Moderating Role of Anemia on the Association between Blood Urea Nitrogen and Atherosclerotic Cardiovascular Disease in Hypertension.

Background: Anemia or blood urea nitrogen (BUN) are both associated with atherosclerotic cardiovascular disease (ASCVD) in hypertension (HTN). However, the relationship between anemia, BUN, and ASCVD remains unclear in HTN. This study aimed to investigate the relationship between BUN, anemia, and ASCVD in HTN patients, and further investigated the moderating effect of anemia on the relationship between BUN and ASCVD. Methods: In total, 15,109 HTN patients were included based on the National Health and Nutritional Examination Survey (NHANES) from 1999 to 2018. The weighted univariate logistic regression model was utilized to select potential covariates. The relationship between BUN, anemia, and ASCVD was investigated using weighted univariate and multivariate logistic regression models. All results were expressed as odds ratios (ORs) and 95% confidence intervals (CIs). Results: A total of 15,109 HTN patients were included for final analysis. BUN level ≥4.69 mmol/L was related to higher odds of ASCVD in HTN patients (OR = 1.68, 95% CI: 1.51-1.88). Similarly, anemia was also associated with increased odds of ASCVD in HTN patients (OR = 1.45, 95% CI: 1.22-1.73). In patients with anemia, a BUN level ≥4.69 mmol/L was associated with increased odds of ASCVD when compared to patients who had a BUN level <4.69 mmol/L (OR = 2.95, 95% CI: 2.05-4.25). Anemia affected the association between BUN and ASCVD in HTN patients. Conclusions: Anemia moderates the association between BUN and ASCVD in HTN patients, amplifying the adverse effects. The findings show the importance of comprehensive management strategies that included renal function monitoring and anemia treatment in HTN patients.