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Degree of Risk Factor Control and Incident Cardiovascular Diseases in Patients With Hypertension
Minghao Kou1, Xuan Wang1, Hao Ma1
1Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA.
Insights
Controlling multiple risk factors significantly lowers cardiovascular disease (CVD) risk in hypertension patients. Achieving optimal control can eliminate the excess CVD risk associated with high blood pressure.
Area of Science:
- Cardiology
- Public Health
- Preventive Medicine
Background:
- Hypertension significantly increases cardiovascular disease (CVD) risk.
- Managing multiple risk factors is crucial for cardiovascular health.
Purpose of the Study:
- To determine if combined control of multiple risk factors reduces the elevated CVD risk in hypertensive individuals.
- To assess the impact of comprehensive risk factor management on CVD outcomes.
Main Methods:
- Utilized UK Biobank data from 75,293 hypertensive patients and 256,619 controls.
- Assessed seven risk factors: blood pressure, BMI, LDL cholesterol, HbA1c, albuminuria, smoking, and physical activity.
- Employed Cox proportional hazards models for outcome analysis.
Main Results:
- Each additional controlled risk factor reduced CVD risk by 14-24%.
- Patients with 6+ controlled factors had significantly lower risks of CVD (HR 0.49), coronary heart disease (HR 0.51), stroke (HR 0.48), and CVD mortality (HR 0.34).
- High-level risk factor control eliminated or reversed the excess CVD risk in hypertensive patients compared to controls.
Conclusions:
- Joint risk factor control is strongly associated with reduced CVD risk.
- Aggressive management of multiple risk factors can substantially mitigate the heightened CVD risk in hypertension.
Objective:
To investigate whether joint risk factor control could reduce the excess risk of cardiovascular disease (CVD) in patients with hypertension.
Patients And Methods:
A total of 75,293 patients with diagnosed hypertension from the UK Biobank study were included, matched with 256,619 nonhypertensive controls, and followed up until May 31, 2021. Seven risk factors were measured to define joint risk factor control, including blood pressure, body mass index, low-density lipoprotein cholesterol, hemoglobin A1c, albuminuria, smoking, and physical activity.
Results:
Among hypertensive patients, 14% to 24% lower risks of CVD outcomes were associated with each additional risk factor control. In the Cox proportional hazards models, adjusted hazard ratios for patients with 6 or more risk factor controls compared with patients having 2 or less risk factor controls were 0.49 (95% CI, 0.45 to 0.55) for CVD, 0.51 (95% CI, 0.45 to 0.57) for coronary heart disease, 0.48 (95% CI, 0.38 to 0.60) for stroke, and 0.34 (95% CI, 0.26 to 0.44) for CVD mortality. The excess risks of CVD outcomes in patients with hypertension were diminished to nonsignificant or even lower compared with controls if achieving 6 or more risk factor controls. Men experienced stronger protective associations of joint risk factor control on risks of CVD than women (P<.001 for interaction).
Conclusion:
The joint risk factor control is associated with lower risks of CVD, and a high degree of risk factor control may considerably attenuate the excess risk of CVD among patients with hypertension.
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