Key result
Maintaining $\ge$4 favorable modifiable factors in new-onset hypertension linked to ~17% lower CVD risk than normotensives.
Why the study?
It was uncertain whether optimizing modifiable factors could eliminate the excess cardiovascular disease risk associated with new-onset hypertension.
Does maintaining favorable modifiable cardiovascular health factors reduce incident cardiovascular disease in adults with new-onset hypertension?
Cohort (n=59,194)
Does maintaining favorable modifiable cardiovascular health factors reduce incident cardiovascular disease in adults with new-onset hypertension?
Effect estimate: HR 0.83 (95% CI 0.72-0.97)
Absolute Event Rate: 4.83% vs 5.77%
In adults with new-onset hypertension, maintaining four or more modifiable cardiovascular health factors at favorable levels is associated with a 10-year and lifetime CVD risk comparable to that of normotensive individuals.
May support modifiable factor optimization in new-onset hypertension; hypothesis-generating for randomized confirmation of CVD benefit.
BACKGROUND: Preventing cardiovascular disease (CVD) in adults with hypertension is essential, but it remains uncertain whether optimizing modifiable factors can eliminate the excess CVD risk associated with new-onset hypertension. METHODS: In this prospective cohort study, 29,597 adults with new-onset hypertension and no prior CVD (from 2006-2016 surveys) were each matched by age and sex to a normotensive control. Eight modifiable factors were assessed using the American Heart Association's Life's Essential 8 algorithm. We followed participants for incident CVD until December 2020, estimating 10-year and lifetime (age 25-95) CVD risks using the Fine-Gray competing risks model. RESULTS: Over a median follow-up of 9.81 years, adults with new-onset hypertension had higher 10-year (8.97% vs. 6.31%) and lifetime CVD risks (45.55% vs. 34.98%) compared to normotensive controls. After adjusting for age, sex, and other unmodifiable factors, each additional favorable factor was associated with a stepwise reduction in CVD risk (P-trend < 0.05). Hypertensive participants with four or more favorable factors had a 17% lower 10-year CVD risk (HR 0.83; 95% CI 0.72-0.97) and a similar lifetime CVD risk (HR 0.90; 95% CI 0.78-1.05) compared to normotensive controls. Notably, the protective effect was weaker among those with early-onset (before age 45) hypertension than those with later-onset (age ≥ 60) hypertension (P-interaction < 0.05). CONCLUSIONS: In adults with new-onset hypertension, maintaining four or more modifiable factors at favorable levels was associated with a CVD risk comparable to that of normotensive individuals. However, young hypertensive adults may require more aggressive interventions to mitigate CVD risk.
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Wu et al. (2025) conducted a cohort in New-onset hypertension (n=59,194). Four or more favorable modifiable factors (Life's Essential 8) vs. Normotensive controls was evaluated on 10-year incident cardiovascular disease (HR 0.83, 95% CI 0.72-0.97). In adults with new-onset hypertension, maintaining four or more modifiable factors at favorable levels was associated with a 17% lower 10-year cardiovascular disease risk (HR 0.83) compared to normotensive controls.
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