Association between care by hypertension specialists and major adverse cardiovascular events in patients with uncontrolled hypertension

Background: The impact of medical care by hypertension specialists on the risk of subsequent major adverse cardiovascular events (MACE) among uncontrolled hypertensive patients remains unclear. We aimed to investigate the association between care by hypertension specialists and the risk of MACE among patients with uncontrolled hypertension. 

Methods: Using the Urumqi Hypertension Database (UHDATA), we studied a retrospective cohort of patients aged 45–79 years who were admitted for uncontrolled hypertension at People's Hospital of Xinjiang Uygur Autonomous Region, China, between 2015 and 2019. Based on hospitalization departments, we identified patients who had been exposed to medical care by hypertension specialists at least once and divided patients into a hypertension specialists group and a non-specialists group. Cox proportional hazards modeling was used to estimate the risk for MACE (a four-component outcome of cardiovascular death, non-fatal stroke, non-fatal myocardial infarction, and coronary revascularization) in the cohort using the propensity score method of stabilized inverse probability of treatment weighting (sIPTW). 

Results: A total of 10,680 patients with uncontrolled hypertension were analyzed, with a median follow-up of 4.0 years. Of these, 5,646 (52.9%) patients received medical care by hypertension specialists and experienced fewer MACE than the non-specialists group [21.5 vs. 39.7 per 1,000-person-year, adjusted hazard ratio (HR) 0.67, 95% confidence interval (CI) 0.57–0.79] after sIPTW. Results persisted for the MACE component, non-fatal stroke (HR 0.62, 95% CI 0.49–0.79), non-fatal myocardial infarction (HR 0.48, 95% CI 0.33–0.69), and coronary revascularization (HR 0.71, 95% CI 0.55–0.93). In subgroup analyses, no significant interaction effect was observed between medical care by hypertension specialists and key subgroup factors on MACE. 

Conclusions: This study demonstrated a significant association between medical care by hypertension specialists and a reduced risk of MACE in patients with uncontrolled hypertension. Our results suggest that medical care by hypertension specialists may play an essential role in improving cardiovascular outcomes among this high cardiovascular disease risk population.