Clinical Summary

Controlled Hypertension Linked to Residual Risks of Adverse Outcomes

Sarfaroj Khan

Takeaway

Controlled hypertension (systolic blood pressure [BP] <140 mmHg and diastolic BP <90 mmHg) was associated with an increased risk of major adverse cardiac and cerebrovascular events (MACCEs) vs normotension.
Moderate or moderate-to-vigorous physical activity was associated with a lower risk of MACCEs and mortality in individuals with controlled hypertension and even in those with normotension or uncontrolled hypertension.

Why this matters

Physicians may encourage physical activity for the general population, even for patients with controlled hypertension, not being reassured by their achieved target BP values.

Study design

This large-scale observational study included participants (age, 40-69 years) from the UK Biobank cohort (UKB, n=220,026) and the Korean National Health Insurance Service cohort (KNHIS, n=3,593,202).
161,405 (73%)/18,844 (9%)/39,777 (18%) and 3,122,890 (87%)/383,828 (11%)/86,484 (2%) individuals were included in the normotension/controlled hypertension /uncontrolled hypertension groups from the UKB and KNHIS cohorts, respectively.
Main outcomes: MACCEs in UKB (myocardial infarction [MI], cardiac death and ischaemic stroke) and KNHIS (MI, revascularisation and acute ischaemic stroke); all-cause mortality.
Funding: Korea Healthcare Technology Research & Development Project and others.

Key results

Compared with the normotensive group, the controlled hypertension group had a significantly greater risk of:
- MACCEs (UKB: adjusted HR [aHR], 1.73; 95% CI, 1.55-1.92; KNHIS: aHR, 1.46; 95% CI, 1.43-1.49); and
- all-cause mortality (UKB: aHR, 1.28; 95% CI, 1.18-1.3; KNHIS: aHR, 1.29; 95% CI, 1.26-1.32).
In the controlled hypertension group, moderate or moderate-to-vigorous physical activity was associated with a better prognosis, and no physical activity was associated with a high risk of adverse outcomes.
In the UKB cohort:
- MACCEs:
  - no moderate physical activity (aHR, 1.82; 95% CI, 1.43-2.30);
  - 1-3 days/week (aHR, 1.45; 95% CI, 1.19-1.78); and
  - 4-7 days/week (aHR, 1.46; 95% CI, 1.20-1.76).
- all-cause mortality:
  - no moderate physical activity (aHR, 1.26; 95% CI, 1.07-1.50);
  - 1-3 days/week (aHR, 0.88; 95% CI, 0.76-1.02); and
  - 4-7 days/week (aHR, 0.93; 95% CI, 0.81-1.06).
In the KNHIS cohort:
- MACCEs:
  - no moderate-to-vigorous physical activity (aHR, 1.48; 95% CI, 1.43-1.52);
  - 1-3 days/week (aHR, 1.31; 95% CI, 1.27-1.35); and
  - 4-7 days/week (aHR, 1.28; 95% CI, 1.22-1.35).
- all-cause mortality:
  - no moderate physical activity (aHR, 1.36; 95% CI, 1.31-1.41);
  - 1-3 days/week (aHR, 1.04; 95% CI, 0.99-1.08); and
  - 4-7 days/week (aHR, 1.08; 95% CI, 1.02-1.16).

Limitations

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.

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