CLUSTERING OF CARDIOVASCULAR RISK FACTORS IN HYPERTENSIVE PATIENTS ADMITTED TO HOSPITAL

Background: Hypertension remains the most common modifiable risk factor for cardiovascular morbidity and mortality worldwide. The clustering of several cardiovascular risk factors (dyslipidemia, diabetes mellitus, obesity and smoking) among hypertensive subjects further increases the risk of adverse cardiovascular events. In the Jordanian population, the prevalence of hypertension and associated risk factors is notably high. However, the pattern and extent of risk factor clustering among hypertensive patients admitted to King Hussein Medical Center have not been systematically characterized.
Objective: This retrospective study aimed to characterize the clustering patterns of major cardiovascular risk factors among hypertensive patients admitted to the internal medicine department at King Hussein Medical Center and to identify the most frequently associated comorbidities.
Methods: This retrospective cross-sectional study was conducted on 302 hypertensive patients (age ≥ 18 years) who were admitted to the internal medicine department at King Hussein Medical Center between January 2023 and August 2026. We reviewed the medical records. Data were extracted from electronic medical records (HAKEEM system) for demographic variables, anthropometric measurements, laboratory parameters and documented clinical history of comorbid conditions. Information on lifestyle factors including smoking status and physical activity was obtained from social history documentation. Risk factor clustering was defined as the presence of hypertension in combination with at least two other cardiovascular risk factors. Descriptive statistics and frequency analyzes were applied to assess the prevalence and the patterns of clustering. Subgroup analyses were performed based on age, gender, and the number of coexisting risk factors.
Results: Among 302 hypertensive patients (mean age 62.8 ± 12.4 years, 54.6% male), risk factor clustering was highly prevalent, with 78.5% (n=237) having at least two additional cardiovascular risk factors, and 42.7% (n=129) having three or more. The most common coexisting risk factors were dyslipidemia (68.2%, n=206), diabetes mellitus (48.7%, n=147), obesity (43.4%, n=131), and current smoking (32.5%, n=98). Physical inactivity was documented in 56.3% (n=170) of patients. Clustering was more common with increasing age, and patients aged ≥65 years had significantly higher mean number of risk factors (2.8 ± 1.1 vs. 2.3 ± 1.0, p<0.001). Male patients were more likely to smoke (42.4% vs 20.4%, p<0.001) and had a higher mean number of risk factors (2.7 ± 1.1 vs 2.4 ± 1.0, p=0.016), while female patients were more likely to be obese (52.9% vs 35.5%, p=0.002). Patients with ≥3 risk factors clustered together had significantly higher rates of coronary artery disease (34.1% vs 18.2%, p=0.003), cerebrovascular disease (16.3% vs 7.5%, p=0.024) and chronic kidney disease (27.9% vs 14.0%, p=0.006). Multivariate logistic regression identified age ≥65 years (OR=2.14, 95% CI: 1.28–3.58, p=0.004), male gender (OR=1.68, 95% CI: 1.02–2.77, p=0.041), and obesity (OR=2.45, 95% CI: 1.48–4.06, p<0.001) as independent predictors of clustering of ≥3 risk factors.
Conclusion: Cardiovascular risk factor clustering is highly prevalent among hypertensive patients admitted to the internal medicine department at King Hussein Medical Center, with nearly 80% having at least two additional risk factors and over 40% having three or more. Clustering of ≥3 risk factors was significantly more common with coronary artery disease, cerebrovascular disease and chronic kidney disease. These results emphasize the necessity of a comprehensive assessment of cardiovascular risk, and the need for integrated management approaches addressing several risk factors at the same time.