Sadeghi Masoumeh, Shokrani Foroushani Reza, Sabouri Erfan, Talaei Mohammad, Sarrafzadegan Nizal, Oveisgharan Shahram, Sheikhbahaei Erfan, Roohafza Hamidreza
Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
Int J Hypertens. 2025 May 20;2025:3743691. doi: 10.1155/ijhy/3743691. eCollection 2025.
Hypertension is the most prominent established risk factor for adverse cardiovascular outcomes. The influence of hypertension in combination with other major cardiovascular disease risk factors (CVD-RFs) on mortality and cardiovascular events has not been fully comprehended yet due to their overlapping and interconnected nature. This study was conducted to evaluate the impact of CVD-RFs quantity on the occurrence of cardiovascular events, CVD-related mortality, and all-cause mortality rates in hypertensive patients. In a secondary analysis of the Isfahan Cohort Study, demographic information, anthropometric measures, and laboratory results of participants were extracted. During the 15 years of follow-up, all-cause mortality, CVD-related mortality, and the occurrence of nonfatal cardiovascular events were assessed by separate panels of experts. Data analysis was performed using Cox proportional hazard models to estimate adjusted hazard ratios (HRs) among normotensive and hypertensive individuals in two subgroups of 3 CVD-RFs and≥ 3 CVD-RFs. Among 5432 eligible participants, hypertensive patients ( = 1509) had 1.3, 2, and 1.4 times higher HRs for all-cause mortality, CVD-related mortality, and nonfatal cardiovascular events, respectively. Compared to the normotensives, HRs for the mentioned outcomes were 1.2, 1.7, and 1.3 for hypertensive participants with < 3 CVD-RFs and 1.7, 3.4, and 2.3 for hypertensive participants with≥ 3 CVD-RFs. These rises were shown to be highly significant ( = 0.003, = 0.001) for CVD-related mortality and nonfatal cardiovascular events in hypertensives with ≥ 3 CVD-RFs compared with hypertensives with < 3 CVD-RFs. Hypertension alone or combined with other CVD-RFs increases the chance of all-cause mortality, CVD-related mortality, and nonfatal cardiovascular events. Rises in the quantity of other CVD-RFs (specifically to≥ 3) result in highly significant increases in fatal and nonfatal cardiovascular events. Therefore, to reduce mortality and cardiovascular events, hypertensive patients should be thoroughly evaluated for coexisting CVD-RFs, aiming to limit the synergistic effects of multiple CVD-RFs by properly managing modifiable RFs.
高血压是已确定的导致不良心血管结局的最主要风险因素。由于高血压与其他主要心血管疾病风险因素（CVD-RFs）相互重叠且相互关联，它们对死亡率和心血管事件的综合影响尚未得到充分理解。本研究旨在评估CVD-RFs数量对高血压患者心血管事件发生、CVD相关死亡率和全因死亡率的影响。在对伊斯法罕队列研究的二次分析中，提取了参与者的人口统计学信息、人体测量指标和实验室检查结果。在15年的随访期间，由不同的专家小组评估全因死亡率、CVD相关死亡率和非致命性心血管事件的发生情况。使用Cox比例风险模型进行数据分析，以估计血压正常和高血压个体在3个CVD-RFs和≥3个CVD-RFs这两个亚组中的调整风险比（HRs）。在5432名符合条件的参与者中，高血压患者（n = 1509）的全因死亡率、CVD相关死亡率和非致命性心血管事件的HRs分别高出1.3倍、2倍和1.4倍。与血压正常者相比，CVD-RFs < 3的高血压参与者上述结局的HRs分别为1.2、1.7和1.3，而CVD-RFs≥3的高血压参与者的HRs分别为1.7、3.4和2.3。与CVD-RFs < 3的高血压患者相比，CVD-RFs≥3的高血压患者的CVD相关死亡率和非致命性心血管事件的这些升高具有高度显著性（P = 0.003，P = 0.001）。单独的高血压或与其他CVD-RFs合并都会增加全因死亡率、CVD相关死亡率和非致命性心血管事件的发生几率。其他CVD-RFs数量的增加（特别是≥3个）会导致致命和非致命性心血管事件显著增加。因此，为降低死亡率和心血管事件，应对高血压患者并存的CVD-RFs进行全面评估，旨在通过适当管理可改变的风险因素来限制多种CVD-RFs的协同作用。
