# Progression from Prehypertension to Hypertension and Risk of Gastrointestinal Cancer—A Nationwide Health-Screening Cohort Study

## TL;DR

This study finds that progressing from prehypertension to hypertension increases the risk of gastrointestinal cancers, especially colorectal and pancreatic cancers.

## Contribution

The study identifies that hypertension progression, not just persistence of prehypertension, is linked to higher gastrointestinal cancer risk.

## Key findings

- Progression to hypertension was associated with a 16% higher risk of overall gastrointestinal cancer.
- Colorectal and pancreatic cancers showed the strongest associations with hypertension progression.
- Low medication adherence or lack of prescriptions amplified the cancer risk among those who progressed to hypertension.

## Abstract

Hypertension is a major risk factor for cardiovascular disease and has been linked to gastrointestinal cancers; however, the cancer risk associated with prehypertension remains uncertain. Using a nationwide Korean health-screening cohort of adults with prehypertension, we evaluated gastrointestinal cancer risk according to blood pressure trajectories: reversion to normotension, persistence of prehypertension, and progression to hypertension. During long-term follow-up, progression to hypertension was associated with a higher risk of gastrointestinal cancers overall, with stronger associations for colorectal and pancreatic cancers. Persistence of prehypertension was not associated with overall risk, but increased colorectal and pancreatic cancer risks were observed. Among those who progressed, excess risk was more pronounced in participants with poor adherence to antihypertensive therapy or without antihypertensive prescriptions. These findings suggest that preventing progression to hypertension and improving early treatment adherence may help reduce the future burden of gastrointestinal cancers.

Background/Objectives: Hypertension is a major risk factor for cardiovascular disease and is associated with gastrointestinal (GI) cancers. However, the association between prehypertension and cancer risk remains uncertain. We investigated the association of progression from prehypertension to hypertension with the risk of GI cancers. Methods: We analyzed a Korean health-screening cohort with prehypertension. Blood pressure (BP) at two consecutive screenings defined three groups: reversion to normotension, persistence of prehypertension, and progression to hypertension. Cause-specific Cox proportional hazards models were used to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs). Sensitivity analyses were conducted by exposure-window (2, 4, and 6 years), lag times (1–5 years), and BP reclassification, along with subgroup and medication adherence (medication possession ratio [MPR]) analyses. Results: Of 131,167 individuals, 40,859 (31.2%) reverted to normotension, 62,600 (47.7%) remained prehypertensive, and 27,708 (21.1%) progressed to hypertension. Progression to hypertension was associated with higher overall GI cancer risk (aHR 1.16, 95% CI 1.08–1.26), whereas persistence was not. Site-specific analyses showed stronger associations for colorectal and pancreatic cancers. Among those who progressed, associations were stronger in participants younger than 65 years and in those without diabetes. Excess risk was more pronounced with low adherence (MPR < 0.80) or non-prescriptions. Moreover, sensitivity analyses using the European Society of Cardiology 2024 criteria showed similar results. Conclusions: Preventing progression from prehypertension to hypertension may reduce long-term GI cancer burden. Early detection and treatment of new-onset hypertension, with high medication adherence, could help reduce the future burden of GI cancers.