‘Residual risk’ concern for treated Japanese hypertension patients

By Eleanor McDermid, Senior medwireNews Reporter

Physicians should be alert to other sources of cardiovascular risk in patients with hypertension, even if they are receiving optimal antihypertensive treatment, say Japanese researchers.

The EPOCH-JAPAN (Evidence for Cardiovascular Prevention From Observational Cohorts in Japan) research group conducted a participant-level meta-analysis involving 39,705 Japanese patients from six cohorts.

They found that, overall, participants receiving treatment for hypertension had a 1.50-fold increased risk of cardiovascular mortality relative to untreated participants, and significant risk increases of 1.53-, 1.39- and 1.48-fold for coronary heart disease, heart failure and stroke, respectively.

This was a particular concern for participants younger than 60 years; the increased risk relative to untreated participants was significantly larger in this age group than among older patients for all outcomes except heart failure.

The findings “do not indicate that antihypertensive therapy increases the risk” for cardiovascular outcomes, caution lead researcher Kei Asayama (University of Leuven, Belgium) and colleagues. They note that “besides the greater severity of hypertension, treatment implies other cardiovascular risk factors, including undetectable residual confounding factors in addition to the classical risk factors”.

Indeed, among untreated patients, cardiovascular risk over a median 10 years of follow-up rose significantly in line with their blood pressure category (from optimal to grade 3 hypertension), most particularly for total cardiovascular mortality and stroke. There were similar trends among treated participants.

Overall, the effect of increasing blood pressure category on cardiovascular risk was significantly greater among participants younger than 60 years than it was in older participants. This was particularly striking for untreated participants, being significant for all outcomes bar coronary heart disease.

Conversely, among treated participants, the interaction was only significant for coronary heart disease.

In addition, the effect of increasing blood pressure among untreated participants was greater for overweight than normal-weight participants.

Writing in Hypertension, the team concludes that “more attention should be paid to the residual cardiovascular risks in treated patients with hypertension.”

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