AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Longitudinal Blood Pressure Stage Transition and Clinical Outcomes in Working-Age Adults
By Takegawa K, Kanaoka K, Iwanaga Y et al.
Background: Hypertension is a growing global public health burden, with a considerable proportion of patients with hypertension not receiving treatment. Longitudinal patterns of blood pressure (BP) stage are heterogeneous, and the association between hypertension stage transition defined by American Heart Association guidelines and cardiovascular outcomes among working-age adults remains unclear. Research Question: Is BP stage transition associated with 10-year cardiovascular outcomes among working-age adults with newly identified stage 1 or stage 2 hypertension? Methods: We analyzed 1,533,054 participants who newly met criteria for stage 1 or stage 2 hypertension at the index health check-up without initiation of antihypertensive medication before the second health check-up between April 2006 and March 2024 using a claims database linked to health check-up data. Participants were classified into 6 transition groups: stage 1 to elevated BP/normal, stage 1, or stage 2; and stage 2 to elevated BP/normal, stage 1, or stage 2. The primary outcome was a composite of all-cause death, acute coronary syndrome, stroke, and heart failure hospitalization within 10 years. We examined the association between BP stage transition and the primary outcome using adjusted Cox proportional hazards models. Results: Among the eligible participants, the mean age was 45±12 years, and systolic/diastolic BP at the index health check-up was 136/84 mm Hg (interquartile range 132-142/78-90). At the index health check-up, 1,026,691 participants had stage 1 hypertension and 506,363 had stage 2 hypertension. At the second health check-up, 548,315 (53.4%), 312,869 (30.5%), and 165,507 (16.1%) participants in the stage 1 cohort transitioned to elevated BP/normal, stage 1, and stage 2, respectively. In the stage 2 cohort, 98,534 (19.5%), 127,314 (25.1%), and 280,515 (55.4%) participants transitioned to elevated BP/normal, stage 1, and stage 2, respectively. (Figure 1) The incidence rates of the primary outcome were 4.15, 5.26, 7.45, 6.30, 7.12, and 9.99 per 1000 person-years, respectively. (Figure 2) Compared with stage 1 to elevated BP/normal, all other transition groups had higher risks of the primary outcome: stage 1 to stage 1 (hazard ratio [HR], 1.15; 95% confidence interval [CI], 1.12-1.19); stage 1 to stage 2 (HR, 1.50; 95% CI, 1.45-1.54); stage 2 to elevated BP/normal (HR, 1.34; 95% CI, 1.29-1.40); stage 2 to stage 1 (HR, 1.44; 95% CI, 1.39-1.48); and stage 2 to stage 2 (HR, 1.90; 95% CI, 1.85-1.95). (Figure 3) Conclusions: Among working-age adults, BP stage transition was associated with cardiovascular risk. Higher index BP stage remained relevant to cardiovascular risk even among participants who transitioned to lower BP stage categories, supporting longitudinal BP stage assessment.