ASSOCIATION OF OXIDATIVE BALANCE BURDEN WITH ALL-CAUSE MORTALITY AMONG PATIENTS WITH HYPERTENSION: A PROSPECTIVE COHORT STUDY FROM NATIONAL HEALTH AND NUTRITION EXAMINATION

Objective: Oxidative stress assumes a crucial role throughout the entire trajectory of hypertensive patients. This study aimed to evaluate the association between oxidative balance score (OBS) and all-cause mortality among hypertensive patients. Design and method: We conducted a cohort study, including 9,735 hypertensive patients from the NHANES spanning from 2007 to 2018. Relevant mortality data were linked until December 2019. The burden of oxidation balance was derived through computation of the OBS. It was obtained by assessing the levels of 15 antioxidants and 5 pro-oxidants for each gender. Survey-weighted multivariable Cox proportional hazards regression and Kaplan-Meier survival curves were employed to examine the association between OBS and all-cause mortality. Restricted cubic spline was used to investigate whether there is a nonlinear relationship between OBS and all-cause mortality in hypertensive patients. Moreover, we conducted a subgroup analysis taking into consideration age, gender, BMI, and history of diabetes. Patients who died within two years of follow-up were excluded for sensitivity analysis to verify the robustness of the results. Results: After a median follow-up period of 79 months, 973 hypertensive patients experienced all-cause deaths (9.99%). We found that every 5 scores increment in OBS was associated with an 11% reduction in the risk of all-cause mortality (HR = 0.89, 95% CI: 0.82-0.98). Restricted cubic spline failed to yield evidence supporting a nonlinear association between OBS and all-cause mortality (P nonlinear = 0.181). After stratifying the OBS into tertiles, it was found that the highest OBS group had a significantly lower risk of all-cause mortality compared to the lowest group (HR=0.72, 95% CI: 0.54 to 0.96, p for trend=0.025). Subgroup analysis revealed a significant negative correlation between OBS and all-cause mortality among individuals aged 60 years and above, males, with BMI<25kg/m2 and those without diabetes. Sensitivity analysis suggested that our results remained stable. Conclusions: Higher OBS was significantly associated with decreased all-cause mortality in adults with hypertension. OBS could serve as a prognostic assessment tool in ameliorating prognosis and enhancing survival outcomes. increasing antioxidant levels is an effective strategy to prevent the risk of all-cause mortality in hypertensive patients.