Associations of grip strength with cardiovascular disease and all-cause mortality in people with and without hypertension: findings from the Prospective Urban Rural Epidemiology (PURE) China Study

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Abstract Background Hypertension and grip strength (GS) are predictors of mortality and cardiovascular disease (CVD), but whether these risk factors interact to affect both CVD and all-cause mortality is unknown. The study aimed to examine whether the associations between hypertension and GS with the risk of major CVD incidence, CVD mortality, and all-cause mortality differed between people with and without hypertension. Methods GS was measured using a Jamar dynamometer in participants aged 35–70 years from 12 provinces in the Prospective Urban Rural Epidemiology (PURE) China study. Hypertension was defined as a baseline systolic and diastolic blood pressure of at least 140/90 mm Hg, a self-reported history of hypertension, or treatment with antihypertensive medications. Cox proportional hazards models were used to examine the associations of GS and hypertension and with the outcomes of all-cause mortality and CVD incidence/mortality, and to test the multiplicative interactions between hypertension and GS. Results Among 39,862 participants included in this study, 15,964 reported having hypertension at baseline and 9095 had high GS. After a median follow-up of 8.9 years [interquartile range (IQR) 6.7–9.9 years], 1822 participants developed major CVD, and 1250 deaths occurred (388 as a result of CVD). Compared with normotensive participants with high GS, hypertensive patients with high GS had a higher risk of major CVD incidence (HR 2.36 [95% CI: 1.84–3.02]; P<0.0001) or CVD mortality (HR 3.05 [95% CI: 1.56–5.95]; P<0.0001) but did not have a significantly increased risk of all-cause mortality (HR 1.23 [95% CI: 0.91–1.67]; P=0.181); these risks were further increased if hypertensive participants whose GS level was low (major CVD incidence (HR 3.33 [95% CI: 2.61, 4.24]; P<0.0001), CVD mortality (HR: 5.20 [95% CI: 2.76, 9.82]; P<0.0001), and all-cause mortality (HR 2.00 [95% CI: 1.53, 2.62]; P<0.0001)). Conclusions The present study demonstrates that hypertensive patients with low GS are associated with the highest risk of major CVD incidence, CVD mortality, and all-cause mortality. High levels of GS appear to mitigate long-term mortality risk among hypertensive patients. Association of adverse outcomes Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): The main PURE study and its components are funded by the Population Health Research Institute, the Canadian Institutes of Health Research, Heart and Stroke Foundation of Ontario, and through unrestricted grants from several pharmaceutical companies. Besides funding from global PURE, this work was also sponsored by CAMS Innovation Fund for Medical Sciences (CIFMS): 2016-I2M-2-004, Construction of Basic Information Technology Support System and Platform for National Prevention and Treatment of Cardiovascular Diseases.