Family CV history indicates intensive treatment need for hypertensive patients

By Eleanor McDermid, Senior medwireNews Reporter

A family history of premature cardiovascular disease (CVD) is a marker of increased mortality risk in patients with hypertension, report researchers.

The increased mortality risk was present despite the patients’ family histories appearing to result in earlier referral to the blood pressure (BP) clinic, compared with patients without a family history of CVD. After referral, they achieved similar reductions in BP and adherence to antihypertensive drugs.

Sandosh Padmanabhan (University of Glasgow, UK) and colleagues say their findings are “surprising” but note that factors such as early referral could still have reduced patients’ risk. “In our population, we do not have data to assess what the true risk would have been, had individuals with positive family history not been referred to the clinic.”

The patients in the study were referred to a single BP clinic in Glasgow, and included 1408 patients with a parent who developed premature CVD (before the age of 60 years) and 9379 patients without. During follow-up, with a median survival time of 29.2 years, the mortality rates for all causes, CVD causes and non-CVD causes were 20.5, 13.8 and 8.9 per 1000 person–years, respectively.

After accounting for confounders including age, gender, systolic blood pressure and baseline CVD, having a family history of premature CVD was associated with significant increases in death from all causes, CVD and ischaemic heart disease, by 12%, 20% and 30%, respectively. Family history was not associated with stroke and non-CVD deaths, however. The findings were similar in a propensity-matched analysis.

This was despite patients with premature CVD in their family being younger than other patients at presentation (45.9 vs 50.3 years), with significantly lower BP and cholesterol levels and a lower rate of kidney disease.

The researchers therefore suggest that “the presence of family history of premature CVD represents a clinically significant sustained increase in [coronary heart disease] and CVD risk across the lifespan, and the pathological processes determining this increased risk must start long before the traditional risk factors are identified and treated.”

However, they do identify areas for intervention, saying that use of lipid-lowering and antiplatelet drugs was similar in patients with and without a family history of premature CVD, and drug adherence was similar, whereas these rates should ideally be higher in patients with a family history.

“This is potentially an aspect of clinical practice to be addressed,” they write in the European Heart Journal.

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