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Background <p>The relationship between high-normal blood pressure (BP) and mortality lacks high-quality evidence based on large population cohorts. This study aims to comprehensively investigate the association of high-normal BP and its trajectory with all-cause and cause-specific mortality.</p> Methods <p>In this community-based population cohort from the China Health Evaluation And risk Reduction Through nationwide teamwork (ChinaHEART) project, 3,598,940 participants aged 35–75&#xa0;years with data for baseline BP were included. High-normal BP was defined as a systolic BP (SBP) of 130–139&#xa0;mmHg and/or a diastolic BP (DBP) of 85–89&#xa0;mmHg at baseline. Overall, 78,130 participants with three or more BP measurements were included in the trajectory pattern analysis during the follow-up. Four BP change trajectory patterns were identified.</p> Results <p>For the baseline BP analysis, compared with the optimal BP group (SBP &lt; 120&#xa0;mmHg and DBP &lt; 80&#xa0;mmHg [18.1%]), participants with high-normal BP (18.7%) had an increase of 4% in all-cause mortality risk (hazard ratio [HR] 1.04, 95% confidence interval [CI] 1.01–1.07) and an increase of 28% in cardiovascular disease (CVD) mortality risk (HR 1.28, 95% CI 1.21–1.34), with the greatest increase in mortality risk observed for hemorrhagic stroke (HR 1.75, 95% CI 1.55–1.98). Among the BP trajectory patterns, compared with participants with optimal-stable BP, those with high-normal-increasing BP had an increase of 35% in all-cause mortality risk (HR 1.35, 95% CI 1.07–1.70) and an increase in CVD mortality risk of 57% (HR 1.57, 95% CI 1.11–2.24), with the greatest increase in mortality risk also observed for hemorrhagic stroke (HR 3.75, 95% CI 1.50–9.34). Approximately 0.7% and 1.6% of all-cause mortality was attributable to high-normal BP at baseline and the high-normal-increasing BP trajectory pattern, respectively.</p> Conclusions <p>Individuals with high-normal BP at baseline exhibited a significantly elevated mortality risk and especially for risk of hemorrhagic stroke mortality during the follow-up. This positive association may be mainly attributed to the “high-normal-increasing” BP change over time.</p>

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Association of high-normal blood pressure defined by the 2023 European Society of Hypertension guideline with mortality in the Chinese population: a nationwide, population-based, prospective study of 3.6 million adults

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  • 发表日期：

    2025年4月16日

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  • Zhiwei Li,
  • Mengmeng Liu,
  • Bowang Chen,
  • Yuelin Wu,
  • Hui Jia,
  • Ruirui Geng,
  • Yixiao Wang,
  • Xiaoyan Zhang,
  • Yang Yang,
  • Jianlan Cui,
  • Jiapeng Lu,
  • Zhiping Guo,
  • Xi Li,
  • Weili Zhang

摘要

Background

The relationship between high-normal blood pressure (BP) and mortality lacks high-quality evidence based on large population cohorts. This study aims to comprehensively investigate the association of high-normal BP and its trajectory with all-cause and cause-specific mortality.

Methods

In this community-based population cohort from the China Health Evaluation And risk Reduction Through nationwide teamwork (ChinaHEART) project, 3,598,940 participants aged 35–75 years with data for baseline BP were included. High-normal BP was defined as a systolic BP (SBP) of 130–139 mmHg and/or a diastolic BP (DBP) of 85–89 mmHg at baseline. Overall, 78,130 participants with three or more BP measurements were included in the trajectory pattern analysis during the follow-up. Four BP change trajectory patterns were identified.

Results

For the baseline BP analysis, compared with the optimal BP group (SBP < 120 mmHg and DBP < 80 mmHg [18.1%]), participants with high-normal BP (18.7%) had an increase of 4% in all-cause mortality risk (hazard ratio [HR] 1.04, 95% confidence interval [CI] 1.01–1.07) and an increase of 28% in cardiovascular disease (CVD) mortality risk (HR 1.28, 95% CI 1.21–1.34), with the greatest increase in mortality risk observed for hemorrhagic stroke (HR 1.75, 95% CI 1.55–1.98). Among the BP trajectory patterns, compared with participants with optimal-stable BP, those with high-normal-increasing BP had an increase of 35% in all-cause mortality risk (HR 1.35, 95% CI 1.07–1.70) and an increase in CVD mortality risk of 57% (HR 1.57, 95% CI 1.11–2.24), with the greatest increase in mortality risk also observed for hemorrhagic stroke (HR 3.75, 95% CI 1.50–9.34). Approximately 0.7% and 1.6% of all-cause mortality was attributable to high-normal BP at baseline and the high-normal-increasing BP trajectory pattern, respectively.

Conclusions

Individuals with high-normal BP at baseline exhibited a significantly elevated mortality risk and especially for risk of hemorrhagic stroke mortality during the follow-up. This positive association may be mainly attributed to the “high-normal-increasing” BP change over time.