Hypertension (HTN) is the worldwide leading risk factor for cardiovascular morbidity and mortality. As a modifiable risk factor, epidemiological measures derived from cohort studies are important to influence policymakers. OBJECTIVE: To determine the population attributable risk (PAR) for cardiovascular disease associated with hypertension.
We included 1244 subjects (mean age 52.3 y, 51% females), who participated in Hortega 13 years Follow-Up Study. HTN was defined as a blood pressure greater than or equal to 140/90 mmHg for systolic and diastolic blood pressure or the use of antihypertensive medication. We used Cox proportional hazard analysis adjusted for traditional CVD risk factors to determine the association of HTN with incident CVD cases. The primary endpoint was incidence of fatal and non-fatal CV events. Due to the presence of confounding factors, the PAR was calculated as pd*(HR-1)/HR and 95% confidence interval was calculated using Bonferroni inequality method. Hazard Ratio (HR) estimates and HTN prevalence among cases (pd) were used to calculate sex-specific PARs for heart failure (HF), coronary heart disease (CHD) and stroke.
In our population, overall prevalence of hypertension was 34.7% (n = 211) and 34.1% (n = 217) for men and women, respectively. The HR for all CVD and the PAR associated with HTN was 1.89 (95% CI 1.63, 2.18) and 33.1 (95% CI 22.1, 43.8) respectively in men and 1.71 (95% CI 1.4, 2.09) and 33.8 (95% CI 19.4, 47) in women. The HR for CHD plus stroke and PAR associated with HTN was 1.7 (95% CI 1.42, 2.02) and 27.3 (95% CI 14.7, 40.6) in men and 1.91 (95% CI 1.48, 2.46) and 38.3 (95% CI 19.4, 54.6) in women. The HR for HF and PAR associated with HTN was 3.2 (95% CI 2.11, 4.83) and 57.4 (95% CI 31.3, 75) in men and 3.97 (95% CI 2.4, 6.56) and 69.4 (95% CI 41.6, 83.5) in women.
In our population, approximately 33% of incident CVD is attributable to hypertension. This study emphasizes the role of hypertension as agent in different cardiovascular diseases, with a burden of up to 70% in women with heart failure.
1Area of Cardiometabolic and Renal Risk, Biomedical Research Institute Hospital Clinic of Valencia (INCLIVA), Valencia, Spain
2Department of Environmental Health Sciences, Johns Hopkins Medical Institutions, Baltimore, USA
3Department of Internal Medicine, University Hospital Rio Hortega, Valladolid, Spain
4CIBER 03/06 Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III, Madrid, Spain