Higher Blood Pressure as a Risk Factor for Diseases Other Than Stroke and Ischemic Heart Disease

Abstract

H ypertension is an established risk factor for stroke, ischemic heart disease, 1,2 and renal dysfunction. 3 The management and prevention of hypertension are important to the prevention of these diseases. Recent evidence has suggested that hypertension also plays a central role in the underlying pathophysiological condition or at prodromal stages before the development of these diseases. Accumulating evidence also indicates that hypertension seems to be linked with common noncardiovascular diseases including dementia, cancer, oral health diseases (OHDs), and osteoporosis. In this brief review, we organize the reported results about the associations between hypertension and these diseases, discussing mainly epidemiological surveys, with the goal of clarifying the relationships between these diseases and hypertension. Hypertension and Cardiorenal Diseases Atrial FibrillationAtrial fibrillation (AF) is one of the most common types of chronic arrhythmia and is a risk factor for ischemic stroke. 4 The Framingham Heart Study revealed that hypertension increases the risk of AF by factors of 1.5 for men and 1.4 for women.5 The Women's Health Study and a cohort study of Norwegian men showed that high-normal blood pressure (BP) was associated with incident AF.6,7 All of these cohort studies were conducted in Westerners, and these associations were also confirmed in a recent Japanese cohort study. 8 In that investigation, compared with normal BP and normal weight, systolic prehypertension with overweight was shown to be associated with an increased risk of incident AF (P for interaction=0.04). Arterial stiffness, left ventricular hypertrophy, and increased left atrial size are important mediators of the relationship between BP and incident AF. 9 Higher systolic BP (SBP) and overweight may mutually exacerbate left ventricular hypertrophy and hypertension, and consequently, they may synergistically increase the risk of AF. Chronic Kidney Disease and High BPChronic kidney disease (CKD) is characterized by a progressive decline in an individual's glomerular filtration rate over several decades, resulting in permanent kidney dysfunction. Hypertension is consistently demonstrated to be an independent risk factor for declining glomerular filtration rate and the progression of CKD, 10-12 partly because of activation of the renin-angiotensin-aldosterone system and sympathetic nervous system activation. A systematic review and meta-analysis of prospective cohort studies showed that prehypertension is associated with incident end-stage renal disease.3 Compared with a normal BP group, the prehypertensive group had a 1.59× increased risk of end-stage renal disease. Even normal BP increased the risk of end-stage renal disease; this association was accentuated by age, sex, and ethnicity and also varied depending on the study. In addition, a systematic meta-analysis showed that individual components of metabolic syndrome other than elevated BP (hazard ratio, 1.61; 95% confidence interval, 1.29-2.01) were also associated with the develo...

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