Stage 1 hypertension and risk of cardiovascular disease mortality in United States adults with or without diabetes

Objective: This study aimed to investigate the association of S1 hypertension, classified according to the 2017 American College of Cardiology/American Heart Association blood pressure (BP) guideline, with cardiovascular disease (CVD) mortality in adults with or without diabetes from the general United States population.

Methods: This cohort study included 40 518 United States adults (including 3555 with diabetes) naive to antihypertensive drugs who attended the National Health and Nutrition Examination Surveys from 1988 to 2014.

Results: Participants were followed up for 489 679 person-years (mean follow-up, 12.1 years) with 1569 CVD deaths being recorded. S1 hypertension was neither associated with an increased CVD mortality risk in the whole cohort nor in participants with or without diabetes after full adjustment. In age-stratified analyses, compared with normal BP, S1 hypertension was associated with increased CVD mortality in young adults, unrelated to CVD mortality in midlife, and associated with lower CVD mortality in the elderly. In older participants (≥70 years), people with S1 hypertension had a 23% lower multivariate-adjusted CVD mortality risk compared with those with normal BP (hazard ratio 0.77; 95% confidence interval 0.61-0.98). In younger (<70 years) adults without diabetes, people with normal BP had the lowest CVD mortality risk; however, in younger adults with diabetes, it was people with elevated BP who had the lowest CVD mortality risk.

Conclusion: In this representative sample of United States adults not on BP-lowering medications, S1 hypertension was associated with elevated CVD mortality in younger adults and with lower CVD mortality in those 70 or more years of age.