Associations between metabolic health and obesity status and blood pressure phenotypes in patients receiving single-pill combination treatment.

Background and aims: Metabolic status and obesity are considered to be related to the risk of hypertension. However, whether metabolic health and obesity status affect blood pressure (BP) control remains unknown. This study aimed to explore the prevalence of BP phenotypes in patients receiving single-pill combination (SPC) treatment and the associations of metabolic health and obesity status with BP phenotypes.

Methods and results: Overall, 685 untreated patients completed the 4-week follow-up in this prospective study. Participants were divided into four groups according to their metabolic health and obesity status. The prevalence of white-coat uncontrolled hypertension, controlled hypertension, masked uncontrolled hypertension (MUCH), sustained uncontrolled hypertension (SUCH) and uncontrolled morning hypertension (UMH) was 2.6 %, 23.0 %, 44.3 %, 30.1 % and 51.1 %, respectively. The metabolically unhealthy overweight/obesity (MUO) group had the highest prevalence of SUCH and UMH, and the highest 24-h, daytime, nighttime, and morning systolic and diastolic BP. In the multivariate logistic analysis, compared with the metabolically healthy normal weight (MHNW) phenotype, the MUO phenotype was associated with increased risks of SUCH (odds ratio (OR) = 2.601, 95 % confidence interval (CI): 1.109-6.099) and UMH (OR = 2.689, 95 % CI: 1.504-4.809). The metabolically healthy overweight/obesity (MHO) phenotype had an increased risk of UMH (OR = 2.277, 95 % CI: 1.014-5.111).

Conclusion: The prevalence of MUCH, SUCH and UMH was high among patients receiving SPC treatment. MHO and MUO individuals are at increased risk for uncontrolled hypertension. Therefore, metabolic health and obesity status should be taken into consideration, and the use of ABPM should be applied to intensify treatment when managing hypertension.

Registration number: ChiCTR2200059719.