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Association of baseline serum cholesterol with benefits of intensive blood pressure control
Xiaoqi Wang1, Yingqing Feng2, Li Yang3
1Department of Cardiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100037, China.
Insights
Intensive systolic blood pressure control benefits cardiovascular outcomes in hypertensive patients. However, baseline cholesterol levels like LDL-C and non-HDL-C did not influence the effectiveness of this intensive blood pressure management strategy.
Area of Science:
- Cardiology
- Hypertension Management
- Lipid Metabolism
Background:
- Intensive systolic blood pressure (SBP) control demonstrated improved outcomes in the STEP trial.
- The influence of baseline serum lipid parameters on the benefits of intensive SBP control remained unclear.
Purpose of the Study:
- To investigate whether baseline low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol (non-HDL-C) concentrations modify the effects of intensive SBP control.
- To analyze the interaction between SBP intervention and baseline lipid levels on cardiovascular disease events.
Main Methods:
- A post hoc analysis of 8283 participants from the randomized controlled STEP trial.
- Comparison of intensive (SBP target 110 to <130 mmHg) versus standard (SBP target 130 to <150 mmHg) SBP control.
- Examination of differences in primary composite cardiovascular disease events based on baseline LDL-C and non-HDL-C levels.
Main Results:
- Baseline LDL-C and non-HDL-C showed a J-shaped association with the primary outcome, irrespective of SBP intervention.
- No significant interaction was found between the intensive SBP intervention and baseline LDL-C (P=0.80) or non-HDL-C (P=0.95) levels.
- Subgroup analyses indicated potential benefits in the highest tertiles of LDL-C and non-HDL-C, but overall interaction P-values were not significant (0.49 and 0.47, respectively).
Conclusions:
- Elevated baseline serum LDL-C and non-HDL-C concentrations are linked to a higher risk of cardiovascular events.
- The study found no evidence that baseline lipid levels alter the cardiovascular benefits of intensive SBP control in elderly hypertensive patients.
Background:
Intensive systolic blood pressure (SBP) control improved outcomes in the Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients (STEP) trial. Whether baseline serum lipid parameters influence the benefits of intensive SBP control is unclear.
Methods:
The STEP trial was a randomized controlled trial that compared the effects of intensive (SBP target of 110 to <130 mmHg) and standard (SBP target of 130 to <150 mmHg) SBP control in Chinese patients aged 60 to 80 years with hypertension. The primary outcome was a composite of cardiovascular disease events. A total of 8283 participants from the STEP study were included in this post hoc analysis to examine whether the effects of the SBP intervention differed by baseline low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol (non-HDL-C) concentrations.
Results:
Regardless of the randomized SBP intervention, baseline LDL-C and non-HDL-C concentrations had a J-shaped association with the hazard of the primary outcome. However, the effects of the intensive SBP intervention on the primary outcome were not influenced by baseline LDL-C level ( P for interaction = 0.80) and non-HDL-C level ( P for interaction = 0.95). Adjusted subgroup analysis using tertiles in LDL-C1 (hazard ratio [HR], 0.77; 95% confidence interval [CI], 0.52-1.13; P = 0.18), LDL-C2 (HR, 0.81; 95% CI, 0.55-1.20; P = 0.29), and LDL-C3 (HR, 0.68; 95% CI, 0.47-0.98; P = 0.04) was provided, with an interaction P value of 0.49. Similar results were showed in non-HDL-C1 (HR, 0.87; 95% CI, 0.59-1.29; P = 0.49), non-HDL-C2 (HR, 0.70; 95% CI, 0.48-1.04; P = 0.08), and non-HDL-C3 (HR, 0.67; 95% CI, 0.47-0.95; P = 0.03), with an interaction P -value of 0.47.
Conclusion:
High baseline serum LDL-C and non-HDL-C concentrations were associated with increased risk of primary cardiovascular disease outcome, but there was no evidence that the benefit of the intensive SBP control differed by baseline LDL-C and non-HDL-C concentrations.
Clinical Trial Registration:
ClinicalTrials.gov, NCT03015311.
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