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Influence of multiple risk factor control level on cardiovascular outcomes in hypertensive patients
Xinyi Peng1, Miaomiao Zhuang1, Qirui Song1
1Hypertension Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease of China, National Center for Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishi Rd. 167, Xicheng District, Beijing 100037, China.
Insights
Controlling more cardiovascular risk factors in hypertensive patients significantly lowers their risk of cardiovascular events and death. Comprehensive risk factor management is crucial for reducing cardiovascular disease risk.
Area of Science:
- Cardiology
- Hypertension Management
- Preventive Medicine
Background:
- The impact of baseline risk factor control on cardiovascular outcomes in hypertensive patients undergoing blood pressure interventions remains unclear.
- The association between baseline risk factor control and cardiovascular outcomes in hypertensive patients using blood pressure-lowering strategies needs further investigation.
Purpose of the Study:
- To investigate the relationship between the level of baseline risk factor control and cardiovascular outcomes in hypertensive patients.
- To determine if baseline risk factor control is associated with cardiovascular outcomes in hypertensive patients receiving blood pressure-lowering therapy.
Main Methods:
- Analysis of data from the Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients (STEP) trial.
- Exclusion of participants lacking complete baseline risk factor data.
- Utilized Cox proportional hazard models to assess the association between risk factor control levels (≥6, 5, 4, ≤3) and cardiovascular outcomes (composite of cardiovascular events and all-cause mortality).
Main Results:
- Analysis included 8337 participants with a median follow-up of 3.19 years.
- Each additional uncontrolled risk factor increased cardiovascular risk by 24% (HR 1.24, 95% CI 1.11-1.37).
- Patients with ≤3 controlled risk factors had a 95% higher cardiovascular risk compared to those with optimal control (HR 1.95, 95% CI 1.37-2.77).
Conclusions:
- A clear, stepwise association exists between cardiovascular risk and the number of controlled risk factors in hypertensive patients.
- Intensified modification of multiple risk factors reduces cardiovascular risk, independent of antihypertensive treatment intensity.
- Comprehensive risk factor control strategies are essential for mitigating cardiovascular disease risk in hypertensive individuals.
Aims:
The relationship between the level of baseline risk factor control and cardiovascular outcomes in hypertensive patients with blood pressure interventions is not well understood. It is also unclear whether the level of baseline risk factor control is persuasively associated with cardiovascular outcomes in hypertensive patients with a blood pressure lowering strategy.
Method And Results:
We performed an analysis of the Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients (STEP) trial. Participants without complete baseline risk factor data were excluded. The primary outcome was a composite of cardiovascular events and all-cause mortality. Cox proportional hazard models were used to calculate the hazard ratio (HR) and estimate the association between risk factor control levels (≥6, 5, 4, and ≤3) and cardiovascular outcomes. A total of 8337 participants were involved in the analysis, and the median follow-up period was 3.19 years. Each additional risk factor uncontrolled was associated with a 24% higher cardiovascular risk (HR 1.24, 95% CI 1.11-1.37). Compared with participants with optimal risk factor control, those with ≤3 factors control exhibited 95% higher cardiovascular risk (HR 1.95, 95% CI 1.37-2.77). The corresponding protective effects of multiple risk factor modification were not influenced by intensive or standard antihypertensive treatment (P for interaction = 0.71).
Conclusion:
A stepwise association was observed between cardiovascular risk and the number of risk factor control in hypertensive patients. The more risk factors were modified, the less cardiovascular risk was observed, irrespective of different blood pressure lowering strategies. Comprehensive risk factor control strategies are warranted to reduce cardiovascular disease risk in hypertensive patients.
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