Association of baseline serum cholesterol with benefits of intensive blood pressure control

BACKGROUND Intensive systolic blood pressure (SBP) control improved outcomes in the Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients (STEP) trial. Whether baseline serum lipid parameters influence the benefits of intensive SBP control is unclear. METHODS The STEP trial was a randomized controlled trial that compared the effects of intensive (SBP target of 110 to <130 mmHg) and standard (SBP target of 130 to <150 mmHg) SBP control in Chinese patients aged 60 to 80 years with hypertension. The primary outcome was a composite of cardiovascular disease events. A total of 8283 participants from the STEP study were included in this post hoc analysis to examine whether the effects of the SBP intervention differed by baseline low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol (non-HDL-C) concentrations. RESULTS Regardless of the randomized SBP intervention, baseline LDL-C and non-HDL-C concentrations had a J-shaped association with the hazard of the primary outcome. However, the effects of the intensive SBP intervention on the primary outcome were not influenced by baseline LDL-C level (P for interaction = 0.80) and non-HDL-C level (P for interaction = 0.95). Adjusted subgroup analysis using tertiles in LDL-C1 (hazard ratio [HR], 0.77; 95% confidence interval [CI], 0.52-1.13; P = 0.18), LDL-C2 (HR, 0.81; 95% CI, 0.55-1.20; P = 0.29), and LDL-C3 (HR, 0.68; 95% CI, 0.47-0.98; P = 0.04) was provided, with an interaction P value of 0.49. Similar results were showed in non-HDL-C1 (HR, 0.87; 95% CI, 0.59-1.29; P = 0.49), non-HDL-C2 (HR, 0.70; 95% CI, 0.48-1.04; P = 0.08), and non-HDL-C3 (HR, 0.67; 95% CI, 0.47-0.95; P = 0.03), with an interaction P-value of 0.47. CONCLUSION High baseline serum LDL-C and non-HDL-C concentrations were associated with increased risk of primary cardiovascular disease outcome, but there was no evidence that the benefit of the intensive SBP control differed by baseline LDL-C and non-HDL-C concentrations. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT03015311.

[1]  Weili Zhang,et al.  Trial of Intensive Blood-Pressure Control in Older Patients with Hypertension. , 2021, The New England journal of medicine.

[2]  Chao-lei Chen,et al.  The U-Shaped Association of Non-High-Density Lipoprotein Cholesterol Levels With All-Cause and Cardiovascular Mortality Among Patients With Hypertension , 2021, Frontiers in Cardiovascular Medicine.

[3]  J. Williamson,et al.  Final Report of a Trial of Intensive versus Standard Blood-Pressure Control. , 2021, The New England journal of medicine.

[4]  Shouling Wu,et al.  Total cholesterol, arterial stiffness, and systolic blood pressure: a mediation analysis , 2021, Scientific Reports.

[5]  Weili Zhang,et al.  Strategy of blood pressure intervention in the elderly hypertensive patients (STEP): Rational, design, and baseline characteristics for the main trial. , 2019, Contemporary clinical trials.

[6]  A. Peters,et al.  Application of non-HDL cholesterol for population-based cardiovascular risk stratification: results from the Multinational Cardiovascular Risk Consortium , 2019, The Lancet.

[7]  H. Soran,et al.  Non-HDL cholesterol should not generally replace LDL cholesterol in the management of hyperlipidaemia. , 2019, Current opinion in lipidology.

[8]  X. Su,et al.  Evidence for changing lipid management strategy to focus on non-high density lipoprotein cholesterol , 2019, Lipids in Health and Disease.

[9]  Hong Yuan,et al.  Associations of non-high-density lipoprotein cholesterol, triglycerides and the total cholesterol/HDL-c ratio with arterial stiffness independent of low-density lipoprotein cholesterol in a Chinese population , 2019, Hypertension Research.

[10]  X. Hou,et al.  Serum lipid and lipoprotein levels of middle-aged and elderly Chinese men and women in Shandong Province , 2019, Lipids in Health and Disease.

[11]  Xiping Xu,et al.  Association Between Lipid Profiles and Arterial Stiffness in Chinese Patients With Hypertension: Insights From the CSPPT , 2019, Angiology.

[12]  V. Gil-Guillén,et al.  Comparison Between Non–High-Density Lipoprotein Cholesterol and Low-Density Lipoprotein Cholesterol to Estimate Cardiovascular Risk Using a Multivariate Model , 2018, The Journal of cardiovascular nursing.

[13]  Zuo Chen,et al.  Status of Hypertension in China: Results From the China Hypertension Survey, 2012–2015 , 2018, Circulation.

[14]  Mohammad Hossein Khosravi,et al.  Global, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the Global Burden of Disease Study 2016 , 2017, Lancet.

[15]  F. Rodríguez‐Artalejo,et al.  The association between blood pressure and lipid levels in Europe: European Study on Cardiovascular Risk Prevention and Management in Usual Daily Practice , 2016, Journal of hypertension.

[16]  G. Francis,et al.  2016 Canadian Cardiovascular Society Guidelines for the Management of Dyslipidemia for the Prevention of Cardiovascular Disease in the Adult. , 2016, The Canadian journal of cardiology.

[17]  Lenore J Launer,et al.  Intensive vs Standard Blood Pressure Control and Cardiovascular Disease Outcomes in Adults Aged ≥75 Years: A Randomized Clinical Trial. , 2016, JAMA.

[18]  Jackson T. Wright,et al.  A Randomized Trial of Intensive versus Standard Blood-Pressure Control. , 2016, The New England journal of medicine.

[19]  P. Hopkins,et al.  Statin Use and Adrenal Aldosterone Production in Hypertensive and Diabetic Subjects , 2015, Circulation.

[20]  A. Parini,et al.  Serum LDL cholesterol levels and new onset of arterial hypertension: an 8‐year follow‐up , 2014, European journal of clinical investigation.

[21]  C. Borghi,et al.  Rate of control of LDL cholesterol and incident hypertension requiring antihypertensive treatment in hypercholesterolemic subjects in daily clinical practice , 2014, Annals of medicine.

[22]  B. Egan,et al.  Blood Pressure and Cholesterol Control in Hypertensive Hypercholesterolemic Patients: National Health and Nutrition Examination Surveys 1988–2010 , 2013, Circulation.

[23]  F. Messerli,et al.  Antihypertensive Effects of Statins: A Meta‐Analysis of Prospective Controlled Studies , 2013, Journal of clinical hypertension.

[24]  Robert Dufour,et al.  2012 update of the Canadian Cardiovascular Society guidelines for the diagnosis and treatment of dyslipidemia for the prevention of cardiovascular disease in the adult. , 2013, The Canadian journal of cardiology.

[25]  A. Zwinderman,et al.  Association of LDL cholesterol, non-HDL cholesterol, and apolipoprotein B levels with risk of cardiovascular events among patients treated with statins: a meta-analysis. , 2012, JAMA.

[26]  J. Kastelein,et al.  Lipid parameters for measuring risk of cardiovascular disease , 2011, Nature Reviews Cardiology.

[27]  D. Swinkels,et al.  Apolipoprotein B, non‐HDL cholesterol and LDL cholesterol for identifying individuals at increased cardiovascular risk , 2010, Journal of internal medicine.

[28]  F. Contreras,et al.  Determination of Non-HDL Cholesterol in Diabetic and Hypertensive Patients , 2010, American journal of therapeutics.

[29]  J. Danesh,et al.  Major lipids, apolipoproteins, and risk of vascular disease. , 2009, JAMA.

[30]  R. D'Agostino,et al.  Increased Small Low-Density Lipoprotein Particle Number: A Prominent Feature of the Metabolic Syndrome in the Framingham Heart Study , 2005, Circulation.

[31]  J. Fruchart,et al.  Atherogenic Lipoprotein Particles in Atherosclerosis , 2004, Circulation.