Degree of joint risk factor control and premature mortality in hypertensive participants

Abstract

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.

Keywords

hypertensive participants / risk factor control / premature mortality / UK Biobank

Acknowledgements

The study was supported by grants from the National Heart, Lung, and Blood Institute (Grant Nos. HL071981, HL034594, HL126024), the National Institute of Diabetes and Digestive and Kidney Diseases (Grant Nos. DK115679, DK091718, DK100383, DK078616), and the National Institute of General Medical Sciences (Grant Nos. 2P20GM109036-06A1, Sub-Project ID 7233). The study funders/sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. This research has been conducted using the UK Biobank Resource (https://www.ukbiobank.ac.uk) under Application Number 29256.

Author contributions

Jian Zhou (Conceptualization, Data curation, Investigation, Methodology, Software, Writing - original draft, Writing - review & editing), Minghao Kou (Writing - review & editing), Rui Tang (Writing - review & editing), Xuan Wang (Writing - review & editing), Hao Ma (Writing - review & editing), Xiang Li (Writing - review & editing), Yoriko Heianza (Writing - review & editing), and Lu Qi (Conceptualization, Funding acquisition, Investigation, Writing - review & editing).

Supplementary data

Supplementary data are available at PCMEDI Journal online.

Conflict of interest

None declared.

Ethics and consent to participate

The UK Biobank study was approved by the National Health and Social Care Information Management Board and the North West Multicentre Research Ethics Committee (No. 11/NW/0382) and the Institutional Review Board of Tulane University (No. 2018-1872).

Data availability

This study was conducted using the UK Biobank Resource, approved project number 29256. The UK Biobank will make the source data available to all bona fide researchers for all types of health-related research that is in the public interest, without preferential or exclusive access for any persons. All researchers will be subject to the same application process and approval criteria as specified by UK Biobank. For more details on the access procedure, see the UK Biobank website: https://www.ukbiobank.ac.uk.

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