausal women. Risk factor clustering was conspicuous, emphasizing the need for trials evaluating the efficacy of global cardiovascular risk reduction through primordial prevention.