Risk-factor clustering and cardiovascular disease risk in hypertensive patients

Background: Patients with hypertension often have other major risk factors for cardiovascular disease (CVD). Little is known, however, about the extent of risk-factor clustering in these patients and its importance in CVD risk and medical-care costs. Methods: Study subjects were selected from the electronic medical records system of Kaiser Permanente Northwest, a large health maintenance organization, and included all patients aged >= 35 years with hypertension who were free of CVD in 1998. Subjects were stratified into eight risk-factor clusters based on whether or not they also had diabetes, hyperlipidemia, or a high body mass index (BMI). The risk of cardiovascular events was examined in each cluster over 6 years beginning January 1, 1999, using Kaplan-Meier methods and Cox proportional hazards models. Cumulative total medical-care costs (per patient) over 6 years also were examined. Results: A total of 57,573 patients with hypertension who were free of CVD in 1998 were identified; 56% ofsubjects also had diabetes, hyperlipidemia, or high BMI. In analyses controlling for age, sex, and smoking status, the relative risk of cardiovascular events over 6 years was highest for patients with comorbid diabetes, ranging from 2.07 (95% confidence interval, 1.86-2.30) for those with diabetes only to 2.80 (95% confidence interval, 2.48 -3.17) for those with diabetes, hyperlipidemia, and high BMI. Cumulative medical-care costs generally increased with additional risk factors. Comorbid diabetes had the greatest impact on costs over 6 years. Conclusions: More than 50% of patients with hypertension also had diabetes, hyperlipidemia, or high BMI. Patients with these additional risk factors (especially diabetes) had a substantially higher CVD risk and medical-care costs. Am J Hypertens 2007;20:599-607 (c) 2007 American Journal of Hypertension, Ltd.