INTEGRATING CARDIOVASCULAR, KIDNEY, AND METABOLIC RISK FACTORS FOR MORTALITY PREDICTION IN PATIENTS WITH ELEVATED BLOOD PRESSURE AND HYPERTENSION: EVIDENCE FROM NHANES 1999-2008

Objective: The importance of specific risk factors related to cardiovascular-kidney-metabolic (CKM) syndrome in hypertension cannot be overlooked. This study aims to explore the association between higher estimated pulse wave velocity (ePWV), higher triglyceride glucose (TyG) index, chronic kidney disease (CKD), and the long-term risk of all-cause mortality in patients with hypertension or elevated blood pressure.Design and method: This study included patients aged over 20 years with elevated blood pressure or hypertension from the NHANES database between 1999 and 2008. Higher ePWV was defined as ePWV > 10 m/s, higher TyG index as TyG index > 8.84, and CKD as estimated glomerular filtration rate < 60 mL/min/1.73 m2and/or urinary albumin-to-creatinine ratio > 30 mg/g. Patients were categorized into four groups based on the count of 0 to 3 CKM-related factors including higher ePWV, higher TyG index and CKD. Cox regression analyses were conducted to determine the association between different CKM-related factors and all-cause mortality. Results: A total of 6361 patients were included, with 26.6% having no CKM-related factors, 41.6% having one, 25.1% having two, and 6.7% having three. Over a median follow-up period of 15.42 years, the all-cause mortality was 21.1%. After adjusting for traditional risk factors, higher ePWV (HR: 1.32, 95% CI: 1.03-1.70) and CKD (HR: 2.04, 95% CI: 1.73-2.40) were independent predictors of all-cause mortality in patients with elevated blood pressure or hypertension (Table1). Kaplan-Meier curves revealed a progressive increase in all-cause mortality with the accumulation of CKM-related factors (log-rank P < 0.001) (Figure1). The risk of all-cause mortality significantly increased in patients with elevated blood pressure or hypertension who had CKM-related factors, and this risk escalated with the number of factors (one, HR: 1.55, 95% CI: 1.24-1.93; two, HR: 1.94, 95% CI: 1.50-2.52; three, HR: 2.83, 95% CI: 2.02-3.97) (Table2). Conclusions: In patients with elevated blood pressure or hypertension, higher ePWV and CKD were independent predictors of all-cause mortality. The risk of all-cause mortality increased progressively with the accumulation of CKM-related factors. A prediction model integrating CKM holds significant potential for risk stratification in patients with elevated blood pressure or hypertension.