Cardiovascular Metabolic Center, State Key Laboratory of Cardiovascular Diseases, Fu Wai Hospital, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
J Hypertens. 2022 Sep 1;40(9):1713-1721. doi: 10.1097/HJH.0000000000003204.
Hypertension is a known risk factor for cardiovascular disease; however, its impact on clinical outcomes in patients with heterozygous familial hypercholesterolemia (HeFH) is unclear. Hence, we aimed to investigate the effects of hypertension on severity of coronary artery atherosclerosis and cardiovascular outcomes in patients with HeFH.
A total of 480 patients with clinical or molecular diagnosis of definite or probable familial hypercholesterolemia according to Dutch Lipid Clinic Network criteria (DLCN score ≥6) were included in the study. They were divided into the two groups according to their blood pressure status: hypertension group and normotension group. The severity of coronary stenosis was assessed by a number of diseased vessels, Gensini, Syntax, and Jeopardy scores. All individuals were followed up for cardiovascular events (CVEs) and cox proportion hazard models were used to evaluate the association of hypertension with cardiovascular outcomes.
Patients with hypertension had more severe coronary stenosis and a higher incidence of CVEs compared with the ones with normotension (log-rank P < 0.001). After multivariable adjustment, there was a 2.1-fold increased risk of CVEs among patients with hypertension compared with patients with normotension (adjusted hazard ratio 2.06, 95% confidential interval 1.17-3.65, P < 0.01). Hypertension control status was also associated with CVEs even after adjustment of multiple variables. However, no combined effect on increased cardiovascular risks was detected in this HeFH cohort.
In patients with HeFH, hypertension is an independent risk factor for cardiovascular events. Moreover, blood pressure control status in patients with hypertension is associated with the worse outcomes.
高血压是心血管疾病的已知危险因素；然而，其对杂合子家族性高胆固醇血症（HeFH）患者临床结局的影响尚不清楚。因此，我们旨在研究高血压对 HeFH 患者冠状动脉粥样硬化严重程度和心血管结局的影响。
共纳入 480 例符合荷兰脂质诊所网络标准（DLCN 评分≥6）的明确或可能家族性高胆固醇血症的临床或分子诊断患者。根据血压状况将他们分为两组：高血压组和正常血压组。冠状动脉狭窄严重程度通过病变血管数量、Gensini、Syntax 和 Jeopardy 评分来评估。所有患者均进行心血管事件（CVE）随访，并使用 Cox 比例风险模型评估高血压与心血管结局的相关性。
与正常血压患者相比，高血压患者的冠状动脉狭窄更严重，CVE 发生率更高（对数秩 P<0.001）。多变量调整后，高血压患者的 CVE 风险比正常血压患者增加 2.1 倍（调整后的危险比 2.06，95%置信区间 1.17-3.65，P<0.01）。即使在调整多个变量后，高血压控制状况也与 CVE 相关。然而，在该 HeFH 队列中未发现联合作用增加心血管风险。
在 HeFH 患者中，高血压是心血管事件的独立危险因素。此外，高血压患者的血压控制状况与较差的结局相关。
