Self-rated health and risk of incident cardiovascular events among individuals with hypertension

Author:

Kazibwe Richard1,Muhammad Ahmad Imtiaz2,Singleton Matthew J.3,Evans Joni K.4,Chevli Parag A.1,Namutebi Juliana H.5,Kazibwe Joseph6,Epiu Isabella7,German Charles8,Soliman Elsayed Z.9,Shapiro Michael D.9,Yeboah Joseph9

Affiliation:

1. Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina

2. Department of Medicine, Section on Hospital Medicine, Wisconsin College of Medicine, Milwaukee, Wisconsin

3. Department of Medicine, Section on Cardiovascular Medicine, WellSpan Health, York, Pennsylvania

4. Department of Biostatistics and Data Science, Wake Forest University School of Medicine

5. Wake Forest University, School of Graduate Studies, Winston-Salem, North Carolina, USA

6. Department of Cardiology, Sheffield Teaching Hospital, Sheffield, UK

7. Prince of Wales Clinical School, University of New South Wales Sydney, Sydney, Australia

8. Department of Medicine, Section on Cardiovascular Medicine, University of Chicago, Illinois

9. Department of Medicine, Section on Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA

Abstract

Background: The relationship between self-rated health (SRH) and cardiovascular events in individuals with hypertension, but without diabetes mellitus, is understudied. Methods: We performed a post hoc analysis of data from SPRINT (Systolic Blood Pressure Intervention Trial). SRH was categorized into excellent, very good, good and fair/poor. Using multivariable Cox regression, we estimated hazard ratios and 95% confidence intervals (CIs) for the association of SRH with both all-cause mortality and a composite of cardiovascular events (the primary outcome), which was defined to include myocardial infarction (MI), other acute coronary syndromes, stroke, acute decompensated heart failure, and cardiovascular death. Results: We included 9319 SPRINT participants (aged 67.9 ± 9 years, 35.6% women) with a median follow-up of 3.8 years. Compared with SRH of excellent, the risk [hazard ratio (95% CI)] of the primary outcome associated with very good, good, and fair/poor SRH was 1.11(0.78–1.56), 1.45 (1.03–2.05), and 1.87(1.28–2.75), respectively. Similarly, compared with SRH of excellent, the risk of all-cause mortality [hazard ratio (95% CI)] associated with very good, good, and fair/poor SRH was 1.13 (0.73–1.76), 1.72 (1.12–2.64), and 2.11 (1.32–3.38), respectively. Less favorable SRH (LF-SRH) was also associated with a higher risk of each component of the primary outcome and serious adverse events (SAE). Conclusion: Among individuals with hypertension, SRH is independently associated with the risk of incident cardiovascular events, all-cause mortality, and SAE. Our study suggest that guidelines should consider the potential significance of including SRH in the clinical history of patients with hypertension.

Publisher

Ovid Technologies (Wolters Kluwer Health)

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