Impact of Cardiovascular-Kidney-Metabolic Burden on Echocardiographic Remodeling and Cardiovascular Outcomes in Hypertension

Key numbers

• 95% CI
• 1,600 patients

Caveats

• Not randomized: its findings are associations.
• Preprint; not yet peer reviewed.

Aims: Cardiovascular-kidney-metabolic (CKM) syndrome highlights the interrelationship between metabolic, renal, and cardiovascular disorders. However, whether CKM burden influences longitudinal cardiac structural and functional recovery and subsequent cardiovascular outcomes remains unclear. Methods: We studied 1,600 patients from the STRATS-HHD registry who underwent echocardiography at baseline and 6-18 months after treatment initiation. CKM burden was defined by obesity, diabetes, chronic kidney disease, and severe hypertension (0-1, 2, or [≥]3 components). The primary outcome was cardiovascular death or heart failure hospitalization (HHF). Results: CKM burden was 0-1 in 973 patients (60.8%), 2 in 440 (27.5%), and [≥]3 in 187 (11.7%). Higher burden was associated with worse baseline cardiac abnormalities and increased primary outcome risk (adjusted HR, 3.09; 95% CI, 1.92-4.98 for [≥]3 vs 0-1; adjusted HR, 1.53; 95% CI, 1.27-1.84 per +1 CKM component). The prognostic association persisted after additional adjustment for hepatic steatosis index-defined metabolic dysfunction-associated steatotic liver disease. Despite overall improvement in most echocardiographic parameters after treatment, patients with CKM burden [≥]3 showed less favorable E/e', LV global longitudinal strain (GLS), and LA stiffness index at follow-up. Normalization of these parameters at follow-up was associated with substantially lower subsequent cardiovascular risk. Mediation analyses suggested that echocardiographic abnormalities partially mediated the association between high CKM burden and the primary outcome. Conclusion: CKM burden identifies hypertensive patients with less favorable cardiac function after treatment and increased cardiovascular risk. These findings highlight the association of CKM burden with cardiac functional recovery and prognosis in patients with hypertension.

H. M. Kim, M. Bak, J. Park, H.-M. Choi, Y. E. Yoon, G.-Y. Cho, I.-C. Hwang

Leverage2 / 5

Reusable within one subfield (a technique, dataset, or protocol a few groups will adopt).

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20% of this desk’s rubric

Evidence3 / 5

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A new combination of known ideas.

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Some room to improve with obvious engineering.

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• Citations0 (reference 20, via semantic-scholar, Oct 24, 2026, 06:17 UTC)

• Reviewed by heuristic-v7 on Oct 24, 2026, 06:17 UTC. Paper type: clinical.
• Categories: cardiovascular medicine
• BRIEF, No.5 in the Medicine edition of October 24, 2026.