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Blood pressure status, trajectories and cardiovascular disease: the CoLaus|PsyCoLaus prospective study
Yaniv Chocron1, Markos Rousakis2, Peter Vollenweider3
1Internal Medicine, CHUV, Lausanne, Switzerland yaniv.chocron@chuv.ch.
Insights
Adequate blood pressure control did not reduce cardiovascular disease events or mortality in a 14-year study. Further research is needed to understand factors influencing outcomes in treated hypertension patients.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- High blood pressure (BP) is a significant risk factor for cardiovascular disease (CVD).
- The impact of adequate BP treatment on reducing CVD risk in the general population remains under-assessed.
Purpose of the Study:
- To assess the association between blood pressure control and cardiovascular disease (CVD) events and mortality.
- To evaluate outcomes in individuals with normal BP, untreated high BP, and treated (controlled and uncontrolled) high BP.
Main Methods:
- A population-based prospective study in Lausanne, Switzerland (2003-2021).
- Categorization of 5341 participants into normal BP, untreated high BP, treated and uncontrolled BP, and treated and controlled BP groups.
- Assessment of total and CVD mortality and CVD events over a median 14-year follow-up.
Main Results:
- Relative to normal BP, participants with untreated, treated and uncontrolled, and treated and controlled high BP showed increased risks for total CVD events.
- Higher hazard ratios for CVD mortality were observed in treated and uncontrolled and treated and controlled high BP groups compared to normal BP.
- Total mortality risk was elevated across all high BP categories compared to normal BP.
Conclusions:
- Long-term blood pressure control was not associated with a reduction in CVD events or mortality.
- Findings suggest a need for further studies to identify factors influencing CVD and mortality in treated hypertension patients.
- This research highlights potential gaps in understanding the management of hypertension for optimal cardiovascular outcomes.
Background:
High blood pressure (BP) is a major risk factor for cardiovascular disease (CVD). Adequate treatment of high BP should reduce the risk of CVD, but this association has seldom been assessed in a general population setting.
Methods:
Population-based prospective study conducted in Lausanne, Switzerland, with a follow-up between 2003 and 2021. Participants were categorised as normal BP, untreated high BP, treated and uncontrolled BP and treated and controlled BP. Total and CVD mortality as well as any CVD event were assessed.
Results:
5341 participants (65% normal, 17.4% untreated, 8.8% treated and uncontrolled and 8.8% treated and controlled) were included. After a median follow-up of 14 years (IQR: 11-15), 575 CVD events occurred. Relative to participants with normal BP, multivariable-adjusted HRs (and 95% CI) for total CVD were 1.38 (1.11 to 1.72) for untreated, 1.35 (1.04 to 1.76) for treated and uncontrolled and 1.50 (1.15 to 1.95) for treated and controlled. The corresponding HRs for CVD mortality (112 events) were 0.94 (0.52 to 1.70), 1.77 (1.00 to 3.12) and 2.52 (1.50 to 4.23), respectively. For total mortality (677 events), the HRs were 1.24 (1.01 to 1.52), 1.26 (0.99 to 1.60) and 1.27 (0.99 to 1.62), respectively. Sensitivity analysis using BP status during a 5-year period and categorising participants as always normal, always treated and uncontrolled, always treated and controlled and other led to similar findings.
Conclusion:
Over a long follow-up period of 14 years, BP control was not associated with reduction of CVD events, CVD-related or total mortality. This finding should help define further studies on factors affecting CVD and mortality in people treated for hypertension in the general population.
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