Managing multiple risk factors can offset hypertension death risk

New research has shown that hypertensive individuals who maintain optimal control of several key health risk factors—such as blood pressure, cholesterol, and lifestyle behaviors—can significantly reduce their risk of dying prematurely. The study found that with each additional risk factor brought under control, the risk of death from cancer, cardiovascular disease, and other causes dropped substantially. Most importantly, those who achieved high levels of joint risk factor control had no greater risk of early death than people without hypertension. This suggests that a comprehensive, multi-pronged approach to managing hypertension could effectively eliminate the excess mortality risk associated with the condition.

Hypertension affects over one-third of the global adult population and is a leading contributor to early death from cardiovascular and other chronic diseases. While treatments for high blood pressure are widely available, many patients still face elevated health risks due to poor management of other contributing factors, such as obesity, high cholesterol, diabetes, and sedentary lifestyles. Past studies have examined how individual risk factors affect mortality, but few have looked at the cumulative effect of controlling multiple risks simultaneously. Based on these challenges, there is a pressing need to investigate whether managing a broader range of health risks can reduce or eliminate premature mortality among individuals with hypertension.

The study (DOI: 10.1093/pcmedi/pbaf006), published on March 19, 2025, in Precision Clinical Medicine, was conducted by researchers from Tulane University, Harvard T.H. Chan School of Public Health, and Central South University. Led by Dr. Jian Zhou and Professor Lu Qi, the research analyzed data from nearly 71,000 hypertensive participants in the UK Biobank. By examining eight modifiable risk factors, the team sought to determine whether better overall health management could offset the heightened risk of premature death associated with hypertension.

The researchers evaluated eight modifiable risk factors: blood pressure, body mass index, waist circumference, LDL cholesterol, glycated hemoglobin, albuminuria, smoking status, and physical activity. Participants were grouped based on how many of these factors they successfully controlled. Over a 13.7-year median follow-up, those with more controlled risk factors had significantly lower risks of premature death. Specifically, controlling all eight factors reduced all-cause premature mortality by 40%, cancer-related deaths by 39%, cardiovascular deaths by 53%, and other deaths by 29%. Moreover, hypertensive participants with at least four controlled risk factors had no greater risk of early death than their non-hypertensive counterparts. These findings emphasize the importance of a holistic approach: rather than focusing on blood pressure alone, managing multiple health behaviors and conditions synergistically can produce profound benefits. Notably, only 7.3% of participants managed to control seven or more risk factors, highlighting the gap in current hypertension care.

“Our study provides compelling evidence that effective joint management of health risks can neutralize the elevated mortality risks typically associated with hypertension,” said Prof. Lu Qi, corresponding author of the study. “This reinforces the need for more comprehensive clinical strategies that go beyond blood pressure control. Addressing multiple risk factors simultaneously may offer the best chance of reducing early death among hypertensive individuals.”

The findings support a shift in hypertension treatment toward multi-factorial prevention strategies. Clinical guidelines and health policies should encourage integrated care that addresses weight, blood sugar, cholesterol, kidney function, smoking, and exercise in addition to blood pressure. This approach could be especially impactful for aging populations and those with existing comorbidities. Public health efforts should also focus on education and resources that help patients achieve and maintain these risk factor targets. Future studies are needed to determine how best to implement such strategies across diverse populations and healthcare systems.

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References

DOI

10.1093/pcmedi/pbaf006

Original Source URL

https://doi.org/10.1093/pcmedi/pbaf006

Funding Information

The study was supported by grants from the National Heart, Lung, and Blood Institute (Grant Nos. HL071981, HL034594, HL126024), the National Institute of Diabetes and Digestive and Kidney Diseases (Grant Nos. DK115679, DK091718, DK100383, DK078616), and the National Institute of General Medical Sciences (Grant Nos. 2P20GM109036-06A1, Sub-Project ID 7233).

About Precision Clinical Medicine

Precision Clinical Medicine (PCM) commits itself to the combination of precision medical research and clinical application. PCM is an international, peer-reviewed, open-access journal that publishes original research articles, reviews, clinical trials, methodologies, perspectives in the field of precision medicine in a timely manner. By doing so, the journal aims to provide new theories, methods, and evidence for disease diagnosis, treatment, prevention and prognosis, so as to establish a communication platform for clinicians and researchers that will impact practice of medicine. The journal covers all aspects of precision medicine, which uses novel means of diagnosis, treatment and prevention tailored to the needs of a patient or a sub-group of patients based on the specific genetic, phenotypic, or psychosocial characteristics. Clinical conditions include cancer, infectious disease, inherited diseases, complex diseases, rare diseases, etc. The journal is now indexed in ESCI, Scopus, PubMed Central, etc., with an impact factor of 5.1 (JCR2023, Q1).