Background: Prehypertension is a critical precursor to cardiovascular diseases, posing a significant public health burden. This study investigated its prevalence, determinants, and predictive modeling among adults in Fujian Province, China. Methods: A population-based cross-sectional survey was conducted from August 2020 to April 2021. Using multi-stage stratified random sampling, 9455 adults (≥18 years) were recruited. Prehypertension was defined according to JNC 7 guidelines (SBP 120–139 and/or DBP 80–89 mmHg) without antihypertensive medication. Determinants were identified via multivariable logistic regression, and a nomogram was developed and validated. Univariate analysis identified smoking and alcohol consumption as potential correlates, while multivariate analysis was used to determine independent predictors. Results: The weighted prevalence of prehypertension was 37.35%. Independent risk factors included older age, rural residence, central obesity, family history of hypertension, dyslipidemia, tea consumption, and elevated triglyceride-glucose (TyG) index. Notably, smoking was associated with a lower odds ratio in the multivariate model (OR = 0.737), a finding likely attributable to residual confounding or reverse causality rather than a true protective effect. The nomogram demonstrated robust predictive performance (AUC: 0.755 in training; 0.746 in validation). Conclusion: Prehypertension is highly prevalent among adults in Fujian Province. The identified risk factors and validated nomogram provide a scientific foundation for precise primary prevention and early intervention strategies.
- Open Access
- Article
Prevalence and Determinants of Pre-Hypertension among Adults in Fujian Province, China: A Large-Scale Cross-Sectional Study
- Xiaowen Ou 1,2,†,
- Danjing Chen 3,4,5,†,
- Wenxin Qiu 3,4,5,
- Daixi Lin 6,7,8,9,10,11,
- Xiuyu Zheng 12,
- Bangbang Huang 6,7,8,9,10,11,
- Liangdi Xie 6,7,8,9,10,11,
- Xian-E Peng 3,4,5,*,
- Ying Han 6,7,8,9,10,11,*
Author Information
Received: 15 Apr 2026 | Revised: 10 May 2026 | Accepted: 13 May 2026 | Published: 30 Sep 2026
Abstract
Keywords
pre-hypertension | public health | risk prediction | nomogram | cross-sectional study
References
- 1.
World Health Organization; International Society of Hypertension Writing Group. World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension. J. Hypertens. 2003, 21, 1983–1992.
- 2.
Marwick, T.H.; Gillebert, T.C.; Aurigemma, G.; et al. Recommendations on the use of echocardiography in adult hypertension: A report from the European Association of Cardiovascular Imaging (EACVI) and the American Society of Echocardiography (ASE). Eur. Heart J. Cardiovasc. Imaging 2015, 16, 577–605.
- 3.
Writing Committee of the Report on Cardiovascular Health and Diseases in China. Report on Cardiovascular Health and Diseases in China 2023: An Updated Summary. Biomed. Environ. Sci. 2024, 37, 949–992.
- 4.
Ishikawa, Y.; Ishikawa, J.; Ishikawa, S.; et al. Progression from prehypertension to hypertension and risk of cardiovascular disease. J. Epidemiol. 2017, 27, 8–13.
- 5.
Chobanian, A.V.; Bakris, G.L.; Black, H.R.; et al. Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 2003, 42, 1206–1252.
- 6.
Whelton, P.K.; Carey, R.M.; Aronow, W.S.; et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. J. Am. Coll. Cardiol. 2018, 71, e127–e248.
- 7.
China Hypertension Prevention and Treatment Guidelines Revision Committee; Hypertension Alliance (China); Hypertension Branch of the China Association for International Exchange in Healthcare; et al. China Hypertension Prevention and Treatment Guidelines (2024 Revised Edition). Chin. J. Hypertens. 2024, 32, 603–700. https://doi.org/10.16439/j.issn.1673-7245.2024.07.002. (In Chinese)
- 8.
Egan, B.M.; Stevens-Fabry, S. Prehypertension–prevalence, health risks, and management strategies. Nat. Rev. Cardiol. 2015, 12, 289–300.
- 9.
Kanegae, H.; Oikawa, T.; Kario, K. Should pre-hypertension be treated? Curr. Hypertens. Rep. 2017, 19, 91.
- 10.
Materson, B.J.; Garcia-Estrada, M.; Degraff, S.B.; et al. Prehypertension is real and can be associated with target organ damage. J. Am. Soc. Hypertens. 2017, 11, 704–708.
- 11.
Izzo, R.; Mancusi, C.; de Simone, G. Are we underestimating prehypertension? Hypertension 2019, 73, 541–542.
- 12.
Foldes, C.; Fisher, J.W. Hypertension. Ann. Intern. Med. 2019, 171, 525.
- 13.
Kim, Y.; Lee, S. Prevalence and Risk Factors Associated with Prehypertension by Gender and Age in a Korean Population in the KNHANES 2010–2012. Iran. J. Public Health 2015, 44, 1594–1602.
- 14.
Malik, K.S.; Adoubi, K.A.; Kouame, J.; et al. Prevalence and Risk Factors of Prehypertension in Africa: A Systematic Review. Ann. Glob. Health 2022, 88, 13.
- 15.
Booth, J.N., 3rd; Li, J.; Zhang, L.; et al. Trends in prehypertension and hypertension risk factors in US adults: 1999–2012. Hypertension 2017, 70, 275–284.
- 16.
Lonati, L.; Cuspidi, C.; Sampieri, L.; et al. Ultrasonographic evaluation of cardiac and vascular changes in young borderline hypertensives. Cardiology 1993, 83, 298–303.
- 17.
Hurtubise, J.; McLellan, K.; Durr, K.; et al. The Different Facets of Dyslipidemia and Hypertension in Atherosclerosis. Curr. Atheroscler. Rep. 2016, 18, 82.
- 18.
Tsao, P.S.; Aoki, N.; Lefer, D.J.; et al. Time course of endothelial dysfunction and myocardial injury during myocardial ischemia and reperfusion in the cat. Circulation 1990, 82, 1402–1412.
- 19.
Schächinger, V.; Britten, M.B.; Zeiher, A.M. Prognostic impact of coronary vasodilator dysfunction on adverse long-term outcome of coronary heart disease. Circulation 2000, 101, 1899–1906.
- 20.
Pepine, C.J.; Nichols, W.W. The pathophysiology of chronic ischemic heart disease. Clin. Cardiol. 2007, 30, I4–I9.
- 21.
Kachur, S.; Morera, R.; De Schutter, A.; et al. Cardiovascular Risk in Patients with Prehypertension and the Metabolic Syndrome. Curr. Hypertens. Rep. 2018, 20, 15.
- 22.
Li, Y.; Xia, P.; Xu, L.; et al. A Meta-Analysis on Prehypertension and Chronic Kidney Disease. PLoS ONE 2016, 11, e0156575.
- 23.
Yang, G.; Ma, Y.; Wang, S.; et al. Prevalence and Correlates of Prehypertension and Hypertension among Adults in Northeastern China: A Cross-Sectional Study. Int. J. Environ. Res. Public Health 2016, 13, 82.
- 24.
Chen, C.; Yuan, Z. Prevalence and risk factors for prehypertension and hypertension among adults in Central China from 2000–2011. Clin. Exp. Hypertens. 2018, 40, 734–743.
- 25.
Hu, L.; Huang, X.; You, C.; et al. Prevalence and Risk Factors of Prehypertension and Hypertension in Southern China. PLoS ONE 2017, 12, e0170238.
- 26.
Shen, Y.; Chang, C.; Zhang, J.; et al. Prevalence and risk factors associated with hypertension and prehypertension in a working population at high altitude in China: A cross-sectional study. Environ. Health Prev. Med. 2017, 22, 19.
- 27.
National Health and Family Planning Commission of the People’s Republic of China. WS/T 428-2013 Adult Weight Determination; China Standards Press: Beijing, China, 2013.
- 28.
Zhu, J.; Gao, R.; Zhao, S.; et al. Chinese Guidelines for Prevention and Treatment of Dyslipidemia in Adults (2016 Revised Edition). Chin. Circ. J. 2016, 31, 937–953. https://doi.org/10.3969/j.issn.1000-3614.2016.10.001. (In Chinese)
- 29.
Borghi, C.; Domienik-Karłowicz, J.; Tykarski, A.; et al. Expert consensus for the diagnosis and treatment of patient with hyperuricemia and high cardiovascular risk: 2021 update. Cardiol. J. 2021, 28, 1–14.
- 30.
Chinese Guidelines for Adult Physical Activity (Excerpt). Acta Nutr. Sin. 2012, 34, 105–110. Available online: http://lib.cqvip.com/Qikan/Article/Detail?id=41733795 (accessed on 18 May 2025). (In Chinese)
- 31.
Wang, W.; Du, X.; Guo, Y.; et al. Associations among screen time, sleep duration and depressive symptoms among Chinese adolescents. J. Affect. Disord. 2021, 284, 69–74.
- 32.
Alizargar, J.; Bai, C.H.; Hsieh, N.C.; et al. Use of the triglyceride-glucose index (TyG) in cardiovascular disease patients. Cardiovasc. Diabetol. 2020, 19, 8.
- 33.
Alhawari, H.; Alzoubi, O.; Alshelleh, S.; et al. Blood pressure difference between pre- and post-menopausal women and age-matched men: A cross-sectional study at a tertiary center. J. Clin. Hypertens. 2024, 26, 1368–1374.
- 34.
Pan, Y.; Guo, C.; Ma, X.; et al. Mechanism of oxidized low-density lipoprotein-induced vascular endothelial cell injury and protective effect of estrogen. Chin. J. Geriatr. Heart Brain Vessel Dis. 2014, 16, 209–212. Available online: http://lib.cqvip.com/Qikan/Article/Detail?id=48697310&from=Qikan_Search_Index (accessed on 18 May 2025). (In Chinese)
- 35.
Fei, F.; Ye, Z.; Cong, L. Prevalence of pre-hypertension and its risk factors among adult residents in Zhejiang Province. Chin. J. Epidemiol. 2013, 34, 311–315. https://doi.org/10.3760/cma.j.issn.0254-6450.2013.04.002. (In Chinese)
- 36.
National Cardiovascular Disease Center Office. National basic hypertension prevention and management guidelines 2020 edition. Chin. Circ. J. 2021, 36, 209–220. Available online: https://www.chinacirculation.org/#/browse_details?year=2021&issue=3&issuecid=243867 (accessed on 18 May 2025). (In Chinese)
- 37.
Hu, B.; Li, W.; Liu, B.; et al. Prevalence of pre-hypertension and its risk factors in urban and rural areas of Beijing. Chin. J. Tissue Eng. Res. Clin. Rehabil. 2010, 14, 4528–4532. https://doi.org/10.3969/j.issn.1673-8225.2010.24.037. (In Chinese)
- 38.
Taleb, S.; Boulaba, K.; Yousfi, A.; et al. Associations between body mass index, waist circumference, waist circumference to-height ratio, and hypertension in an Algerian adult population. Environ. Sci. Pollut. Res. Int. 2021, 28, 46514–46522.
- 39.
Basu, A.; Lucas, E.A. Mechanisms and effects of green tea on cardiovascular health. Nutr. Rev. 2007, 65, 361–375.
- 40.
Nurminen, M.L.; Niittynen, L.; Korpela, R.; et al. Coffee, caffeine and blood pressure: A critical review. Eur. J. Clin. Nutr. 1999, 53, 831–839.
- 41.
Gebremeskel, G.G.; Haile, T.G.; Gebrewahd, G.T.; et al. High Blood Pressure and Its Associated Factors Among Aksum University Students, Northern Ethiopia, 2019: A Cross-Sectional Study. Int. J. Public Health 2024, 69, 1607275.
- 42.
Gaya, P.V.; Fonseca, G.W.P.; Tanji, L.T.; et al. Smoking cessation decreases arterial blood pressure in hypertensive smokers: A subgroup analysis of the randomized controlled trial GENTSMOKING. Tob. Induc. Dis. 2024, 22, 80.
- 43.
Zhang, X.; Zhang, P.; Shen, D.; et al. Effect of home cook interventions for salt reduction in China: Cluster randomised controlled trial. BMJ 2023, 382, e074258.
This work is licensed under a Creative Commons Attribution 4.0 International License.
Suite 4002 Level 4, 447 Collins Street, Melbourne, Victoria 3000, Australia
General Inquiries: info@sciltp.com