Impact of high-normal blood pressure on the risk of cardiovascular disease.

Background: Information is limited regarding the risk of cardiovascular dis ease in persons with high-normal blood pressure (systolic pressure of 130 t o 139 mm Hg, diastolic pressure of 85 to 89 mm Hg, or both). Methods: We investigated the association between blood-pressure category at base line and the incidence of cardiovascular disease on follow-up among 6 859 participants in the Framingham Heart Study who were initially free of h ypertension and cardiovascular disease. Results: A stepwise increase in cardiovascular event rates was noted in per sons with higher base-line blood-pressure categories. The 10-year cumulativ e incidence of cardiovascular disease in subjects 35 to 64 years of age who had high-normal blood pressure was 4 percent (95 percent confidence interv al, 2 to 5 percent) for women and 8 percent (95 percent confidence interval , 6 to 10 percent) for men; in older subjects (those 65 to 90 years old), t he incidence was 18 percent (95 percent confidence interval, 12 to 23 perce nt) for women and 25 percent (95 percent confidence interval, 17 to 34 perc ent) for men. As compared with optimal blood pressure, high-normal blood pr essure was associated with a risk-factor-adjusted hazard ratio for cardiova scular disease of 2.5 (95 percent confidence interval, 1.6 to 4.1) in women and 1.6 (95 percent confidence interval, 1.1 to 2.2) in men. Conclusions: High-normal blood pressure is associated with an increased ris k of cardiovascular disease. Our findings emphasize the need to determine w hether lowering high-normal blood pressure can reduce the risk of cardiovas cular disease. (N Engl J Med 2001;345:1291-7.) Copyright (C) 2001 Massachus etts Medical Society.