Prehypertension significantly increased CVD risk in patients with NCDs, but a paradoxical all-cause mortality association was seen, with higher risk among NCD patients with optimal BP versus prehypertension.
Key Findings
Results
Prehypertension combined with NCDs was associated with the highest cardiovascular disease risk compared to optimal blood pressure alone.
The study included 56,114 participants from the Kailuan Study followed for a median of 9.04 years.
3,367 CVD events occurred during follow-up.
Multivariable adjusted HR for CVD was 2.33 (95% CI: 2.10–2.58) for prehypertension with NCDs compared to optimal BP alone (P < 0.001).
Prehypertension alone had HR of 1.36 (95% CI: 1.23–1.51) and optimal BP with NCDs had HR of 1.82 (95% CI: 1.55–2.14) for CVD.
Participants were divided into four groups: optimal BP without NCDs, prehypertension without NCDs, optimal BP with NCDs, and prehypertension with NCDs.
Results
A paradoxical association was observed for all-cause mortality, where NCD patients with optimal blood pressure had a higher mortality risk than NCD patients with prehypertension.
5,754 all-cause mortality events occurred during the median follow-up of 9.04 years.
HR for all-cause mortality was 2.07 (95% CI: 1.85–2.32) for optimal BP with NCDs compared to optimal BP alone (P < 0.001).
HR for all-cause mortality was 1.85 (95% CI: 1.72–2.00) for prehypertension with NCDs compared to optimal BP alone (P < 0.001).
Prehypertension alone showed HR of 1.13 (95% CI: 1.04–1.21) for all-cause mortality.
The authors describe this as a 'paradoxical all-cause mortality association' where optimal BP with NCDs carried higher mortality risk than prehypertension with NCDs.
Results
Females with prehypertension and NCDs showed the highest all-cause mortality risk among sex-stratified analyses.
Stratified and sensitivity analyses were performed to verify robustness of results.
The finding of highest all-cause mortality risk in females with prehypertension and NCDs was notable and specifically highlighted by the authors.
Cox proportional hazards models and Kaplan-Meier survival curves were used to assess associations.
Results were described as consistent across sensitivity and stratified analyses.
Methods
The study design was a prospective cohort that followed 56,114 participants from the Kailuan Study until December 31, 2018.
Median follow-up duration was 9.04 years.
Participants were categorized into four groups based on blood pressure status (optimal BP vs. prehypertension) and NCD status (with or without NCDs).
CVD events and all-cause mortality were the primary outcomes tracked.
Cox proportional hazards models were used for multivariable-adjusted analyses.
Results
Prehypertension alone was independently associated with increased risks of both CVD and all-cause mortality compared to optimal blood pressure without NCDs.
HR for CVD with prehypertension alone was 1.36 (95% CI: 1.23–1.51, P < 0.001).
HR for all-cause mortality with prehypertension alone was 1.13 (95% CI: 1.04–1.21, P < 0.001).
All comparisons were made against the reference group of optimal BP without NCDs.
All P-values were reported as < 0.001.
What This Means
This research examined how having both mildly elevated blood pressure (prehypertension) and other chronic diseases (noncommunicable diseases, or NCDs) affects the risk of heart disease and death. Using data from over 56,000 participants followed for about nine years, the researchers found that people with both prehypertension and NCDs had more than double the risk of cardiovascular disease events compared to people with normal blood pressure and no NCDs. This suggests that the combination of prehypertension and existing chronic conditions is particularly dangerous for heart health.
A surprising finding emerged when looking at the risk of death from any cause: people with NCDs and normal blood pressure actually had a higher risk of all-cause mortality than people with NCDs and prehypertension. This counterintuitive result — sometimes called a 'paradoxical' association — may reflect underlying complexities such as reverse causation (where serious illness causes blood pressure to drop) or selection effects, and the authors highlight it as an area warranting further investigation. Among all groups studied, females with both prehypertension and NCDs faced the highest all-cause mortality risk.
This research suggests that prehypertension should not be considered a benign condition, especially in people who already have chronic diseases, given its strong association with cardiovascular events. At the same time, the paradoxical mortality finding underscores that the relationship between blood pressure and health outcomes in people with existing chronic conditions is complex and cannot be interpreted straightforwardly. Clinicians and researchers may need to consider the interplay between blood pressure levels and underlying disease burden when evaluating patient risk.
Zhang R, Li L, Wang Y, Li J, Ruan C, Wu S, et al.. (2026). Cardiovascular Diseases and All-Cause Mortality Risk in Patients With Prehypertension and Noncommunicable Diseases: Results From the Kailuan Study.. Journal of clinical hypertension (Greenwich, Conn.). https://doi.org/10.1111/jch.70366