Metabolic health and cardiovascular outcomes in treated hypertension: a secondary analysis of SPRINT

Metabolic abnormalities frequently coexist with hypertension and independently contribute to cardiovascular disease (CVD) risk. Whether metabolic dysfunction predicts incident CVD events and/or modifies the efficacy of intensive blood pressure control in primary prevention remains uncertain.

Data from Systolic Blood Pressure Intervention Trial participants without baseline CVD or diabetes were analyzed. Metabolic health was classified based on triglycerides ≥ 150 mg/dL, high-density lipoprotein cholesterol < 40 mg/dL in men or < 50 mg/dL in women, fasting glucose ≥ 100 mg/dL, and body mass index ≥ 30 kg/m². Participants with ≤ 1 abnormality were classified as metabolically healthy (MH) and those with ≥ 2 as metabolically unhealthy (MUH). Cox proportional hazards models assessed the association of metabolic health status with outcomes and tested for effect modification by treatment arm. The primary outcome was a composite of myocardial infarction, acute coronary syndrome, stroke, heart failure, and cardiovascular death.

A total of 7,299 participants (mean age, 67.5 years; 37.9% female) were included, of whom 2,852 (39.1%) were classified as MUH. Over a median follow-up of 3.2 years, 440 primary outcome events occurred. The incidence of primary outcome events was higher in the MUH compared with the MH group (6.4% vs. 5.8%). After multivariable adjustment, MUH participants had a significantly higher risk of the primary outcome compared with MH participants (hazard ratio, 1.27; 95% confidence interval, 1.03-1.57; P = 0.024).

Among hypertensive adults free of diabetes and CVD, MUH status was associated with higher cardiovascular risk; however, intensive systolic blood pressure lowering was protective across levels of metabolic burden.