Association of baseline serum cholesterol with benefits of intensive blood pressure control

Background:Intensive systolic blood pressure(SBP)control improved outcomes in the Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients(STEP)trial.Whether baseline serum lipid parameters influence the benefits of intensive SBP control is unclear.Methods:The STEP trial was a randomized controlled trial that compared the effects of intensive(SBP target of 110 to<130 mmHg)and standard(SBP target of 130 to<150 mmHg)SBP control in Chinese patients aged 60 to 80 years with hypertension.The primary outcome was a composite of cardiovascular disease events.A total of 8283 participants from the STEP study were included in this post hoc analysis to examine whether the effects of the SBP intervention differed by baseline low-density lipoprotein cholesterol(LDL-C)and non-high-density lipoprotein cholesterol(non-HDL-C)concentrations.Results:Regardless of the randomized SBP intervention,baseline LDL-C and non-HDL-C concentrations had a J-shaped association with the hazard of the primary outcome.However,the effects of the intensive SBP intervention on the primary outcome were not influenced by baseline LDL-C level(P for interaction=0.80)and non-HDL-C level(P for interaction=0.95).Adjusted subgroup analysis using tertiles in LDL-C1(hazard ratio[HR],0.77;95%confidence interval[CI],0.52-1.13;P=0.18),LDL-C2(HR,0.81;95%CI,0.55-1.20;P=0.29),and LDL-C3(HR,0.68;95%CI,0.47-0.98;P=0.04)was provided,with an interaction P value of 0.49.Similar results were showed in non-HDL-C1(HR,0.87;95%CI,0.59-1.29;P=0.49),non-HDL-C2(HR,0.70;95%CI,0.48-1.04;P=0.08),and non-HDL-C3(HR,0.67;95%CI,0.47-0.95;P=0.03),with an interaction P-value of 0.47.Conclusion:High baseline serum LDL-C and non-HDL-C concentrations were associated with increased risk of primary cardiovascular disease outcome,but there was no evidence that the benefit of the intensive SBP control differed by baseline LDL-C and non-HDL-C concentrations.Clinical trial registration:ClinicalTrials.gov,NCT03015311.

Severity of non-alcoholic fatty liver disease is a risk factor for developing hypertension from prehypertension

Background:There is little published evidence about the role of non-alcoholic fatty liver disease(NAFLD)in the progression from prehypertension to hypertension.This study was conducted to investigate the association of NAFLD and its severity with the risk of hypertension developing from prehypertension.Methods:The study cohort comprised 25,433 participants from the Kailuan study with prehypertension at baseline;those with excessive alcohol consumption and other liver diseases were excluded.NAFLD was diagnosed by ultrasonography and stratified as mild,moderate,or severe.Univariable and multivariable Cox proportional hazard regression was used to calculate the hazard ratios(HRs)and 95%confidence intervals(CIs)of incident hypertension according to the presence and 3 categories of severity of NAFLD.Results:During a median of 12.6 years of follow-up,10,638 participants progressed to hypertension from prehypertension.After adjusting for multiple risk factors,patients with prehypertension and NAFLD had a 15%higher risk of incident hypertension than those without NAFLD(HR=1.15,95%CI 1.10-1.21).Moreover,the severity of NAFLD was associated with the incidence of hypertension,which was higher in patients with more severe NAFLD(HR=1.15[95%CI 1.10-1.21]in the mild NAFLD group;HR=1.15[95%CI 1.07-1.24]in the moderate NAFLD group;and HR=1.20[95%CI 1.03-1.41]in the severe NAFLD group).Subgroup analysis indicated that age and baseline systolic blood pressure may modify this association.Conclusions:NAFLD is an independent risk factor for hypertension in patients with prehypertension.The risk of incident hypertension increases with the severity of NAFLD.

Considerations for Optimal Blood Pressure Target of Hypertension

Hypertension is a major risk factor for cardiovascular morbidity and mortality that has led to a huge public health burden.The optimal target of blood pressure(BP)to prevent cardiovascular complications remains unclear.Based on the results of the Systolic BP Intervention Trial(SPRINT)in 2015,the 2017 American College of Cardiology/American Heart Association guidelines for diagnosis and management of high BP in adults has changed the diagnostic threshold from 140/90 to 130/80 mmHg,and the target BP to 130/80 mmHg for nearly all hypertensive patients diagnosed using the new criteria.However,the findings from the SPRINT trial were to an extent contrasting with the results of previous large randomized controlled trials,namely Action to Control Cardiovascular Risk in Diabetes(ACCORD)and Secondary Prevention of Small Subcortical Strokes(SPS3).Besides,the 2018 European Society of Cardiology/European Society of Hypertension guidelines and the 2018 Chinese guidelines have maintained the conventional threshold and recommended target of 140/90 mmHg for most hypertensive patients.Given the special measurement of BP in the SPRINT trial and using an automated measurement system,the intensive systolic BP target of 120 mmHg provided by the SPRINT trial was not widely adopted.Most recently,the Strategy of BP Intervention in the Elderly Hypertensive Patients(STEP)trial,with a higher systolic BP target of 110 to 130 mmHg in the intensive group,confirmed the benefit and safety of intensive BP control in patients with hypertension,in accordance with the SPRINT trial.Here,the results from randomized controlled trials,meta-analyses,and other observational research studies,have been reviewed to evaluate the optimal target of BP treatment and the threshold of diagnostic criteria for hypertension.