Cardiovascular Risk Factors for Incident Hypertension in the Prehypertensive Population

Abstract

OBJECTIVESThe aim of this study was to investigate the effect of changes in cardiovascular disease (CVD) risk factors on progression from prehypertension (PreHTN) to hypertension (HTN) using an 8-yr prospective Korean Cancer Prevention Study (KCPS) by the National Health Insurance Corporation (NHIC) in Korea.METHODSA total of 16,229 subjects, aged 30 to 54, with new onset preHTN at baseline (1994-1996) in a biennial national medical exam were selected and followed up till 2004 at 2-yr intervals. All subjects underwent a biennial health examination including biochemical measurements and behavior. The log-rank test was performed to assess the relationship between changes in CVD risk factors and progression to HTN. The Cox proportional hazard model was used to identify factors influencing progression to HTN.RESULTSWith regards the progression rate in men, ex-smokers (42.9%), abstainers (37.5%), and regular exercisers (37.6%) showed a slower progression rate than continuous smokers (49.5%) and continuous drinkers (50.9%). In women, those who participated in regular exercise (22.6%) had a lower rate of progression than continuous non-exercisers (36.1%). According to the results of the Cox proportional hazard model, improvements in smoking (hazard ratio [HR], 0.756), drinking (HR, 0.669), regular exercise (HR, 0.653), body mass index (HR, 0.715), and total cholesterol (HR, 0.788) played a protective role in progression to HTN in men, while in women, participating in regular exercise (HR, 0.534) was beneficial.CONCLUSIONImprovements in CVD-related behaviors diminished the progression rate of HTN. This study suggests that individuals with PreHTN should be targeted for specific health behavioral intervention to prevent the progression of HTN.

Physical Activity and the Prevention of Hypertension

“…Since that time, three recent publications have identified physical activity and its related components as factors associated with progression to hypertension from prehypertension. Kim et al reported that Korean adults who self-reported engaging in regular exercise had a slower rate of progression from prehypertension to hypertension than non-exercisers[32]. Similarly, among adults with prehypertension living in rural areas of China, individuals with low levels of physical activity had a 40% higher risk of progression from prehypertension to hypertension compared to individuals who engaged in moderate physical activity[33].…”

The Korean Society of Hypertension Guidelines for the Management of Hypertension in 2013: Its Essentials and Key Points

“…For example, in the KMIC study, the risk of coronary artery disease was 2.51-fold higher in the stage 2 prehypertension group than in the stage 1 prehypertension group [6,7] . In addition, the probability of progressing to hypertension and the risk for a cardiovascular event were both reported to be higher in the prehypertension group than in the normal BP group [8][9][10] . In another paper from the KMIC study, a BP >135/85 mm Hg was associated with the occurrence of hemorrhagic stroke in male subjects.…”

Pathophysiological mechanisms underlying the beneficial effects of physical activity in hypertension

“…44 Nevertheless, if on one hand the major effect of exercise training is recorded in hypertensive conditions, on the other hand the training inhibits the progression from normal to pre-hypertension and from pre-hypertension to hypertension. 43,[45][46][47][48] Therefore, physical exercise represents a powerful therapeutic tool to prevent the development of hypertension, especially in high-risk populations like diabetic patients or individuals with family history of hypertension.…”