Individuals with newly defined high BP categories carry high burden of modifiable risk factors
There appears to be a high burden of potentially modifiable risk factors among individuals within newly defined categories of hypertension (elevated blood pressure [BP] and stage 1 hypertension), according to a recent study. Such burden shows a progressive increase along the BP categories and represents potential targets for nonpharmacologic intervention.
During the study period, the prevalence of certain modifiable risk factors decreased. However, the prevalence of low fibre intake, suboptimal physical activity, abdominal obesity and binge drinking remained high during the last combined survey cycle (2011 to 2014). [Am J Med 2018;131:1349-1358.e5]
Overall, there were dose–response relationships between modifiable risk factors and high BP categories. Low fibre intake, suboptimal physical activity, high non–high-density lipoprotein (HDL) cholesterol and abdominal obesity constituted the most common type of risk factor clustering, with its prevalence rising gradually from 9.5 percent (95 percent CI, 8.8–10.3 percent) in the normal BP group to 16.5 percent (14.8–18.3 percent) in the stage 2 hypertension group (p<0.001 for trend).
A stepwise increase was observed in the prevalence of four or more modifiable risk factors per participant, ranging from 28.5 percent in the normal BP group to 48.0 percent in the stage 2 hypertension group (p<0.001 for trend).
“The 2017 ACC/AHA guidelines defined new categories of BP and enlarged the population considered potential candidates for monitoring and treatment,” researchers said. [JAMA 2017;318:2083-2084; Ann Intern Med 2018;168:359-360]
“The vast majority of these newly classified patients are recommended for nonpharmacologic interventions intended not only to reduce the need of antihypertensive therapy, but to decrease the overall burden of cardiovascular disease,” they added. [Am J Hypertens 2018;31:133-135; J Am Coll Cardiol 2018;71:e127-e248]
Findings of the current study did show a high burden of potentially modifiable risk factors among patients in these categories, which generally demonstrated dose–response relationships across the categories of high BP.
Previous studies have shown BP-lowering effects of many nonpharmacologic interventions, including weight loss, healthy diet and increased physical activity. Certain balanced dietary interventions, such as Mediterranean diet, can also improve overall reduce BP and improve lipid profile. [J Am Coll Cardiol 2014;63:1230-1238; Ann Intern Med 2018;168:110-120; Hypertension 2012;60:333-338]
“Similar to the current study, observational studies have tied alcohol consumption, especially binge drinking, to hypertension; therefore, moderation of alcohol intake is recommended in patients in the high BP categories,” researchers said. [Hypertension 1999;33:79-82; PLoS One 2013;8:e65856]
The present study analysed data from the 1999–2014 National Health and Nutrition Examination Survey (n=37,448). Potentially modifiable risk factors were as follows: abdominal obesity, high non-HDL cholesterol, secondhand smoking, binge drinking, suboptimal physical activity and low-fibre diet.
“The current study has several limitations... The recordings of BP represent 1-day measurements as opposed to average measurement from several visits as recommended by 2017 ACC/AHA guidelines. Despite the rigorous collection of dietary data, 24-hour dietary recalls are typically prone to nondifferential misclassification; hence, the associations between dietary intake and BP are subject to underestimation,” researchers said. [Circulation 2018;137:237-246]