Residual Cardiovascular Risk in Individuals on Blood Pressure–Lowering Treatment

Abstract

BackgroundHypertensive individuals on blood pressure (BP)–lowering treatment with BP in the normal or high‐normal range have higher cardiovascular risk than untreated persons with usual BP in the same range. This residual risk (relative and absolute) is not well quantified and may be attributable in part to the higher burden of subclinical disease in treated individuals.Methods and ResultsWe assigned 3024 Framingham Offspring Cohort participants to 5 categories based on systolic BP (SBP) and diastolic BP (DBP) and use of BP‐lowering treatment: (1) untreated SBP/DBP <120/80 mm Hg; (2) untreated SBP/DB ≥120/80 to <140/90 mm Hg; (3) treated SBP/DBP <140/90 mm Hg; (4) untreated SBP/DBP ≥140/90 mm Hg; and (5) treated SBP/DBP ≥140/90 mm Hg. A composite subclinical disease score was constructed, including information on left ventricular hypertrophy, systolic dysfunction, carotid ultrasound abnormality, peripheral artery disease, and microalbuminuria. The prevalence of subclinical disease rose across BP groups, as did the event rates for incident cardiovascular disease (449 events, median follow‐up of 11 years; group 1, 0.65 event per 100 person‐years; group 5, 3.20 events per 100 person‐years; P<0.0001 for trend). On multivariable adjustment, treated hypertensives in groups 3 and 5 had 50% (95% CI 13% to 99%) and 28% (95% CI −6% to 73%) higher hazards, respectively, of developing cardiovascular disease compared with their untreated counterparts with similar levels of BP (groups 1 and 2 and group 4, respectively). The increased risk of cardiovascular disease in treated hypertensives was attributable in part to greater subclinical disease burden.ConclusionsTreated hypertensives have higher subclinical cardiovascular disease burden, which partly explains their higher cardiovascular disease risk compared with untreated persons with similar BP levels.

Prevalence of Optimal Metabolic Health in American Adults: National Health and Nutrition Examination Survey 2009–2016

“…This option was consistent with the guidelines for the definition of metabolic syndrome. 1,3,4 In addition, previous studies have shown that there is residual cardiovascular disease risk in patients treated for elevated blood pressure and cholesterol [26][27][28][29] compared with adults with similar risk factor levels without pharmacologic treatment. Further, when the medication criteria were removed from the definition, prevalence of optimal metabolic health increased by only 1.2 percentage points.…”

Development of a Risk Equation for the Incidence of Coronary Artery Disease and Ischemic Stroke for Middle-Aged Japanese – Japan Public Health Center-Based Prospective Study –

“…As there is massive evidence to support the benefits of antihypertensive medication use to lower CVD risk, users of antihypertensive medication in observational studies typically are participants with more severe hypertension and with greater subclinical atherosclerosis burden. 36 In addition, the period during which antihypertensive medication was used, as well as the age at which the treatment was initiated, might have confounded the association. We did not consider medications for hyperlipidemia in the present study because the proportion of those taking these medicines was very small (1.9%) at baseline.…”

Defining Hypertension by Blood Pressure 130/80 mm Hg Leads to an Impressive Burden of Hypertension in Young and Middle‐Aged Black Adults: Follow‐Up in the CARDIA Study

“…In fully adjusted models accounting for age, sex, body mass index, systolic BP, diastolic BP, cigarette smoking, parental history of hypertension, highest level of education, physical fitness, serum uric acid, alcohol consumption, and Dietary Approaches to Stop Hypertension eating plan concordance, blacks were ≈1.5 to 2.5 times more likely to develop hypertension than their white counterparts 3. Treating hypertension does not completely abolish excess hypertension‐related risk 5. Thus, eliminating racial disparities in incident hypertension, which ultimately will lead to eliminating disparities in prevalent hypertension, is an important component of any credible plan to attain cardiovascular health equity in black and white Americans.…”