IMPACT OF RISK FACTOR QUANTITY ON CARDIOVASCULAR EVENTS IN HYPERTENSIVE PATIENTS: EVIDENCE FROM THE ISFAHAN COHORT STUDY

Objective: Hypertension is considered the most prominent established risk factor (RF) for adverse cardiovascular outcomes. The influence of hypertension in alliance with other major cardiovascular disease risk factors (CVD-RFs) (i.e., aging, sex, family history, obesity, diabetes, dyslipidemia, and smoking) on mortality and occurrence of cardiovascular accidents has not been fully comprehended yet, due to their overlapping and interconnected nature. This study was conducted to evaluate the impact of CVD-RF quantity on the occurrence of cardiovascular events, CVD-related mortality, and all-cause mortality rates in hypertensive patients.Design and method: In a secondary analysis of 6,504 subjects from the Isfahan Cohort Study, demographic information, anthropometric measures, and laboratory results of participants were extracted. Through the 15 years of follow-up, all-cause mortality, CVD-related mortality, and occurrence of non-fatal cardiovascular events were assessed biannually and confirmed by separate panels of experts blinded to participants’ RF profiles. These rates were analyzed separately using Cox proportional-hazard models to estimate adjusted hazard ratios (HRs) among normotensive and hypertensive individuals in two subgroups: hypertensive patients with <3 CVD-RFs and those with >=3 CVD-RFs. Results: Among 5432 eligible participants (mean age: 50.6 ± 11.6), hypertensive patients (n=1,509) had 1.3, 2, and 1.4 times higher HRs for all-cause mortality, CVD-related mortality, and non-fatal cardiovascular events, respectively. Compared to the normotensive group, HRs for the aforementioned 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, respectively. The indicated rises of the HRs in hypertensive participants with >=3 CVD-RFs compared with the other group were shown to be highly significant (P= 0.003, P=0.001) for CVD-related mortality and non-fatal cardiovascular events. Conclusions: Hypertension alone, or combined with other CVD-RFs, increases the chances of all-cause mortality, CVD-related mortality, and non-fatal cardiovascular events. An increase in the quantity of other CVD-RFs (specifically to >=3) results in a highly significant increase in fatal and non-fatal cardiovascular events. Therefore, to reduce mortality and CVD 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.