Combination of treatment intensity score and interankle diastolic blood pressure is associated with cardiovascular prognosis among adults with controlled hypertension who have pre-existing cardiovascular disease

BACKGROUND: Despite adequate blood pressure control, many hypertensive patients remain at risk of cardiocerebral events. This study investigated the relationship between antihypertensive treatment intensity score (TIS) and interankle diastolic blood pressure difference (dIAND), and their utility in risk stratification. METHODS: We analyzed 368 patients with well-controlled hypertension (24-hour ambulatory blood pressure monitoring ≤ 130/80 mmHg), and pre-existing cardiovascular disease. Patients were stratified by median TIS (0.625) into low (TIS1) and high (TIS2) intensity groups. dIAND was calculated as the absolute difference in diastolic pressure between ankles. Patients were followed for 3 years for adverse cardiocerebral events. RESULTS: During follow-up (median 36 months), 73 major events were documented. The high TIS group exhibited significantly higher event rates (25.8 vs. 14.6%, log-rank P = 0.021), and remained an independent predictor after multivariable adjustment adjusted hazard ratio: 1.92, 95% confidence interval (CI): 1.07-3.45, P = 0.027. A modest correlation was observed between TIS and dIAND ( r = 0.26, P < 0.001). Patients with dIAND ≥15 mmHg had higher event rates (35.0 vs. 18.0%; P = 0.015); this association was attenuated in multivariable models. Notably, the combination of high TIS and elevated dIAND identified a subgroup with a 3.22-fold increased risk (adjusted hazard ratio: 3.22, 95% CI: 1.51-6.85, P = 0.002) compared with the reference group (TIS ≤ 0.625 and dIAND < 15 mmHg). CONCLUSION: TIS independently predicts cardiocerebral risk and correlates with dIAND. The combined assessment may refine risk stratification in controlled hypertension, offering a practical approach to identify high-risk patients requiring intensified management.