Metabolic health and cardiovascular outcomes in treated hypertension: a secondary analysis of SPRINT

Background: Metabolic abnormalities frequently coexist with hypertension and independently contribute to cardiovascular disease (CVD) risk.Whether metabolic dysfunction predicts incident CVD events and/or modifies the efficacy of intensive blood pressure control in primary prevention remains uncertain.Methods: Data from Systolic Blood Pressure Intervention Trial participants without baseline CVD or diabetes were analyzed.Metabolic health was classified based on triglycerides ≥ 150 mg/dL, high-density lipoprotein cholesterol < 40 mg/dL in men or < 50 mg/dL in women, fasting glucose ≥ 100 mg/dL, and body mass index ≥ 30 kg/m 2 .Participants with ≤ 1 abnormality were classified as metabolically healthy (MH) and those with ≥ 2 as metabolically unhealthy (MUH).Cox proportional hazards models assessed the association of metabolic health status with outcomes and tested for effect modification by treatment arm.The primary outcome was a composite of myocardial infarction, acute coronary syndrome, stroke, heart failure, and cardiovascular death.Results: A total of 7,299 participants (mean age, 67.5 years; 37.9% female) were included, of whom 2,852 (39.1%) were classified as MUH.Over a median follow-up of 3.2 years, 440 primary outcome events occurred.The incidence of primary outcome events was higher in the MUH compared with the MH group (6.4% vs. 5.8%).After multivariable adjustment, MUH participants had a significantly higher risk of the primary outcome compared with MH participants (hazard ratio, 1.27; 95% confidence interval, 1.03-1.57;P = 0.024).Conclusions: Among hypertensive adults free of diabetes and CVD, MUH status was associated with higher cardiovascular risk; however, intensive systolic blood pressure lowering was protective across levels of metabolic burden.