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Degree of joint risk factor control and premature mortality in hypertensive participants
Jian Zhou1,2,3,4, Minghao Kou2, Rui Tang2
1Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha 410011, China.
Insights
Controlling multiple risk factors significantly lowers premature death risk in hypertensive individuals. Optimal control of six or more factors may eliminate hypertension
Area of Science:
- Cardiovascular Health
- Public Health
- Epidemiology
Background:
- Hypertension is a major risk factor for premature mortality.
- Excess mortality risk associated with hypertension requires investigation into mitigation strategies.
Purpose of the Study:
- To determine if combined control of major cardiovascular risk factors can reduce or eliminate the excess premature mortality risk in hypertensive individuals.
Main Methods:
- A large cohort study (UK Biobank) involving 70,898 hypertensive and 224,069 matched non-hypertensive participants followed from 2006-2022.
- Evaluation of joint risk factor control based on blood pressure, BMI, waist circumference, LDL cholesterol, HbA1c, albuminuria, smoking, and physical activity.
- Cox proportional hazards models were employed to analyze the association between risk factor control and premature mortality.
Main Results:
- Each additional controlled risk factor was linked to a significant reduction in premature mortality risk (all-cause, cancer, CVD, other).
- Optimal control (≥6 factors) was associated with a 55% lower risk of all-cause mortality and up to 67% lower risk of CVD mortality.
- Hypertensive individuals achieving optimal control of key risk factors showed no excess mortality risk compared to non-hypertensive controls.
Conclusions:
- Joint control of cardiovascular risk factors demonstrates a dose-response relationship with reduced premature mortality in hypertensive patients.
- Achieving optimal control of multiple risk factors may effectively eliminate the excess mortality risk attributable to hypertension.
Objective:
To investigate whether the excess premature mortality risk related to hypertension could be reduced or eliminated through joint risk factor control.
Methods:
A total of 70 898 hypertensive participants and 224 069 matched non-hypertensive participants without cancer or cardiovascular disease (CVD) at baseline were included and followed from 2006 to 2022. The degree of joint risk factor control was evaluated based on the major cardiovascular risk factors, including blood pressure, body mass index, waist circumference, low-density lipoprotein cholesterol, glycated haemoglobin, albuminuria, smoking, and physical activity. Cox proportional hazards models were used to investigate the relationship between degree of risk factor control and premature mortality.
Results:
Each additional risk factor control was associated with a 15%, 12%, 24%, and 11% lower risk of premature all-cause mortality, premature cancer mortality, premature CVD mortality, and premature other mortality, respectively. Optimal risk factor control (≥6 risk factors) was associated with a 55% [hazard ratio (HR): 0.45, 95% confidence interval (CI): 0.40-0.51], 50% (HR: 0.50, 95% CI: 0.41-0.60), 67% (HR: 0.33, 95% CI: 0.26-0.42), and 50% (HR: 0.50, 95% CI: 0.40-0.62) lower risk of premature all-cause mortality, premature cancer mortality, premature CVD mortality, and premature other mortality, respectively. Hypertensive participants with 3, 2, 4, and 2 or more controlled risk factors showed no excess risk of premature all-cause mortality, premature cancer mortality, premature CVD mortality, and premature other mortality, respectively, compared to matched non-hypertensive participants.
Conclusions:
In this cohort study of UK Biobank participants, degree of joint risk factor control shows gradient inverse association with risk of premature mortality in hypertensive participants; optimal risk factor control may eliminate hypertension-related excess risk of premature mortality.
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