Hypertension breakthrough: Controlling just 4 of 8 risk factors can eliminate early mortality danger
A comprehensive study involving nearly 300,000 participants reveals that controlling multiple cardiovascular risk factors simultaneously can eliminate the excess mortality risk associated with hypertension, offering new hope for preventive medicine strategies.
Hypertension affects more than 30% of adults globally and remains the leading preventable risk factor for premature death worldwide. However, groundbreaking research from Tulane University suggests that people with high blood pressure can dramatically reduce – and potentially eliminate – their increased risk of dying before age 80 by simultaneously managing multiple health risk factors.
The comprehensive study, published in Precision Clinical Medicine, tracked 70,898 people with hypertension and 224,069 without it from the UK Biobank for nearly 14 years. The research identified eight critical health parameters that, when controlled together, could neutralise hypertension’s deadly effects.
Multifactorial approach shows dramatic results
The eight risk factors evaluated include blood pressure, body mass index, waist circumference, LDL “bad” cholesterol, blood sugar levels, kidney function, smoking status, and physical activity levels. Remarkably, hypertensive patients who addressed at least four of these factors showed no greater risk of early death than those without high blood pressure.
“Our study shows that controlling blood pressure is not the only way to treat hypertensive patients, because high blood pressure can affect these other factors,” explained corresponding author Dr Lu Qi, professor of epidemiology at Tulane University’s School of Public Health and Tropical Medicine. “By addressing the individual risk factors, we can help prevent early death for those with hypertension.”
The study revealed a dose-response relationship between risk factor control and mortality reduction. Each additional controlled risk factor was associated with a 13% lower risk of early death overall, 12% lower risk of cancer-related early death, and 21% lower risk of cardiovascular disease mortality – the leading cause of premature death globally.
Optimal control delivers unprecedented protection
Participants achieving “optimal risk control”– managing seven or more risk factors – experienced the most dramatic benefits. These individuals showed 40% less risk of early death, 39% less risk of cancer-related early death, and 53% less risk of cardiovascular disease mortality compared to those with minimal risk factor control.
The authors noted in their discussion that “hypertension-related excess risk of premature mortality could be totally eliminated by joint risk factor control.” They emphasised that this represents the first study to explore the association between controlling joint risk factors and premature mortality specifically in hypertensive patients.
Synergistic mechanisms drive mortality reduction
The researchers propose several biological mechanisms underlying these remarkable benefits. Hypertension affects multiple organ systems, with cardiovascular disease and chronic kidney disease emerging as principal complications that substantially increase mortality risk. The study authors explained that “effective management of different risk factors can potentially amplify the reduction of disease risk through distinct mechanisms.”
Simultaneous control of multiple factors – including blood sugar, blood pressure, and cholesterol – can significantly reduce risks of coronary artery disease and heart failure. Additionally, controlling both blood pressure and protein in urine may reduce kidney failure risk, thereby lowering premature mortality in hypertensive patients.
The research also highlighted the importance of cardiorenal mechanisms, noting that “cardiorenal mechanisms play an important role in the development of multiple diseases and cardiorenal syndrome is related to adverse clinical outcomes, underscoring the advantages of jointly managing cardiovascular disease and chronic kidney disease risk factors.”
Implementation challenges highlight prevention gap
Despite the promising findings, the study revealed a concerning implementation gap. Only 7.3% of hypertensive participants achieved optimal control of seven or more risk factors, highlighting what researchers called “a major opportunity for prevention.”
The findings were particularly pronounced in certain subgroups. Hypertensive participants over 60 years old and those taking antihypertensive medications showed greater benefits from multi-factor control compared to matched non-hypertensive participants. The authors suggested that “antihypertensive medication may enhance the effect of joint risk factor control on risk of mortality, thereby amplifying the impact of combined risk factor management.”
Clinical implications for personalised care
“To our knowledge, this is the first study to explore the association between controlling joint risk factors and premature mortality in patients with hypertension,” Qi emphasised. “Importantly, we found that any hypertension-related excess risk of an early death could be entirely eliminated by addressing these risk factors.”
The research underscores the importance of moving beyond single-factor approaches to hypertension management. Rather than focusing solely on prescribing blood pressure medications, the findings advocate for personalised, multifaceted care addressing broader health behaviours and conditions.
The study’s authors concluded that “degree of joint risk factor control shows gradient inverse association with risk of premature mortality in hypertensive participants,” and that “optimal risk factor control may eliminate hypertension-related excess risk of premature mortality.”
This research provides compelling evidence that comprehensive lifestyle and medical interventions could transform outcomes for the millions of people worldwide living with hypertension, potentially eliminating their excess mortality risk entirely.
Reference:
Zhou, J., Kou, M., Tang, R., Wang, X., Ma, H., Li, X., Heianza, Y., & Qi, L. (2025). Degree of joint risk factor control and premature mortality in hypertensive participants. Precision Clinical Medicine, 8, pbaf006. https://doi.org/10.1093/pcmedi/pbaf006
