Demonstration of antihypertensive beneficial role in population settings is difficult. Relationships of antihypertensive treatment, blood pressure control, risk factors and cardiovascular outcomes were investigated in the Gubbio study.
Among 2248 cardiovascular disease-free men and women aged 35–74 years, individuals were classified as nonhypertensive, controlled hypertensive, uncontrolled hypertensive and untreated hypertensive based on cut-off limits of 140/90 mmHg for SBP/DBP and/or the use of antihypertensive drugs. End-point was the first major coronary, cerebrovascular or peripheral hard event [cardiovascular disease (CVD)] during a 15-year average. Univariate and multivariate analyses were run.
Nonhypertensive individuals were about 10 years younger and had lower risk factor levels than the other categories. The relative risk (and 95% confidence interval) for CVD versus nonhypertension was 1.78 (1.02–3.10) for controlled hypertension, 3.76 (2.79–5.06) for uncontrolled hypertension and 3.30 (2.59–4.21) for untreated hypertension (UTH). After adjusting for covariates, such as sex, age, achieved blood pressure and other risk factors, the CVD risk of controlled hypertension was practically equal to that of nonhypertension, and remained unchanged even when blood pressure was excluded from the model (1.03, 0.58–1.82). The higher cardiovascular risk of uncontrolled hypertension and UTH was reduced after adjusting for covariates, but remained significantly higher than in nonhypertension, with no significant differences between uncontrolled hypertension and UTH.
A higher level of baseline risk is not due to treatment per se, the risk being similar in uncontrolled hypertension and UTH. Adjustment for risk factors reduces the risk only in controlled hypertension, suggesting that there may be structural alterations scarcely reversible by antihypertensive treatment.
aAssociazione per la Ricerca Cardiologica, Via Arco di Parma
bDepartment of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, Sapienza University of Rome, Viale del Policlinico, Rome
cCentre of Preventive Medicine, Gubbio
dDepartment of Medicine and Surgery, University of Salerno, Salerno
eDepartment of Clinical Medicine and Surgery, Federico II University, Naples
fIstituto Auxologico Italiano and University of Milan, Milan, Italy
Correspondence to Paolo E. Puddu, MD, PhD, FESC, FACC, Laboratory of Biotechnologies Applied to Cardiovascular Medicine, Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, Sapienza University of Rome, Viale del Policlinico, 155, Rome 00161, Italy. Tel: +39 06 49972659; fax: +39 06 4453891; e-mail: email@example.com
Abbreviations: CI, confidence interval; CKD, chronic kidney disease; CVD, cardiovascular disease; eGFR, estimated glomerular filtration rate; HDL, high-density lipoprotein; LDL, low-density lipoprotein; UTH, untreated hypertension
Received 16 July, 2014
Revised 14 November, 2014
Accepted 14 November, 2014