Stage 1 Hypertension and the 10‐Year and Lifetime Risk of Cardiovascular Disease: A Prospective Real‐World Study

BACKGROUND: The 10‐year and lifetime cardiovascular disease risk in the population with stage 1 hypertension and the effects of recovery from and progression of stage 1 hypertension remain undetermined. METHODS AND RESULTS: This prospective cohort study included 96 268 individuals with blood pressure measurements obtained in 2006 and again in 2010. The 10‐year cardiovascular disease risk was estimated using the multivariable Cox proportional hazards model, and the lifetime risk was calculated using a modified survival analysis that accounted for the competing risk of death. Stage 1 hypertension was detected in 30.83% of the cohort. The 10‐year cardiovascular disease risk was 2.80%, and the lifetime risk was 16.61%. Compared with the normal blood pressure group, the stage 1 hypertension group had a 35% higher 10‐year risk (hazard ratio [HR], 1.35 [95% CI, 1.19–1.52]) and a 36% higher lifetime risk (HR, 1.36 [95% CI, 1.25–1.49]). By 2010, 12.57% of the participants with stage 1 hypertension had progressed to stage 2, with a significant 156% increase in 10‐year risk (HR, 2.56 [95% CI, 2.11–3.11]) and an increased lifetime risk of 129% (HR, 2.29 [95% CI, 1.89–2.77]). There was no appreciable change in risk in those with stage 1 hypertension whose blood pressure returned to the normal‐elevated range. CONCLUSIONS: Stage 1 hypertension was associated with a significant increase in 10‐year and lifetime cardiovascular disease risk. Progression to stage 2 hypertension was associated with a marked increase in lifetime risk. The current guidelines require revision to promote early detection and appropriate management of blood pressure.