A recent study examined how managing eight different heart disease risk factors significantly reduced the likelihood of premature death in people with high blood pressure. It highlights the need for a broad approach to preventing or treating hypertension.
As a major cause of premature death globally, high blood pressure or hypertension is well-researched. However, most studies look at how managing a single risk factor – eating a balanced diet, for example – affects the condition.
Now, new research, a US-Chinese collaboration, has examined how managing multiple cardiovascular risk factors at the same time – things like cholesterol levels, smoking, and weight – impacts hypertension.
“Our study provides compelling evidence that effective joint management of health risks can neutralize the elevated mortality risks typically associated with hypertension,” said Professor Lu Qi, MD, PhD, the study’s corresponding author and Director of the Obesity Research Centre at Tulane University’s School of Public Health and Tropical Medicine.
Qi was joined by other researchers from New Orleans’ Tulane University, from the Harvard TH Chan School of Public Health, and from The Second Xiangya Hospital of Central South University, China. They obtained data from the UK Biobank on 70,898 adults with hypertension and 224,069 matched participants without hypertension who hadn’t been diagnosed with cancer or heart disease at baseline. All participants were followed for an average of 13-and-a-half years.
Their joint risk factor control was evaluated, based on eight modifiable cardiovascular risk factors: blood pressure, body mass index (BMI), waist circumference, low-density lipoprotein (LDL) cholesterol levels, glycated hemoglobin (HbA1c), urinary protein levels (albuminuria), smoking, and physical activity. Cox proportional hazards models were used to investigate the relationship between the control of various factors and premature death. Simply put, the Cox model compares “hazard rates” (the risk or likelihood of an event occurring) between different groups while taking into account the passage of time. It allows an estimation of how much each factor increases or decreases the hazard rate, without assuming the shape of the hazard (that is, whether the risk is constant, increasing or decreasing over time), unlike other statistical models.
The researchers found that participants who had controlled more risk factors were at significantly lower risk of premature death. In hypertensive participants with “optimal risk factors,” that is, they’d controlled at least seven of the eight risk factors studied, premature death from any cause was reduced by 40%, cancer-related premature death reduced by 39%, premature cardiovascular death by 53%, and premature deaths from “other causes” reduced by 29%. They noted, however, that participants who managed to control this number of risk factors were in the minority; only 7.3% did so. But, importantly, the researchers found that hypertensive participants who had at least four risk factors under control had no greater risk of early death than participants without high blood pressure.
They said their findings highlight the need for a broad approach to treating or preventing hypertension, which would require a shift away from focusing on one or two modifiable risk factors.
“This [study] reinforces the need for more comprehensive clinical strategies that go beyond blood pressure control,” Qi said. “Addressing multiple risk factors simultaneously may offer the best chance of reducing early death among hypertensive individuals.”
The research was published in the journal Precision Clinical Medicine.
Source: Chinese Academy of Sciences via Newswise