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Author Spotlight: Assessing the Cardiovascular Profile of Patients with Metabolic Syndrome
Published on: September 27, 2024
Intensive Blood Pressure Strategy on Cardiovascular Diseases in Patients With Metabolic Syndrome: Post Hoc Analysis
Guozhe Sun1, Xiaofan Guo1, Guangxiao Li2
1Department of Cardiology The First Hospital of China Medical University Shenyang China.
Insights
Intensive blood pressure control (<130/80 mmHg) significantly reduced major cardiovascular events in patients with hypertension and metabolic syndrome. This strategy, implemented by community health professionals, proved effective over a 3-year period.
Area of Science:
- Cardiology
- Public Health
- Metabolic Disorders
Background:
- Management of hypertension in patients with metabolic syndrome presents unique challenges.
- Optimal blood pressure (BP) targets for this population are still under investigation.
- The China Rural Hypertension Control Project (CRHCP) trial previously showed intensive BP control benefits.
Purpose of the Study:
- To assess the efficacy of intensive BP control in patients with hypertension and metabolic syndrome.
- This secondary analysis evaluated cardiovascular event reduction in this specific patient group.
Main Methods:
- A post hoc analysis of a cluster randomized trial involving 18,076 hypertensive patients with metabolic syndrome.
- Participants were followed for 3 years across 3 Chinese provinces.
- Intervention groups received multifaceted BP management aiming for <130/80 mmHg by nonphysician healthcare professionals.
Main Results:
- The intervention group achieved a mean BP of 126.3/73.0 mmHg, compared to 147.3/82.0 mmHg in the usual care group.
- Major adverse cardiovascular events were reduced by 35% in the intervention group (HR, 0.65; P<0.001).
- Significant reductions were observed for stroke, myocardial infarction, and cardiovascular/all-cause mortality.
Conclusions:
- Intensive BP control (<130/80 mmHg) is effective in reducing cardiovascular events in patients with hypertension and metabolic syndrome.
- Trained nonphysician community health professionals can successfully implement this intensive BP management strategy.
- This approach offers a viable strategy for improving cardiovascular outcomes in at-risk populations.
Background:
Blood pressure (BP) management in patients with metabolic syndrome is complex, and optimal targets remain debated. The CRHCP (China Rural Hypertension Control Project) trial demonstrated that intensive BP control reduces cardiovascular events. This secondary analysis assessed its efficacy in patients with hypertension and metabolic syndrome.
Methods And Results:
This a post hoc analysis of a cluster randomized trial (NCT03527719) across 3 Chinese provinces; 18 076 hypertensive patients with metabolic syndrome were followed up for 3 years. Intervention groups received multifaceted BP management by nonphysician health care professionals aiming for <130/80 mm Hg BP under physician supervision. The primary outcome of major adverse cardiovascular events included stroke, myocardial infarction, heart failure, and death from cardiovascular causes, during a 3-year follow-up. A total of 18 076 participants (median [range] age, 63 [54-72] years; 13 056 [72.2%] women) were enrolled in 2 clusters and were adjudicated for the primary outcome (control, 9337; intervention, 8739). At the end of the 3-year follow-up, the mean systolic/diastolic BP was 126.3/73.0 mm Hg in the intervention group versus 147.3/82.0 mm Hg in the usual care group. Compared with the usual care group, the intervention group had a lower rate of major adverse cardiovascular events (1.58% versus 2.42% per year; hazard ratio [HR], 0.65 [95% CI, 0.57-0.74]; P<0.001), as well as stroke (HR, 0.68 [95% CI, 0.55-0.83]; P=0.015), myocardial infarction (HR, 0.70 [95% CI, 0.51-0.97]; P=0.034), death from cardiovascular causes (HR, 0.67 [95% CI, 0.47-0.96]; P=0.029), and death from all causes (HR, 0.82 [95% CI, 0.71-0.94]; P=0.005).
Conclusions:
Intensive BP control (<130/80 mm Hg) by trained nonphysician community health care professionals effectively reduces cardiovascular events in patients with hypertension and metabolic syndrome.
Registration:
URL: https://www.clinicaltrials.gov; Unique identifier: NCT03527719.
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