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Kim, Hong, Choi, Choi, Jeong, Lee, and Kim: Rates and Related Factors of Progression to Hypertension among Prehypertensive Local Residents Aged 45 or Over in Chuncheon City: Hallym Aging Study from a Community-Based Cross-Sectional Study
Original Article
Korean Circulation Journal

Korean Circulation Journal 2008; 38(1): 43-50.

Published online: 31 January 2008

DOI: https://doi.org/10.4070/kcj.2008.38.1.43

Rates and Related Factors of Progression to Hypertension among Prehypertensive Local Residents Aged 45 or Over in Chuncheon City: Hallym Aging Study from a Community-Based Cross-Sectional Study

Young-Mook Kim, MD1, Kyung-Soon Hong, MD2, Young-Ho Choi, MD3, Moon-Gi Choi, MD4, Jin-Young Jeong5, Jung-mee Lee, MD6, Dong-Hyun Kim, MD7

1Internal Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea.

2Division of Cardiology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea.

3Department of Family Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea.

4Division of Endocrinology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea.

5Hallym Institute for Aging Research, Hallym University, Chuncheon, Korea.

6Speech, Language and Hearing Sciences, University of Arizona, Arizona, USA.

7Department of Social and Preventive Medicine, Hallym University College of Medicine, Chuncheon, Korea.

Correspondence: Kyung-Soon Hong, MD, Division of Cardiology, Hallym University College of Medicine, 153 Gyo-dong, Chuncheon 200-704, Korea. Tel: 82-33-240-5210, Fax: 82-33-252-9275, kshong@hallym.ac.kr

Received 26 October 2007       Accepted 31 October 2007

Copyright © 2008 The Korean Society of Cardiology

Abstract

Background and Objectives

Prehypertension (preHT) is considered to a precursor of hypertension and it is a predictor of excessive cardiovascular risk. We investigated the rates and determinants of progression to hypertension (HT) among local residents aged 45 or over, and we compared the differences in demographic factors, anthropometric measurements, life styles and metabolic profiles between the progression individuals and non-progression individuals.

Subjects and Methods

Data from the Hallym Aging Study, which was conducted 3 years apart were used to form the sample of 489 adults. PreHT was defined by the Joint National Committee (JNC-7) criteria. We conducted interviews to determine the life style (alcohol, smoking and exercise) and the measured obesity indices. The metabolic profiles were fasting blood sugar (FBS), cholesterol, triglyceride and high density lipoprotein (HDL)-Cholesterol. The factors related to progression to HT were examined by using multiple logistic regression analysis.

Results

The progression rate to HT was 56.4% (56.9% in men, 55.9% in women). The presence of metabolic syndrome was significantly greater and the body mass index (BMI) and systolic blood pressure were significantly higher in the progression group compared with the non-progression group (p=0.0475, p=0.0099, p=0.0082, respectively). Important determinants of progression to HT are a BMI≥25 kg/m2 [odds ratio (OR): 2.26, 95% confidence interval (CI): 1.02-5.22] and a diastolic blood pressure of 85-89 mmHg (OR: 6.11, CI: 1.55-24.13). Changes of FBS (ΔFBS) and pulse pressure (ΔPP) according to a time interval of 3 years are the significant related factors (OR: 3.40, CI: 1.04-11.13 and OR: 9.40, CI: 2.19-40.12, respectively).

Conclusion

PreHT frequently progresses to HT over a period of 3 years. A higher BMI and diastolic blood pressure at the index survey are significantly related to progression. ΔFBS and ΔPP are also important determinants. Therefore, early recognition of preHT and intensive life style modification are needed to prevent progression to HT.

Keywords: Prehypertension, Hypertension, Progression, Risk factors

Figures and Tables

Fig. 1
Flow chart of the study population for Hallym Aging Study.
kcj-38-43-g001
Table 1
Comparison of demographic data and lifestyle habits according to blood pressure at baseline survey in 2004
kcj-38-43-i001

NT: normotension, PreHT: prehypertension, HT: hypertension

Table 2
Comparison of metabolic profiles according to blood pressure at baseline survey in 2004
kcj-38-43-i002

NT: normotension, PreHT: prehypertension, HT: hypertension, MetSynd: metabolic syndrome, BMI: body mass index, HDL-C: high density lipoprotein-cholesterol, FBS: fasting blood sugar, TG: triglyceride, hs-CRP: high sensitivity-C reactive protein, SBP: systolic blood pressure, DBP: diastolic blood pressure

Table 3
Progression rate to hypertension
kcj-38-43-i003

BP: blood pressure, NT: normotension, PreHT: prehypertension, HT: hypertension

Table 4
General characteristics between progression and non-progression group
kcj-38-43-i004

*Previous history. MetSynd: metabolic syndrome, BMI: body mass index, HDL-C: high density lipoprotein-cholesterol, FBS: fasting blood sugar, TG: triglyceride, hs-CRP: high sensitivity-C reactive protein, SBP: systolic blood pressure, DBP: diastolic blood pressure

Table 5
Determinants of progression to hypertension from univariate and multivariate logistic regression model
kcj-38-43-i005

Univariate analysis: age and sex were adjusted. Multivariate analysis: age, sex, BMI, cholesterol, HDL-C, FBS, TG, hs-CRP, SBP, DBP and pulse pressure were adjusted. BMI: body mass index, HDL-C: high density lipoprotein-cholesterol, FBS: fasting blood sugar, TG: triglyceride, hs-CRP: high sensitivity-C reactive protein, SBP: systolic blood pressure, DBP: diastolic blood pressure, OR: odds ratio, CI: confidence interval

Table 6
Determinants of progression to hypertension from univariate and multivariate logistic regression model
kcj-38-43-i006

Univariate analysis: age and sex were adjusted. Multivariate analysis: age, sex, BMI, cholesterol, HDL-C, FBS, TG, hs-CRP, SBP, DBP and pulse pressure were adjusted. FBS: fasting blood sugar, PP: Pulse pressure, BMI: body mass index, HDL-C: high density lipoprotein-cholesterol, TG: triglyceride, hs-CRP: high sensitivity-C reactive protein, SBP: systolic blood pressure, DBP: diastolic blood pressure, OR: odds ratio, CI: confidence interval

References

1. Izzo JL, Black HR, editors. Hypertension Premier. 2003. 3rd ed. Baltimore: Lippincott Williams and Wilkins;235–238.
2. Suh I. Risk of death in men with normal of high-normal blood pressure. Circulation. 2002. 106:Suppl. 760.
3. Seo IL, Kim HC, Ahn SB, et al. Korea Institute for Health and Social Affaires. National Health and nutrition examination in Korea, 2005. Ministry of Health and Welfare. 2007. 37–41.
4. Kim HJ, Ahn YA, Chun HI, Lee JS, Huh SC, Kim ST. Epidemiological studies on geriatric hypertension in Korea. Korean Circ J. 1984. 14:327–332.
5. Chobanian AV, Bakris GL, Black HR, et al. Seventh report of the Joint National Committee on Prevevtion, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003. 42:1206–1252.
6. Levy RL, Hillman CC, Stroud WD, White PD. Transient hypertension: its significance in terms of later development of sustained hypertension and cardiovascular-renal diseases. JAMA. 1944. 126:829–833.
7. Julius S, Schork MA. Borderline hypertension: a critical review. J Chronic Dis. 1971. 23:723–754.
8. Leitschuh M, Cupples LA, Kannel W, Gagnon D, Chobanianl A. High-normal blood pressure progression to hypertension in the Framingham Heart Study. Hypertension. 1991. 17:22–27.
9. Vasan RS, Larson MG, Leip EP, Kannel WB, Levy D. Assessment of frequency of progression to hypertension in non-hypertensive participants in the Framingham Heart Study: a cohort study. Lancet. 2001. 358:1682–1686.
10. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002. 360:1903–1913.
11. Vasan RS, Larson MG, Leip EP, et al. Impact of high-normal blood pressure on the risk of cardiovascular disease. N Engl J Med. 2001. 345:1291–1297.
12. Qureshi AI, Suri MF, Kirmani JF, Divani AA, Mohammad Y. Is prehypertension a risk factor for cardiovascular disease? Stroke. 2005. 36:1859–1863.
13. Qureshi AI, Suri MF, Kirmani JF, Divani AA, Mohammad Y. Prevalence and trends of prehypertension and hypertension in United States: National Health and Nutrition Examination Surveys 1976 to 2000. Med Sci Monit. 2005. 11:CR403–CR409.
14. Kshirsagar AV, Carpenter M, Bang H, Wyatt SB, Colindres RE. Blood pressure usually considered normal is associated with an elevated risk of cardiovascular disease. Am J Med. 2006. 119:133–141.
15. Greenlund KJ, Croft JB, Mensah GA. Prevalence of heart disease and stroke risk factors in persons with prehypertension in the United States, 1999-2000. Arch Intern Med. 2004. 164:2113–2118.
16. Zhang Y, Lee EF, Devereux RB, et al. Prehypertension, diabetes, and cardiovascular disease risk in a population-based sample. Hypertension. 2006. 47:410–414.
17. Liszka HA, Mainous AG 3rd, King DE, Everett CJ, Egan BM. Prehypertension and cardiovascular morbidity. Ann Fam Med. 2005. 3:294–299.
18. Wang Y, Wang OJ. The prevalence of prehypertension and hypertension among US adults according to the new joint national committee guidelines. Arch Intern Med. 2004. 164:2126–2134.
19. Lee JE, Kim YG, Choi YH, Huh W, Kim DJ, Oh HY. Serum uric acid is associated with microalbuminuria in prehypertension. Hypertension. 2006. 47:962–967.
20. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of the Third Rreport of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA. 2001. 285:2486–2497.
21. Jee SH, Suh I, Kim IS, Appel LJ. Smoking and atherosclerotic cardiovascular disease in men with low levels of serum cholesterol. JAMA. 1999. 282:2149–2155.
22. Joint National Committee. Sixth report of the Joint National Committee on Prevevtion, Detection, Evaluation, and Treatment of High Blood Pressure. Arch Intern Med. 1997. 157:2413–2446.
23. Washio M, Tokunaga S, Yoshimasu K, et al. Role of prehypertension in the development of coronary atherosclerosis in Japan. J Epidemiol. 2004. 14:57–62.
24. Rodriguez BL, Labarthe DR, Huang B, Lopez-Gomez J. Rise of blood pressure with age: new evidence of population differences. Hypertension. 1994. 24:779–785.
25. Julius S, Nesbitt SD, Egan BM, et al. Feasibility of treating prehypertension with an angiotensin-receptor blocker. N Engl J Med. 2006. 354:1685–1697.
26. Hong KS, Jeong JY, Jang SN, et al. The prevalence and related risk factors of prehypertension among local residents aged 45 or over in Chuncheon city. Korean Circ J. 2006. 36:535–542.
27. Stamler J. Epidemiologic findings on body mass and blood pressure in adults. Ann Epidemiol. 1991. 1:347–362.
28. Cordero A, Laclaustra M, Leon M, et al. Prehypertension is associated with insulin resistance state and not with an initial renal function impairment. Am J Hypertens. 2006. 19:189–196.
29. Mainous AG 3rd, Everett CJ, Liszka H, King DE, Egan BM. Prehypertension and mortality in a nationally representative cohort. Am J Cardiol. 2004. 94:1496–1500.
30. Tsai PS, Ke TL, Huang CJ, et al. Prevalence and determinants of prehypertension status in the Taiwanese general population. J Hypertens. 2005. 23:1355–1360.
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