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June 19, 2026Clinical HypertensionOpen Access

Metabolically unhealthy status is linked to ~27% greater cardiovascular risk in non-diabetic hypertensive adults.

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Why the study?

Does intensive systolic blood pressure lowering reduce cardiovascular events in hypertensive adults free of diabetes and CVD across different levels of metabolic health?

Population

7,299 hypertensive adults free of diabetes and baseline cardiovascular disease from the SPRINT trial, mean…

Comparison

Intensive systolic blood pressure lowering vs Standard systolic blood pressure lowering

Design

Cohort, Randomized to intensive treatment or standard treatment, Open-label…

Follow-up

median 3.22 years

Key result

Metabolically unhealthy status was associated with a significantly higher risk of cardiovascular events (HR 1.27) compared to metabolically healthy status among hypertensive adults free of diabetes and cardiovascular disease.

Authors

PCPatrick CheonUSUttsav SandesaraSMSaeid Mirzai

Discussion

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Member takes

Overview

May support consistent CV benefit from intensive BP lowering across metabolic health; leaves open confirmation in RCTs.

Key Points

  • This research investigates how metabolic health affects cardiovascular risk in treated hypertensive individuals without diabetes or prior CVD.
  • Analyzed data from Systolic Blood Pressure Intervention Trial participants (N=7,299) without baseline CVD or diabetes.
  • Classified metabolic health based on triglycerides, HDL cholesterol, fasting glucose, and body mass index.
  • Employed Cox proportional hazards models to assess associations with cardiovascular outcomes.
  • MUH participants had a higher incidence of primary outcome events (6.4% vs. 5.8% in MH, p<0.05).
  • After adjustments, MUH participants showed a significantly increased risk of cardiovascular events (HR 1.27; 95% CI, 1.03-1.57; P=0.024).
  • Intensive blood pressure lowering was beneficial across different levels of metabolic health.

Study Design

Type

Cohort (n=7,299)

Blinding

Open-label

Randomization

Randomized

Multicenter

Yes

Structured PICO

Does intensive systolic blood pressure lowering reduce cardiovascular events in hypertensive adults free of diabetes and CVD across different levels of metabolic health?

P
Population
7,299 hypertensive adults aged 50 and older, free of diabetes and baseline cardiovascular disease, followed for a median of 3.2 years.
E
Exposure
Intensive systolic blood pressure lowering (target SBP < 120 mmHg)
C
Comparator
Standard systolic blood pressure lowering (target SBP < 140 mmHg)
O
Outcome
Composite of myocardial infarction, acute coronary syndrome, stroke, acute decompensated heart failure, or death from cardiovascular causes at a median follow-up of 3.22 years, centrally adjudicated by blinded investigatorscomposite

Main Result

Hazard Ratio: 1.27 (95% CI 1.03–1.57)

Absolute Event Rate: 6.4% vs 5.8%

p-value: p=0.024

Intensive systolic blood pressure lowering to <120 mmHg provides consistent cardiovascular protection in hypertensive adults without diabetes or baseline CVD, regardless of their underlying metabolic health status.

Limitations

  • Secondary analysis of a randomized trial not specifically designed to test effect modification by metabolic health status
  • Used a modified definition of metabolic syndrome that substituted BMI for waist circumference
  • Metabolic health was assessed at a single baseline timepoint without evaluating changes during follow-up
  • Excluded participants with baseline cardiovascular disease, limiting applicability to secondary prevention populations
  • Subgroup analyses may be underpowered to detect modest interactions
  • Trial conditions with close follow-up and frequent medication titration may not reflect routine clinical practice

Cite This Study

Cheon et al. (2026) conducted a cohort in Hypertension (n=7,299). Metabolically unhealthy (MUH) status vs. Metabolically healthy (MH) status was evaluated on Composite of myocardial infarction, acute coronary syndrome, stroke, heart failure, and cardiovascular death (HR 1.27, 95% CI 1.03-1.57, p=0.024). Metabolically unhealthy status was associated with a significantly higher risk of cardiovascular events (HR 1.27) compared to metabolically healthy status among hypertensive adults free of diabetes and cardiovascular disease.

synapsesocial.com/papers/6a35982fdd3be7785e70ecc0https://doi.org/10.5646/ch.2026.32.e33
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