title: Progression from prehypertension to hypertension and risk of cardiovascular disease.
abstract: BACKGROUND
  Subjects with prehypertension (pre-HT; 120/80 to 139/89 mm Hg) have an increased risk of cardiovascular disease (CVD); however, whether the risk of pre-HT can be seen at the pre-HT status or only after progression to a hypertensive (HT; ≥140/90 mm Hg) state during the follow-up period is unknown.
  
  
  METHODS
  The Jichi Medical Cohort study enrolled 12,490 subjects recruited from a Japanese general population. Of those, 2227 subjects whose BP data at baseline and at the middle of follow-up and tracking of CVD events were available (median follow-up period: 11.8 years). We evaluated the risk of HT in those with normal BP or pre-HT at baseline whose BP progressed to HT at the middle of follow-up compared with those whose BP remained at normal or pre-HT levels.
  
  
  RESULTS
  Among the 707 normotensive patients at baseline, 34.1% and 6.6% of subjects progressed to pre-HT and HT, respectively, by the middle of follow-up. Among 702 subjects with pre-HT at baseline, 26.1% progressed to HT. During the follow-up period, there were 11 CVD events in normotensive patients and 16 CVD events in pre-HT patients at baseline. The subjects who progressed from pre-HT to HT had 2.95 times higher risk of CVD than those who remained at normal BP or pre-HT in a multivariable-adjusted Cox hazard model.
  
  
  CONCLUSIONS
  This relatively long-term prospective cohort study indicated that the CVD risk with pre-HT might increase after progression to HT; however, the number of CVD events was small. Therefore, the results need to be confirmed in a larger cohort.
authors.affiliation: Division of Community and Family Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan.
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Ishikawa
authors.affiliation: Tokyo Metoropolitan Geriatric Hospital and Institute of Gerontology, Division of Cardiology, Tokyo, Japan.
authors.forename: Joji
authors.initials: J
authors.lastname: Ishikawa
authors.affiliation: Division of Community and Family Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan. Electronic address: yuishi@jichi.ac.jp.
authors.forename: Shizukiyo
authors.initials: S
authors.lastname: Ishikawa
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan.
authors.forename: Kazuomi
authors.initials: K
authors.lastname: Kario
authors.affiliation: Division of Community and Family Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Kajii
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D058246:Prehypertension / Q000503:physiopathology*; D011446:Prospective Studies; D012306:Risk
keywords: Cardiovascular disease; Japanese; Population-based study; Prehypertension