Intensive Blood Pressure Strategy on Cardiovascular Diseases in Patients With Metabolic Syndrome: Post Hoc Analysis of a Clinical Trial.

Abstract

Background: Blood pressure (BP) management in patients with metabolic syndrome is complex, and optimal targets remain debated. The CRHCP (China Rural Hypertension Control Project) trial demonstrated that intensive BP control reduces cardiovascular events. This secondary analysis assessed its efficacy in patients with hypertension and metabolic syndrome.

Methods and results: This a post hoc analysis of a cluster randomized trial (NCT03527719) across 3 Chinese provinces; 18 076 hypertensive patients with metabolic syndrome were followed up for 3 years. Intervention groups received multifaceted BP management by nonphysician health care professionals aiming for <130/80 mm Hg BP under physician supervision. The primary outcome of major adverse cardiovascular events included stroke, myocardial infarction, heart failure, and death from cardiovascular causes, during a 3-year follow-up. A total of 18 076 participants (median [range] age, 63 [54-72] years; 13 056 [72.2%] women) were enrolled in 2 clusters and were adjudicated for the primary outcome (control, 9337; intervention, 8739). At the end of the 3-year follow-up, the mean systolic/diastolic BP was 126.3/73.0 mm Hg in the intervention group versus 147.3/82.0 mm Hg in the usual care group. Compared with the usual care group, the intervention group had a lower rate of major adverse cardiovascular events (1.58% versus 2.42% per year; hazard ratio [HR], 0.65 [95% CI, 0.57-0.74]; P<0.001), as well as stroke (HR, 0.68 [95% CI, 0.55-0.83]; P=0.015), myocardial infarction (HR, 0.70 [95% CI, 0.51-0.97]; P=0.034), death from cardiovascular causes (HR, 0.67 [95% CI, 0.47-0.96]; P=0.029), and death from all causes (HR, 0.82 [95% CI, 0.71-0.94]; P=0.005).

Conclusions: Intensive BP control (<130/80 mm Hg) by trained nonphysician community health care professionals effectively reduces cardiovascular events in patients with hypertension and metabolic syndrome.

Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03527719.