Blood pressure severity, not awareness alone, tracked mortality in two cohorts

A population-based observational analysis of adults aged 45 years or older in China and the United States examined hypertension awareness, measured blood pressure and all-cause mortality. Uncontrolled hypertension and severe hypertension without prior awareness were associated with higher mortality than normotension, while awareness status within similar blood-pressure categories was not consistently associated with mortality.

Uncontrolled hypertension was linked to higher mortality in both cohorts.
Unaware severe hypertension showed similar mortality associations.
Awareness was not consistently associated with mortality within severity categories.
Observational findings do not establish causation.

Researchers analyzed 12,868 participants in the China Health and Retirement Longitudinal Study (CHARLS; 12,640 contributed mortality follow-up) and 26,351 in the US National Health and Nutrition Examination Survey (NHANES). Participants aged 45 years or older were classified by self-reported prior hypertension diagnosis and measured baseline blood pressure. Cohort-specific weighted Cox models assessed all-cause mortality, adjusting for demographic, lifestyle and clinical factors.

Compared with normotension, aware but uncontrolled hypertension was associated with higher mortality in CHARLS (hazard ratio [HR], 1.53; 95% CI, 1.26–1.85) and NHANES (HR, 1.39; 95% CI, 1.28–1.52). Unaware grade 2–3 hypertension showed similar associations: HR 1.58 (95% CI, 1.25–1.99) in CHARLS and 1.50 (95% CI, 1.29–1.76) in NHANES. Within broad blood-pressure severity categories, awareness was not consistently associated with mortality across cohorts.

The findings suggest baseline blood-pressure severity and control were more consistently associated with mortality than self-reported awareness. Because this was observational research using baseline-defined categories, it cannot establish that awareness affects mortality or that awareness is unimportant. The authors emphasize detection followed by ongoing follow-up and blood-pressure control.

In practice

For adults aged 45 years or older represented in these cohorts, uncontrolled hypertension and severe hypertension without prior reported diagnosis were associated with higher all-cause mortality than normotension. Within broad blood-pressure severity categories, self-reported awareness was not consistently associated with mortality across the China and US cohorts. These observational results do not show that awareness itself changes risk and do not support reducing hypertension detection; they reinforce the importance of assessing blood pressure and maintaining follow-up and control, without establishing a specific intervention effect.

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Source

BMC Public Health: Hypertension awareness, blood pressure severity, and all-cause mortality: independent analyses of population-based cohorts in China and the United States ↗

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