Abstract
OBJECTIVE: Intermediate blood pressure states, such as high-normal blood pressure and prehypertension, represent a continuous spectrum of cardiovascular risk. Their natural history in the working population has not been fully characterized. The objective of this study was to describe the transitions between different blood pressure states (normopressure, prehypertension, and hypertension) and to analyze their trajectories during a 7-year follow-up in an occupational cohort. METHOD: Retrospective longitudinal study including 12,027 workers evaluated between 2013 and 2021. They were classified as normotension < 120/80 mmHg and hypertension ≥ 140/90 mmHg. Intermediate states were analyzed using two categories: prehypertension with 120-139/80-89 mmHg and high-normal blood pressure with 130-139/85-89 mmHg. Incidence rates were calculated and evolutionary trajectories were analyzed. RESULTS: The incidence of prehypertension was 25.80 per 1,000 person-years (95% CI: 25.05-26.55), higher than high-normal blood pressure (9.64; 95% CI: 9.25-10.03) and hypertension (9.86; 95% CI: 9.54-10.19). In the transition analysis, of the workers who started with normopressure, 60.1% progressed to prehypertension and 26.7% developed hypertension. Of those with initial prehypertension, 49.7% remained in their state and 43.8% progressed to hypertension. In the alternative classification, 21.2% progressed from normopressure to high-normal blood pressure, and of the latter, 55.9% developed hypertension. CONCLUSIONS: Intermediate blood pressure states show distinctive patterns of progression, with significant transition rates toward hypertension. These findings underscore the importance of strengthening occupational surveillance and developing early preventive interventions in workers with intermediate blood pressure states.