Association between high blood pressure and long term cardiovascular events in young adults: systematic review and meta-analysis

作者：Dongling Luo, Yunjiu Cheng, Haifeng Zhang, Mingchuan Ba, Pengyuan Chen, Hezhi Li, Kequan Chen, Weihong Sha, Caojin Zhang, Hao Hui Chen · 发表于：BMJ · 年份：2020 · DOI：10.1136/bmj.m3222 · 被引用次数：235 · 研究领域：Blood Pressure and Hypertension Studies、Sodium Intake and Health、Cardiovascular Health and Disease Prevention

OBJECTIVE: To evaluate and quantify the future risk of cardiovascular events in young adults with high blood pressure. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Medline, Embase, and Web of Science were searched from inception to 6 March 2020. Relative risks were pooled using a random effects model and expressed with 95% confidence intervals. Absolute risk difference was calculated. Dose-response relations between blood pressure and individual outcomes were assessed by a restricted cubic spline model. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Studies were selected that investigated the adverse outcomes of adults aged 18-45 with raised blood pressure. The primary study outcome was a composite of total cardiovascular events. Coronary heart disease, stroke, and all cause mortality were examined as secondary outcomes. RESULTS: Seventeen observational cohorts consisting of approximately 4.5 million young adults were included in the analysis. The average follow-up was 14.7 years. Young adults with normal blood pressure had increased risk of cardiovascular events compared with those with optimal blood pressure (relative risk 1.19, 95% confidence interval 1.08 to 1.31; risk difference 0.37, 95% confidence interval 0.16 to 0.61 per 1000 person years). A graded, progressive association was found between blood pressure categories and increased risk of cardiovascular events (high normal blood pressure: relative risk 1.35, 95% confidence interval 1.22 to 1.49; risk diffe...