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The role of oxidative stress in modulating mortality risk across the hypertension control cascade
Weihao Liu1, Chunyang Hou1, Hongjie Wang1
1Department of Urology, The First Hospital of Jilin University, Changchun, Jilin, China.
Insights
A higher Oxidative Balance Score (OBS) is linked to reduced mortality in hypertensive individuals, especially those with controlled blood pressure. This benefit is partly explained by reduced inflammation and better organ function.
Area of Science:
- Cardiovascular Research
- Nutritional Epidemiology
- Public Health
Background:
- Oxidative stress plays a critical role in hypertension, but its impact on mortality is not fully understood.
- The Oxidative Balance Score (OBS) quantifies dietary and lifestyle factors related to oxidative stress.
- Investigating the OBS-hypertension-mortality relationship is crucial for public health strategies.
Purpose of the Study:
- To examine the association between the Oxidative Balance Score (OBS) and all-cause and cardiovascular mortality in hypertensive U.S. adults.
- To assess how hypertension control status modifies the OBS-mortality relationship.
- To investigate the mediating roles of low-grade systemic inflammation and multi-organ function.
Main Methods:
- Analysis of 1999-2018 National Health and Nutrition Examination Survey (NHANES) data.
- Inclusion of U.S. adults with hypertension, with mortality data from the National Death Index (NDI).
- Statistical methods included Kaplan-Meier analysis, Cox models, restricted cubic splines, subgroup analyses, and mediation analysis to assess OBS, inflammation, and organ function.
Main Results:
- Higher OBS quartiles were associated with significantly lower all-cause and cardiovascular mortality.
- The protective effect of OBS on mortality was more pronounced in individuals with controlled hypertension compared to those with uncontrolled hypertension.
- Mediation analysis indicated that low-grade systemic inflammation and multi-organ function partially explained the OBS-mortality association.
Conclusions:
- A higher Oxidative Balance Score is associated with reduced mortality in hypertensive populations.
- Hypertension control status significantly influences the effectiveness of OBS in mitigating mortality risk.
- The findings highlight the importance of lifestyle and nutritional factors in managing hypertension-related mortality, with partial mediation by inflammatory and organ function markers.
Background:
The role of oxidative stress in hypertensive populations has not yet been fully elucidated. This study examines the association between the Oxidative Balance Score (OBS) and all-cause and cardiovascular mortality under different hypertension control cascade outcomes while assessing mediation by low-grade systemic inflammation and multi-organ function.
Methods:
This cohort study analyzed 1999-2018 NHANES data, with mortality outcomes from the National Death Index (NDI). It encompassed U.S. adults with hypertension. OBS consists of 20 nutrition and lifestyle factors. Low-grade systemic inflammation (NLR, SIRI) and multi-organ function (eGFR, UACR, FIB-4 index, SUA) were examined as potential mediators. Statistical analyses included Kaplan-Meier analysis, Cox models, restricted cubic splines (RCS), subgroup analyses, and mediation analysis.
Results:
Participants in the highest OBS quartile (Q4) exhibited lower all-cause mortality (HR: 0.72; 95% CI: 0.59-0.88; P = 0.001) and cardiovascular mortality (HR: 0.64; 95% CI: 0.42-0.99; P = 0.044) than Q1 after adjusting for confounders. The OBS-mortality association varied by hypertension control status, with greater risk reduction in controlled hypertension (Q4 vs. Q1, HR: 0.43; 95% CI: 0.27-0.69; P < 0.001) than in uncontrolled hypertension (Q4 vs. Q1, HR: 0.82; 95% CI: 0.66-0.87; P < 0.001). A significant interaction was observed between OBS and hypertension control status (P for interaction = 0.017 and 0.026), corroborated by sensitivity analyses (P for interaction = 0.025). Sensitivity analyses confirmed Nutrition-OBS reduced all-cause mortality by 31%, and Lifestyle-OBS decreased cardiovascular mortality by 45%. RCS analyses verified the inverse OBS-mortality relationship, with mediation analysis revealing partial mediation through low-grade systemic inflammation and multi-organ function.
Conclusions:
A higher OBS is associated with lower all-cause and cardiovascular mortality under different hypertension control cascade outcomes, with a more pronounced effect in controlled hypertension. This relationship is partially mediated through systemic inflammation and multi-organ function.
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