Abstract
Objective: To investigate whether the excess premature mortality risk related to hypertension could be reduced or eliminated through joint risk factor control.
Methods: A total of 70 898 hypertensive participants and 224 069 matched non-hypertensive participants without cancer or cardiovascular disease (CVD) at baseline were included and followed from 2006 to 2022. The degree of joint risk factor control was evaluated based on the major cardiovascular risk factors, including blood pressure, body mass index, waist circumference, low-density lipoprotein cholesterol, glycated haemoglobin, albuminuria, smoking, and physical activity. Cox proportional hazards models were used to investigate the relationship between degree of risk factor control and premature mortality.
Results: Each additional risk factor control was associated with a 15%, 12%, 24%, and 11% lower risk of premature all-cause mortality, premature cancer mortality, premature CVD mortality, and premature other mortality, respectively. Optimal risk factor control (≥6 risk factors) was associated with a 55% [hazard ratio (HR): 0.45, 95% confidence interval (CI): 0.40-0.51], 50% (HR: 0.50, 95% CI: 0.41-0.60), 67% (HR: 0.33, 95% CI: 0.26-0.42), and 50% (HR: 0.50, 95% CI: 0.40-0.62) lower risk of premature all-cause mortality, premature cancer mortality, premature CVD mortality, and premature other mortality, respectively. Hypertensive participants with 3, 2, 4, and 2 or more controlled risk factors showed no excess risk of premature all-cause mortality, premature cancer mortality, premature CVD mortality, and premature other mortality, respectively, compared to matched non-hypertensive participants.
Conclusions: In this cohort study of UK Biobank participants, degree of joint risk factor control shows gradient inverse association with risk of premature mortality in hypertensive participants; optimal risk factor control may eliminate hypertension-related excess risk of premature mortality.