Presence of baseline prehypertension and risk of incident stroke: A meta-analysis
Objective: To qualitatively and quantitatively assess the association of prehypertension with incident stroke through a meta-analysis of prospective cohort studies.
Methods: We searched Medline, Embase, the Cochrane Library, and bibliographies of retrieved articles. Prospective cohort studies were included if they reported multivariate-adjusted relative risks RRs and corresponding 95%confidence intervals CI of stroke with respect to baseline prehypertension.
Results: Twelve studies with 518,520 participants were included. Prehypertension was associated with risk of stroke RR 1.55, 95% CI 1.35–1.79; p < 0.001. Seven studies further distinguished a low prehypertensive population systolic blood pressure [SBP] 120–129 mm Hg or diastolic blood pressure [DBP] 80–84 mm Hg and a high prehypertensive population SBP 130–139 mm Hg or DBP 85–89 mm Hg. Among persons with lower-range prehypertension, stroke risk was not significantly increased RR 1.22, 0.95–1.57. However, for persons with higher values within the prehypertensive range, stroke risk was substantially increased RR 1.79, 95% CI 1.49–2.16.
Conclusions: Prehypertension is associated with a higher risk of incident stroke. This risk is largely driven by higher values within the prehypertensive range and is especially relevant in nonelderly persons. Randomized trials to evaluate the efficacy of blood pressure reduction in persons with this designation are warranted.