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Degree of Joint Risk Factor Control and Incident Heart Failure in Hypertensive Patients
Minghao Kou1, Xuan Wang1, Hao Ma1
1Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA.
Insights
Controlling multiple cardiovascular risk factors significantly lowers heart failure (HF) risk in hypertensive patients. Optimal control of six or more factors can eliminate the excess HF risk associated with hypertension.
Area of Science:
- Cardiovascular Medicine
- Hypertension Research
- Epidemiology
Background:
- Heart failure (HF) is a significant complication in individuals with hypertension.
- Hypertension management is crucial for preventing cardiovascular events.
Purpose of the Study:
- To assess how controlling multiple risk factors impacts hypertension-related HF risk.
- To determine the effectiveness of joint risk factor management in mitigating HF incidence.
Main Methods:
- Utilized UK Biobank data from 75,293 hypertensive and 256,619 non-hypertensive individuals.
- Assessed joint risk factor control (blood pressure, BMI, cholesterol, HbA1c, albuminuria, smoking, physical activity).
- Employed Cox proportional hazards models to analyze associations between risk factor control and HF risk.
Main Results:
- Each additional controlled risk factor reduced incident HF risk by 20%.
- Optimal control (≥6 factors) was linked to a 62% lower HF risk (HR: 0.38).
- Optimal control eliminated the excess HF risk in hypertensive patients compared to controls (HR: 0.79).
Conclusions:
- Joint risk factor control cumulatively reduces HF risk, with stronger effects in men.
- Optimal risk factor management can potentially eliminate hypertension-related excess HF risk.
Background:
Heart failure (HF) is a major complication in patients with hypertension.
Objectives:
This study aimed to investigate the extent to which joint risk factor control could attenuate hypertension-related excess risk of HF.
Methods:
The study included a total of 75,293 participants with diagnosed hypertension from the UK Biobank and matched with 256,619 nonhypertensive control subjects, followed up until May 31, 2021. The degree of joint risk factor control was assessed on the basis of the major cardiovascular risk factors, including blood pressure, body mass index, low-density lipoprotein cholesterol, hemoglobin A1c, albuminuria, smoking, and physical activity. The Cox proportional hazards models were used to estimate associations between the degree of risk factor control and risk of HF.
Results:
Among hypertensive patients, joint risk factor control showed an association with a stepwise reduction of incident HF risk. Each additional risk factor control was related to a 20% lower risk, and the optimal risk factor control (controlling ≥6 risk factors) was associated with a 62% lower risk (HR: 0.38; 95% CI: 0.31-0.45). In addition, the study found that the hypertension-related excess risk of HF among participants jointly controlling ≥6 risk factors were even lower than in nonhypertensive control subjects (HR: 0.79; 95% CI: 0.67-0.94). The protective associations of joint risk factor control and risk of incident HF were broadly stronger among men than women and among medication users than nonusers (P for interaction < 0.05).
Conclusions:
The joint risk factor control is associated with a lower risk of incident HF in an accumulative and sex-specific manner. Optimal risk factor control may eliminate hypertension-related excess risk of HF.
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