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Objective: The relationship between level of baseline risk factor control and cardiovascular outcomes in hypertensive patients with blood pressure intervention is not well understood. It is unclear whether the level of baseline risk factor control is persuasively associated with cardiovascular outcomes in hypertensive patients with blood pressure lowering strategy. Design and method: We performed a post hoc analysis of the Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients (STEP) trial. 8337 participants with complete demographics and clinical data were involved in the analysis and analyzed for seven risk factors (BMI, low-density lipoprotein cholesterol, fast blood glucose, smoking, alcohol consumption, physical activity, and renal function). The primary outcome was a composite of cardiovascular events and death from any causes. Cox proportional hazards models were used to calculate hazard ratio and estimate association between risk factor control and cardiovascular outcomes. Results: A total of 8337 participants were involved in the analysis and the mean follow-up period of 3.19±0.66 years. Patients were categorized according to numbers of risk factors control: more than(or including) 6 risk factor control, 4 risk factor control, 5 risk factor control, and less than(or including) 3 risk factor control. Adjusted hazard ratio for patients in group with most risk factor control were1.95 (95% confidence interval CI: 1.37-2.77) compared with controls. In this analysis, protective effects of multiple risk factor control were not modified by systolic blood pressure (SBP) intervention (P for interaction=0.71). Conclusions: A stepwise association was observed between decreasing number of risk factor control and increasing risk of cardiovascular outcomes and all-cause mortality in hypertensive patients. Comprehensive risk factor control strategies are needed to reduce the risk of cardiovascular diseases and mortality.
Zhuang et al. (Wed,) studied this question.