Abstract 2750: Prehypertension and Cardiovascular Risk in the Women’s Health Initiative
Background: Prehypertension is common, but its clinical impact is not well established, particularly among ethnic minorities.
Methods: We assessed the prevalence of prehypertension, defined as systolic BP 120–139 or diastolic BP 80 – 89 mm Hg, in the Women’s Health Initiative, excluding women with cardiovascular (CV) disease at baseline. BP was measured annually; clinical outcomes were ascertained semi-annually and adjudicated following medical record review. We used Cox regression models including multiple covariates as time-dependent variables to compare hazard ratios for incident myocardial infarction (MI), stroke, hospitalized heart failure (HF) and CV death among normotensive women (referent), those with prehyper-tension and hypertension.
Results: 60,785 postmenopausal women were followed for 7.7±1.8 years. Prevalence of prehypertension at baseline was 40%, 32%, 43%, 39% and 40% among white, black, Hispanic, American Indian and Asian women, respectively (p<.0001 across ethnic groups). Body mass index, prevalence of diabetes and hypercholesterolemia increased across BP categories, whereas smoking prevalence decreased (all p<.0001). Hazard ratios (95% CI) for CV events in the entire cohort are shown (Table⇓). Hazard ratios for the composite outcome of MI/stroke/HF/CV death did not differ (p value for interaction = 0.71) between white (1.53, 95% CI 1.35–1.73), black (1.68, 95% CI 1.01–2.77), Hispanic (2.70, 95% CI 1.18 – 6.16) and Asian women (3.27, 95% CI 0.92–11.55), although numbers of events among Hispanic and Asian women were small.
Conclusion: Prehypertension is associated with increased risk of MI, stroke, HF and CV death in white and non-white postmenopausal women. Because of risk factor clustering, this increased risk is likely attributable to multiple characteristics, emphasizing the importance of global risk assessment and risk reduction through primordial prevention.