Metabolic syndrome severity and the effects of intensive blood pressure lowering: Results from the STEP randomized trial.
Jiajia Zhao, Xilan Dong, Qirui Song et al.
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In 30 seconds
This post hoc analysis of the randomized STEP trial examined whether baseline metabolic syndrome (MetS) severity modified the benefits and risks of intensive versus standard systolic blood pressure lowering. It included 8,231 participants with complete MetS severity data and had a median follow-up of 3.32 years. Intensive treatment reduced the primary cardiovascular outcome overall, while absolute event incidence was highest in the most severe MetS tertile. Relative treatment effects did not differ significantly by MetS severity; the largest reduction in the primary outcome was in the middle tertile (Q2: HR, 0.66; 95% CI, 0.44-0.99).
Key findings
- Absolute incidence of the primary outcome and major adverse cardiac events was highest in the highest MetS severity tertile.
- Intensive treatment was associated with lower event rates across MetS tertiles; the largest primary-outcome reduction was in Q2 (HR, 0.66; 95% CI, 0.44-0.99).
- Treatment-by-MetS interactions were not significant for efficacy or safety outcomes.
- Hypotension was numerically more frequent with intensive treatment in the highest MetS tertile.
Why it matters
MetS severity may help identify patients with greater absolute cardiovascular risk, but this analysis does not show that it meaningfully changes the relative cardiovascular benefit of intensive blood pressure lowering. The safety findings also draw attention to possible hypotension in those with greater metabolic burden, while the absence of a significant interaction means this signal should be interpreted cautiously.
What to keep in mind
This was a post hoc analysis of STEP, rather than a trial designed to test whether MetS severity modifies treatment effects.