Cardiovascular Health Change Patterns After Multifaceted Antihypertensive Intervention and Cardiovascular Outcomes: A Post Hoc Analysis of CRHCP Trial.

Abstract

Cardiovascular health (CVH), as defined by the American Heart Association, provides a multidimensional framework for cardiovascular risk assessment. An increasing number of studies have developed intervention strategies based on CVH metrics. However, the multidimensional health change patterns resulting from these interventions and their relationship with clinical outcomes remain unclear. The purposes of this study were to characterize patterns of change in CVH after intervention and to examine how multidimensional response domains derived from Life's Simple 7 (LS7) components relate to subsequent cardiovascular outcomes. This post hoc analysis of the China Rural Hypertension Control Project included 26,700 participants. The intervention consisted of intensive blood pressure (BP) management delivered by nonphysician community health care providers, targeting <130/80 mm Hg. Changes in CVH over 0-36 months were longitudinally characterized across the LS7 components and grouped into BP, metabolic, and behavioral domains. Associations between domain-specific change patterns and subsequent cardiovascular outcomes (36-48 months) were evaluated using Cox proportional hazards models. Among 26,700 participants (age 62.5 ± 9.0 years; 63.0% women), the intervention improved LS7 scores at 36 months (net difference: 0.52; 95% CI: 0.38-0.66), with cardiovascular risk reduction observed among participants with improved CVH (HR: 0.71; 95% CI: 0.54-0.89). Longitudinal analyses showed sustained separation in BP between groups, with only modest and less-differentiated changes in other components. Across multidomain patterns, the greatest reduction in cardiovascular risk was observed among participants with BP improvement plus concurrent behavioral or metabolic gains (HR: 0.57; 95% CI: 0.30-0.84), followed by BP improvement alone (HR: 0.76; 95% CI: 0.55-0.98), with no significant benefit in other patterns. Net benefit analyses showed a consistent gradient across patterns. Mediation analyses indicated that BP accounted for the majority of the observed effect (67.5%), with modest contributions from behavioral (8.0%) and minimal contributions from metabolic domains. Results were consistent across sensitivity analyses. In this large community-based randomized trial, a scalable intervention delivered by nonphysician providers reduced cardiovascular risk, with the benefit primarily driven by BP, alongside modest contributions from behavioral and metabolic domains. This asymmetry highlights heterogeneous, domain-specific responses and provides a quantitative framework for understanding how multifaceted interventions translate into cardiovascular outcomes. (China Rural Hypertension Control Project (CRHC); NCT03527719).