Association between HDL‐C and intensive blood pressure control in patients with hypertension: A post‐hoc analysis of SPRINT

Abstract

AbstractPrevious studies in patients with hypertension have demonstrated that there is a U‐shaped association between HDL‐C (high‐density lipoprotein cholesterol) and the risk of cardiovascular events in male patients with hypertension. However, to the best of our knowledge, the relationship between HDL‐C and intensive blood pressure control in specific cardiovascular events has never been investigated. To fill this knowledge gap, the authors analyzed the relationship between HDL‐C levels and cardiovascular events in hypertensive patients within the Systolic Blood Pressure Intervention Trial (SPRINT). The SPRINT evaluated the impact of intensive blood pressure control (systolic blood pressure < 120 mm Hg) versus standard blood pressure control (systolic blood pressure < 140 mm Hg). The Cox proportional risk regression was used to investigate the association between different HDL‐C status and clinical outcomes. Additional stratified analyzes were performed to evaluate the robustness of sex difference. A total of 9323 participants (6016 [64.53%] males and 3307 [35.47%] females) with hypertension from the SPRINT research were included in the analysis. The median follow‐up period was 3.26 years. Our population was divided into five groups based on the HDL‐C plasma levels: HDL‐C < 30 mg/dL, HDL‐C between 30 and 40 mg/dL, HDL‐C between 40 and 60 mg/dL, HDL‐C between 60 and 80 mg/dL and HDL‐C > 80 mg/dL. Sensitivity analyzes showed that in the SPRINT, women in the HDL‐C high population had a higher risk of mortality from all causes than men. In this cohort study, results suggest that patients with HDL‐C levels higher than 80 mg/dL had lower risk of SPRINT primary outcome, cardiovascular death, and stroke, but this study tested association, not causation. HDL‐C levels were associated with composite cardiovascular outcomes in male but not female patients. Our results demonstrated that in patients with hypertension, the association between HDL‐C and risk of cardiovascular events is L‐shaped.