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Background <p>The key to preventing and treating hypertension is predicting the progression of prehypertension and implementing preventive and control measures. Whether C-reactive protein (CRP) can predict the progression from prehypertension to hypertension remains to be confirmed.</p> Methods <p>Based on prospective data from CHARLS from 2011 to 2015, 1,236 middle-aged and elderly individuals with prehypertension were enrolled and stratified into three groups according to their baseline CRP levels using predefined CRP categories. We employed interval-censored Cox models and restricted cubic spline analysis to assess the association between CRP level and hypertension risk, as well as model improvement metrics after incorporating CRP.</p> Results <p>During the 4-year follow-up period, 269 participants developed incident hypertension, accounting for 21.8% of the study population. In the adjusted interval-censored Cox model, higher log-transformed CRP was associated with a higher risk of hypertension (HR = 1.34; 95% CI: 1.07–1.68). Because the restricted cubic spline analysis suggested a nonlinear pattern (P for nonlinearity = 0.040), this estimate should be interpreted as an overall summary rather than a constant risk increase across the full CRP range. In the analysis based on clinical CRP categories, participants with CRP &gt; 3&#xa0;mg/L had a higher risk than those with CRP &lt; 1&#xa0;mg/L (HR = 1.61; 95% CI: 1.15–2.26). Subgroup analyses showed no significant interactions across age, sex, BMI, systolic blood pressure, or remnant cholesterol groups. After adding CRP to the conventional risk model, the C-index increased from 0.626 to 0.634.</p> Conclusions <p>Elevated CRP levels were associated with the progression from prehypertension to hypertension among middle-aged and elderly adults. Adding CRP to conventional risk factors provided modest additional predictive information. CRP may serve as a supplementary indicator for identifying individuals who need closer follow-up, but it should not be used alone for risk assessment.</p>

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Predictive value of C-reactive protein for progression from prehypertension to hypertension: a prospective cohort study based on the CHARLS database

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年8月5日

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  • Yadong Fan,
  • Chao Zhang,
  • Yulan Qian,
  • Zijie Zhu,
  • Xue Tian,
  • Xuechen Cui,
  • Mengxin Wang,
  • Daocheng Wang,
  • Gang Xue

摘要

Background

The key to preventing and treating hypertension is predicting the progression of prehypertension and implementing preventive and control measures. Whether C-reactive protein (CRP) can predict the progression from prehypertension to hypertension remains to be confirmed.

Methods

Based on prospective data from CHARLS from 2011 to 2015, 1,236 middle-aged and elderly individuals with prehypertension were enrolled and stratified into three groups according to their baseline CRP levels using predefined CRP categories. We employed interval-censored Cox models and restricted cubic spline analysis to assess the association between CRP level and hypertension risk, as well as model improvement metrics after incorporating CRP.

Results

During the 4-year follow-up period, 269 participants developed incident hypertension, accounting for 21.8% of the study population. In the adjusted interval-censored Cox model, higher log-transformed CRP was associated with a higher risk of hypertension (HR = 1.34; 95% CI: 1.07–1.68). Because the restricted cubic spline analysis suggested a nonlinear pattern (P for nonlinearity = 0.040), this estimate should be interpreted as an overall summary rather than a constant risk increase across the full CRP range. In the analysis based on clinical CRP categories, participants with CRP > 3 mg/L had a higher risk than those with CRP < 1 mg/L (HR = 1.61; 95% CI: 1.15–2.26). Subgroup analyses showed no significant interactions across age, sex, BMI, systolic blood pressure, or remnant cholesterol groups. After adding CRP to the conventional risk model, the C-index increased from 0.626 to 0.634.

Conclusions

Elevated CRP levels were associated with the progression from prehypertension to hypertension among middle-aged and elderly adults. Adding CRP to conventional risk factors provided modest additional predictive information. CRP may serve as a supplementary indicator for identifying individuals who need closer follow-up, but it should not be used alone for risk assessment.