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<p>We sought to investigate whether remnant cholesterol (RC) modified the effect of intensive blood pressure (BP) lowering treatment. This study was a post hoc analysis of ESPRIT. In this trial, hypertensive patients with high cardiovascular risk were randomly assigned to intensive (systolic BP &lt; 120 mmHg) or standard (systolic BP &lt; 140 mmHg) treatment. Cox regression analysis was used to examine heterogeneity of treatment effect on the primary composite outcome (myocardial infarction, heart failure, stroke, coronary or non-coronary revascularization, or death from cardiovascular causes), individual components, and death from any cause in participants grouped by RC tertiles or the cut-off value (0.8 mmol/L). A total of 11,221 participants with complete data of baseline RC were included for analysis (females 41.3%, mean age 64.6 years). During a median follow-up of 3.3 years, 1163 primary outcomes occurred, and hazard ratios (HR) for the primary outcome were 0.98 (95% CI 0.80–1.20), 0.90 (95% CI 0.74–1.11), and 0.77 (95% CI 0.64–0.94) in the lowest, middle, and highest RC tertiles, respectively (<i>P</i> for interaction: 0.11). Additionally, intensive treatment only reduced the risk of myocardial infarction in the highest RC tertile (HR 0.56, 95% CI 0.36–0.89, <i>P</i> for interaction: 0.01). When grouping by RC level of 0.8 mmol/L, significant interactions were also noted for the primary outcome, myocardial infarction, death from cardiovascular causes, and death from any cause (all <i>P</i> for interaction &lt;0.05). These results showed that effects of intensive treatment were shown to be modified by baseline RC level, and further research is needed to confirm our findings.</p><p></p>

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Remnant cholesterol level modified the effects of intensive systolic blood pressure lowering treatment in high-risk hypertensive patients: a post hoc analysis of the ESPRIT trial

  • 期刊论文

  • 发表日期：

    2026年4月21日

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  • Haixu Wang,
  • Shitian Li,
  • Ying Sun,
  • Yan Li,
  • Wuhan Bilige,
  • Fengjun Qi,
  • Liying Xie,
  • Guanghan Wu,
  • Haiyan Yan,
  • Yanhua Yang,
  • Xiaojuan Zhai,
  • Xia Luo,
  • Anran Guo,
  • Wentang Niu,
  • Hairong Chen,
  • Yihui Ren,
  • Xiaohan Zhang,
  • Chunxia Huang,
  • Zuyi Chen,
  • Lichun Chen,
  • Haibo Zhang,
  • Jing Li,
  • Jiamin Liu,
  • Xin Zheng

摘要

We sought to investigate whether remnant cholesterol (RC) modified the effect of intensive blood pressure (BP) lowering treatment. This study was a post hoc analysis of ESPRIT. In this trial, hypertensive patients with high cardiovascular risk were randomly assigned to intensive (systolic BP < 120 mmHg) or standard (systolic BP < 140 mmHg) treatment. Cox regression analysis was used to examine heterogeneity of treatment effect on the primary composite outcome (myocardial infarction, heart failure, stroke, coronary or non-coronary revascularization, or death from cardiovascular causes), individual components, and death from any cause in participants grouped by RC tertiles or the cut-off value (0.8 mmol/L). A total of 11,221 participants with complete data of baseline RC were included for analysis (females 41.3%, mean age 64.6 years). During a median follow-up of 3.3 years, 1163 primary outcomes occurred, and hazard ratios (HR) for the primary outcome were 0.98 (95% CI 0.80–1.20), 0.90 (95% CI 0.74–1.11), and 0.77 (95% CI 0.64–0.94) in the lowest, middle, and highest RC tertiles, respectively (P for interaction: 0.11). Additionally, intensive treatment only reduced the risk of myocardial infarction in the highest RC tertile (HR 0.56, 95% CI 0.36–0.89, P for interaction: 0.01). When grouping by RC level of 0.8 mmol/L, significant interactions were also noted for the primary outcome, myocardial infarction, death from cardiovascular causes, and death from any cause (all P for interaction <0.05). These results showed that effects of intensive treatment were shown to be modified by baseline RC level, and further research is needed to confirm our findings.