Nelson Julianne Theresa, Liu Longjian
Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104, United States.
World J Cardiol. 2023 May 26;15(5):262-272. doi: 10.4330/wjc.v15.i5.262.
A limited number of studies have been conducted to test the magnitudes of the association between apparent treatment resistant hypertension (aTRH) and risk of cardiovascular disease (CVD).
To investigate the association between aTRH and risk of CVD and examine whether sex and age modify this association.
We applied an observational analysis study design using data from the United States Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). ALLHAT recruited participants ( = 25516) from 625 primary care settings throughout the United States, Canada, Puerto Rico, and United States Virgin Islands, aged 55 and older with hypertension and at least one additional risk factor for heart disease. aTRH was assessed from the year 2 visit. CVD event was defined as one of the following from the year 2 follow-up visit: Fatal or non-fatal myocardial infarction, coronary revascularization, angina, stroke, heart failure, or peripheral artery disease. Cox proportional hazards regression was used to examine the effect of aTRH on CVD risk. Potential modifications of sex and age on this association were examined on the multiplicative scale by interaction term and additive scale by joint effects and relative excess risk for interaction.
Of the total study participants ( = 25516), 5030 experienced a CVD event during a mean of 4.7 years follow-up. aTRH was associated with a 30% increase in risk of CVD compared to non-aTRH [hazards ratio (HR) = 1.3, 95%CI: 1.19-1.42]. Sex and age modified this relationship on both multiplicative and additive scales independently. Stratified by sex, aTRH was associated with a 64% increase in risk of CVD (HR = 1.64, 95%CI: 1.43-1.88) in women, and a 13% increase in risk of CVD (HR = 1.13, 95%CI: 1.01-1.27) in men. Stratified by age, aTRH had a stronger impact on the risk of CVD in participants aged < 65 (HR = 1.53, 95%CI: 1.32-1.77) than it did in those aged ≥ 65 (HR = 1.18, 95%CI: 1.05-1.32). Significant two-way interactions of sex and aTRH, and age and aTRH on risk of CVD were observed ( < 0.05). The observed joint effect of aTRH and ages ≥ 65 years (HR = 1.85, 95%CI: 1.22-2.48) in males was less than what was expected for both additive and multiplicative models (HR = 4.10, 95%CI: 3.63-4.57 and 4.88, 95%CI: 3.66-6.31), although three-way interaction of sex, age, and aTRH on the risk of CVD and coronary heart disease did not reach a statistical significance ( > 0.05).
aTRH was significantly associated with an increased risk of CVD and this association was modified by both sex and age. Further studies are warranted to test these mechanisms.
已开展的研究数量有限，用于检验貌似难治性高血压（aTRH）与心血管疾病（CVD）风险之间关联的强度。
研究aTRH与CVD风险之间的关联，并检验性别和年龄是否会改变这种关联。
我们采用观察性分析研究设计，使用来自美国预防心脏病发作的抗高血压和降脂治疗试验（ALLHAT）的数据。ALLHAT从美国、加拿大、波多黎各和美属维尔京群岛的625个初级保健机构招募了参与者（n = 25516），年龄在55岁及以上，患有高血压且至少有一项其他心脏病风险因素。aTRH从第2年的访视中进行评估。CVD事件定义为第2年随访访视中的以下情况之一：致命或非致命性心肌梗死、冠状动脉血运重建、心绞痛、中风、心力衰竭或外周动脉疾病。采用Cox比例风险回归来检验aTRH对CVD风险的影响。通过交互项在乘法尺度上以及通过联合效应和交互作用的相对超额风险在加法尺度上检验性别和年龄对这种关联的潜在影响。
在总共25516名研究参与者中，5030人在平均4.7年的随访期间发生了CVD事件。与非aTRH相比，aTRH与CVD风险增加30%相关[风险比（HR）= 1.3，95%置信区间（CI）：1.19 - 1.42]。性别和年龄在乘法和加法尺度上均独立改变了这种关系。按性别分层，aTRH与女性CVD风险增加64%相关（HR = 1.64，95%CI：1.43 - 1.88），与男性CVD风险增加13%相关（HR = 1.13，95%CI：1.01 - 1.27）。按年龄分层，aTRH对年龄<65岁参与者的CVD风险影响（HR = 1.53，95%CI：1.32 - 1.77）比对年龄≥65岁参与者的影响（HR = 1.18，95%CI：1.05 - 1.32）更强。观察到性别与aTRH以及年龄与aTRH对CVD风险存在显著的双向交互作用（P < 0.05）。在男性中，观察到aTRH与年龄≥65岁的联合效应（HR = 1.85，95%CI：1.22 - 2.48）小于加法模型和乘法模型预期的值（HR = 4.10，95%CI：3.63 -
4.57和4.88，95%CI：3.66 - 6.31），尽管性别、年龄和aTRH对CVD和冠心病风险的三向交互作用未达到统计学显著性（P > 0.05）。
aTRH与CVD风险增加显著相关，且这种关联受到性别和年龄的影响。有必要进一步研究以检验这些机制。
