AbstractBackgroundThe study was performed to investigate the impact of prehypertension defined by the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7) on the risk of major adverse cardiovascular events (MACE) in a Chinese rural cohort.MethodsThe epidemiological prospective cohort study included 38,765 participants aged ≥35 years followed for a median of 12.5 years—divided into normal BP (n = 7,366), prehypertension (n = 18,095), and hypertension groups (n = 13,304)—were enrolled for the final analysis. Follow-up for MACE including cardiovascular disease (CVD) death, stroke and myocardial infarction (MI) was conducted. Adjusted Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI).ResultsThe age and sex-adjusted incidence of MACE and its subtypes rose progressively with elevation of BP levels (P < 0.001). After adjusting multivariable Cox proportional hazards, significant increases were observed from the prehypertensive group for incident MACE (HR = 1.337, 95% CI: 1.186–1.508, P < 0.001), CVD mortality (HR = 1.331, 95% CI: 1.109–1.597, P = 0.002), and stroke (HR = 1.424, 95% CI：1.237–1.639, P < 0.001) but not MI (P > 0.05) compared with normal BP.ConclusionPrehypertensive individuals had a greater risk of incident MACE, CVD mortality, and stroke, implying that improvements in BP monitoring and early intervention in individuals with prehypertension in rural China are urgently needed.