Effects of individual risk factors on the incidence of cardiovascular events in the treated hypertensive patients of the Hypertension Optimal Treatment Study

Alberto Zanchetti, Lennart Hansson, Björn Dahlöf, Dag Elmfeldt, Sverre Kjeldsen, Rainer Kolloch, Pierre Larochelle, Gordon T. McInnes, Jean Michel Mallion, Luis Ruilope, Hans Wedel

Research output: Contribution to journalArticle

Abstract

Background The Hypertension Optimal Treatment (HOT) Study has provided information about cardiovascular events in 18 790 hypertensives, subjected to pronounced blood pressure (BP) lowering for a mean of 3.8 years. The HOT study data have subsequently been analysed after stratification of the patients according to global cardiovascular risk, and it has been found that, despite intensive blood pressure lowering in all risk strata, morbid event rates increased with increasing risk stratum. Objectives Previously analysed global risk strata were based on combinations of risk factors. The analyses presented here were intended to provide information on the relative role that the presence of each individual factor may have in increasing cardiovascular risk, despite good BP control. Methods Risk ratios (RR) for patients with and those without a risk factor were calculated with 95% confidence intervals (CI) using a Cox proportional hazard model, and adjusted for all variables except the one under examination. Results For all risk factors considered and for all types of event, RR were always greater than 1, indicating a greater risk in the presence, compared with that in the absence of each factor. The male gender was a statistically significant risk for cardiovascular (CV) events, CV and total mortality and particularly for myocardial infarction (MI); age ≥ 65 years for CV events, stroke, CV and particularly total mortality; smoking for all events analysed, but particularly for total mortality (twice higher in smokers than in non-smokers); high serum cholesterol (> 6.8 mmol/l) for CV events, MI and CV mortality; high serum creatinine (> 155 [μmol/l) for CV events, stroke, CV and total mortality; diabetes for CV events, stroke, total mortality and particularly CV mortality; and ischaemic heart disease for all events analysed. Adjusted RR were often close to or greater than 2. Conclusions Each of the risk factors considered was found to be an important cause of residual risk, despite good BP control. These findings emphasize the importance of addressing other correctable risk factors, e.g. smoking, hypercholesterolaemia and diabetes, as well as rigorous control of blood pressure, and of initiating antihypertensive therapy before cardiovascular and renal damage becomes manifest.

Original languageEnglish
Pages (from-to)1149-1159
Number of pages11
JournalJournal of Hypertension
Volume19
Issue number6
DOIs
Publication statusPublished - 2001

Fingerprint

Hypertension
Incidence
Mortality
Myocardial Infarction
Blood Pressure
Odds Ratio
Therapeutics
Smoking
Hypercholesterolemia
Serum
Proportional Hazards Models
Antihypertensive Agents
Myocardial Ischemia
Creatinine
Cholesterol
Confidence Intervals
Kidney

Keywords

  • Age
  • Antihypertensive treatment
  • Cardiovascular risk factors
  • Diabetes
  • Gender
  • HOT Study
  • Hypercreatininaemia
  • Ischaemic heart disease
  • Smoking

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology

Cite this

Effects of individual risk factors on the incidence of cardiovascular events in the treated hypertensive patients of the Hypertension Optimal Treatment Study. / Zanchetti, Alberto; Hansson, Lennart; Dahlöf, Björn; Elmfeldt, Dag; Kjeldsen, Sverre; Kolloch, Rainer; Larochelle, Pierre; McInnes, Gordon T.; Mallion, Jean Michel; Ruilope, Luis; Wedel, Hans.

In: Journal of Hypertension, Vol. 19, No. 6, 2001, p. 1149-1159.

Research output: Contribution to journalArticle

Zanchetti, A, Hansson, L, Dahlöf, B, Elmfeldt, D, Kjeldsen, S, Kolloch, R, Larochelle, P, McInnes, GT, Mallion, JM, Ruilope, L & Wedel, H 2001, 'Effects of individual risk factors on the incidence of cardiovascular events in the treated hypertensive patients of the Hypertension Optimal Treatment Study', Journal of Hypertension, vol. 19, no. 6, pp. 1149-1159. https://doi.org/10.1097/00004872-200106000-00021
Zanchetti, Alberto ; Hansson, Lennart ; Dahlöf, Björn ; Elmfeldt, Dag ; Kjeldsen, Sverre ; Kolloch, Rainer ; Larochelle, Pierre ; McInnes, Gordon T. ; Mallion, Jean Michel ; Ruilope, Luis ; Wedel, Hans. / Effects of individual risk factors on the incidence of cardiovascular events in the treated hypertensive patients of the Hypertension Optimal Treatment Study. In: Journal of Hypertension. 2001 ; Vol. 19, No. 6. pp. 1149-1159.
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abstract = "Background The Hypertension Optimal Treatment (HOT) Study has provided information about cardiovascular events in 18 790 hypertensives, subjected to pronounced blood pressure (BP) lowering for a mean of 3.8 years. The HOT study data have subsequently been analysed after stratification of the patients according to global cardiovascular risk, and it has been found that, despite intensive blood pressure lowering in all risk strata, morbid event rates increased with increasing risk stratum. Objectives Previously analysed global risk strata were based on combinations of risk factors. The analyses presented here were intended to provide information on the relative role that the presence of each individual factor may have in increasing cardiovascular risk, despite good BP control. Methods Risk ratios (RR) for patients with and those without a risk factor were calculated with 95{\%} confidence intervals (CI) using a Cox proportional hazard model, and adjusted for all variables except the one under examination. Results For all risk factors considered and for all types of event, RR were always greater than 1, indicating a greater risk in the presence, compared with that in the absence of each factor. The male gender was a statistically significant risk for cardiovascular (CV) events, CV and total mortality and particularly for myocardial infarction (MI); age ≥ 65 years for CV events, stroke, CV and particularly total mortality; smoking for all events analysed, but particularly for total mortality (twice higher in smokers than in non-smokers); high serum cholesterol (> 6.8 mmol/l) for CV events, MI and CV mortality; high serum creatinine (> 155 [μmol/l) for CV events, stroke, CV and total mortality; diabetes for CV events, stroke, total mortality and particularly CV mortality; and ischaemic heart disease for all events analysed. Adjusted RR were often close to or greater than 2. Conclusions Each of the risk factors considered was found to be an important cause of residual risk, despite good BP control. These findings emphasize the importance of addressing other correctable risk factors, e.g. smoking, hypercholesterolaemia and diabetes, as well as rigorous control of blood pressure, and of initiating antihypertensive therapy before cardiovascular and renal damage becomes manifest.",
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N2 - Background The Hypertension Optimal Treatment (HOT) Study has provided information about cardiovascular events in 18 790 hypertensives, subjected to pronounced blood pressure (BP) lowering for a mean of 3.8 years. The HOT study data have subsequently been analysed after stratification of the patients according to global cardiovascular risk, and it has been found that, despite intensive blood pressure lowering in all risk strata, morbid event rates increased with increasing risk stratum. Objectives Previously analysed global risk strata were based on combinations of risk factors. The analyses presented here were intended to provide information on the relative role that the presence of each individual factor may have in increasing cardiovascular risk, despite good BP control. Methods Risk ratios (RR) for patients with and those without a risk factor were calculated with 95% confidence intervals (CI) using a Cox proportional hazard model, and adjusted for all variables except the one under examination. Results For all risk factors considered and for all types of event, RR were always greater than 1, indicating a greater risk in the presence, compared with that in the absence of each factor. The male gender was a statistically significant risk for cardiovascular (CV) events, CV and total mortality and particularly for myocardial infarction (MI); age ≥ 65 years for CV events, stroke, CV and particularly total mortality; smoking for all events analysed, but particularly for total mortality (twice higher in smokers than in non-smokers); high serum cholesterol (> 6.8 mmol/l) for CV events, MI and CV mortality; high serum creatinine (> 155 [μmol/l) for CV events, stroke, CV and total mortality; diabetes for CV events, stroke, total mortality and particularly CV mortality; and ischaemic heart disease for all events analysed. Adjusted RR were often close to or greater than 2. Conclusions Each of the risk factors considered was found to be an important cause of residual risk, despite good BP control. These findings emphasize the importance of addressing other correctable risk factors, e.g. smoking, hypercholesterolaemia and diabetes, as well as rigorous control of blood pressure, and of initiating antihypertensive therapy before cardiovascular and renal damage becomes manifest.

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