Abstract 4155: Hypertension and Risk of Cardiovascular Disease Mortality among the US Adults
Background. Hypertension is a major risk factor for cardiovascular morbidity and mortality. Less is known about whether pre-hypertension is also an independent risk factor for cardiovascular events in the U.S. adult population and whether undiagnosed or untreated hypertension and treated but uncontrolled hypertension are associated with an increase in cardiovascular mortality in the U.S. hypertensive population.
Methods. Data from the Third National Health and Nutrition Examination Survey 1988–1994 and mortality follow-up through 2000 were examined to estimate the relative risk of death from cardiovascular disease associated with hypertension, pre-hypertension, undiagnosed/untreated hypertension, and treated but uncontrolled hypertension, after adjusting for confounding and modifying factors.
Results. At baseline, 23.7% adults aged >=18 were identified as hypertensive (BP >=140/90 mmHg or current treatment for hypertensive with a prescription medication) and 30.8%, as pre-hypertensive (BP 120–140/80–90 mmHg). Among hypertensive adults, 48% were undiagnosed or untreated and 32% were treated but uncontrolled. Relative to persons with normal blood pressure (BP <120/80 mm Hg), the relative risk of cardiovascular mortality for hypertension and pre-hypertension were 1.64 (95% CI 1.11–2.41, p=0.01) and 1.23 (95% CI 0.85–1.78, p=0.26) respectively. Among hypertensives, undiagnosed or untreated hypertension and treated but uncontrolled hypertension were associated with 54% (hazard ratio 1.54, 95% CI 1.09–2.17, p=0.01) and 79% (hazard ratio 1.79, %95 CI 1.30–2.48, p=0.001) increases in cardiovascular mortality compared to persons with treated and controlled hypertension.
Conclusions. Based on a 10 year follow-up population-based U.S. sample, hypertension, but not pre-hypertension was associated with significantly increased cardiovascular mortality independent of other cardiovascular risk factors. Improving the detection and treatment of hypertension and achieving blood pressure control might prevent a considerable proportion of cardiovascular death among the U.S. hypertensive population.