Ideal Cardiovascular Health Metrics and Fatal Major Adverse Cardiovascular Events in Hypertensive Patients With Blood Pressure At or Above Target

BACKGROUND: High blood pressure (BP) is a major risk factor for cardiovascular disease (CVD) events. The ideal cardiovascular health metrics (ICVHMs) have beneficial effects on the cardiovascular system. The present study examined the association between ICVHMs and the risk of hypertension-related CVD in hypertensive patients across different BP ranges. METHODS: Analyses included 31,427 adults from the National Health and Nutrition Examination Survey 2005-2018. The BP target was < 130/80 mm Hg and ICVHMs were defined based on the 2022 American Heart Association Presidential Advisory. Fatal major adverse cardiovascular events (MACE) were the primary outcomes. Cox proportional hazards models were used to calculate the HR and 95% CI for MACE mortality. RESULTS: Among 31,427 participants, hypertensive patients with ≥ 5 ICVHMs did not appear significantly additional risk of MACE mortality compared to participants without hypertension (BP at target: HR, 1.09; 95% CI, 0.72-1.64; BP above target: HR, 0.98; 95% CI, 0.69-1.39). Compared to patients with 0-1 ICVHMs, experiencing ≥ 5 ICVHMs was associated with a lower MACE mortality risk (BP at target: HR, 0.60; 95% CI, 0.36-0.98; BP above target: HR, 0.43; 95% CI, 0.30-0.62). Among hypertensive patients, each increase in the number of ICVHMs was associated with a lower risk of MACE mortality (BP at target: HR, 0.86; 95% CI, 0.76-0.97; BP above target: HR, 0.84; 95% CI, 0.78-0.91), even in patients with high-risk factors for CVD. CONCLUSIONS: Compared to participants without hypertension, hypertensive patients with fewer ICVHMs, regardless of whether their blood pressure is well-controlled, face a significantly higher risk of MACE mortality.