Aim: The overall aim of this thesis was to study determinants and risks associated with increasing blood pressure categories based on a combination of systolic and diastolic blood pressure ranging from optimal blood pressure to manifest hypertension. Emphasis was placed on the importance of focusing on modifiable lifestyle factors and assessment of global risk. The ultimate aim was to identify targets for treatment and prevention. We set out to: 1) study the prevalence and control of hypertension in a representative Swedish population; 2) investigate the association between global risk (SCORE) and ESH/ESC blood pressure categories; 3) study the extent to which physiological factors and lifestyle factors such as physical activity, smoking and alcohol consumption contribute to higher blood pressure levels; 4) investigate the risk of cardiovascular disease associated with different blood pressure categories.
Methods: A random sample of residents aged 30-74 years in the municipalities of Vara and Skövde, southwestern Sweden, was surveyed for cardiovascular risk factors in 2002-2005, and 2816 individuals were enrolled (76%). Participants provided detailed information about their medical history and current medication, and completed a questionnaire about lifestyle. Blood pressure was categorised according to the 2007 ESH/ESC recommendations based on a combination of systolic and diastolic blood pressure ranging from optimal blood pressure to manifest hypertension. Information about fatal and non-fatal cardiovascular events was collected from national registers from baseline until end of 2011, and global risk was estimated using the Swedish SCORE chart.
Results: In Paper I, the prevalence of hypertension in the age group 30-75 years was 20%. A “rule of thirds” emerged, as 1/3 of the participants were