Anemia May Heighten Cardiovascular Risk in Hypertensive Patients, Warn Researchers

The findings, published in Reviews in Cardiovascular Medicine, suggest that anemia may significantly strengthen the association between elevated BUN and atherosclerotic cardiovascular disease (ASCVD), emphasizing the need for more integrated patient management strategies.

Hypertension is a well-established risk factor for atherosclerotic cardiovascular disease, yet patients often continue to face residual cardiovascular risk despite receiving antihypertensive treatment. While both anemia and elevated blood urea nitrogen levels have been individually linked to ASCVD in hypertensive patients, their combined influence and interaction remain unclear. Limited research has explored these associations, particularly in the context of persistent cardiovascular risk following therapy.

To fill this knowledge gap, Qianqian Yu and Haitao Yu from the Department of Blood Transfusion, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China, and colleagues aimed to examine how blood urea nitrogen and anemia are linked to atherosclerotic cardiovascular disease in individuals with hypertension, while also assessing whether anemia modifies the association between BUN levels and ASCVD risk.

For this purpose, the researchers analyzed data from 15,109 patients with hypertension using the National Health and Nutrition Examination Survey (NHANES) spanning 1999 to 2018. To identify potential covariates, they applied a weighted univariate logistic regression model. The associations between blood urea nitrogen, anemia, and atherosclerotic cardiovascular disease were assessed through weighted univariate and multivariate logistic regression analyses. Findings were reported as odds ratios (ORs) along with 95% confidence intervals (CIs).

The study revealed the following findings:

• A total of 15,109 patients with hypertension were included in the final analysis.
• Blood urea nitrogen (BUN) levels ≥4.69 mmol/L were linked to a higher risk of ASCVD in hypertensive patients (OR = 1.68).
• Anemia was also associated with increased odds of ASCVD in the hypertensive population (OR = 1.45).
• Among patients with anemia, those with BUN levels ≥4.69 mmol/L had significantly higher odds of ASCVD than those with lower BUN levels (OR = 2.95).
• Anemia moderated the association between BUN and ASCVD in individuals with hypertension.

In conclusion, the study highlights that anemia significantly amplifies the link between elevated BUN levels and ASCVD in patients with hypertension. These findings emphasize the need for integrated management strategies that prioritize renal function assessment and timely anemia intervention to help reduce cardiovascular risks.

According to Yu and colleagues, incorporating early detection and treatment of anemia into hypertension care may enhance oxygen delivery and lessen cardiovascular strain. They emphasized the importance of future prospective studies to confirm these associations and identify effective therapeutic approaches.

Reference:

Qianqian Yu, Haitao Yu. Moderating Role of Anemia on the Association between Blood Urea Nitrogen and Atherosclerotic Cardiovascular Disease in Hypertension. Rev. Cardiovasc. Med. 2025, 26(3), 26245. https://doi.org/10.31083/RCM26245