Risk factors influencing the prognosis in patients with arterial hypertension
Keywords:arterial hypertension, prognosis, risk factors
Abstract524 patients, who were treated in specialized secondary hypertension unit, were included in 5-year reprospective analysis. All patients during hospital stay underwent standard examination: office blood pressure measurement, electrocardiography (ECG), echocardiography, blood pressure monitoring. After 5 years, all patients were mailed questionnaires, on which they answered by themselves. In case of patients death, their relatives answered. Mantel-Haenszel and Cox regression univariate and multivariate analysis was performed to detect independent risk factors for combined end-point (myocardial infarction, unstable angina, stroke, new heart failure, new renal failure, death, new diabetes mellitus, other cardiovascular events — coronary artery bypass graft, aortic aneurysm, etc.). The study found that main risk factors of end-point development were age, systolic (> 160 mmHg) and pulse (> 64 mmHg) blood pressure at the time of discharge from hospital, myocardial infarction and stroke/ transient ischemic attack in the past medical history, enlarged left atrium, decreased ejection fraction (less than 40 %), increased interventricular septum thickness (> 1.2 cm), left ventricular mass index > 137 g/m2 , ECG signs of left ventricular hypertrophy (Estes > 3), daily index < 10 % (non-dippers) and day time pulse pressure > 64 mmHg during blood pressure monitoring. Among indicated factors, independent ones were office pulse pressure > 64 mmHg, ejection fraction < 40 %, increased interventricular septum thickness (> 1.2 cm), left ventricular mass index > 137 g/m2 , ECG signs of left ventricular hypertrophy (Estes > 3), daily index < 10 % (non-dippers) and daytime pulse pressure > 64 mmHg during blood pressure monitoring. Such risk factors as office pulse pressure, decreased ejection fraction, non-dipper blood pressure profile and increased daytime pulse pressure saved their influence on prognosis independently from antihypertensive therapy. We did not find the benefits of any antihypertensive drug groups. Only level of blood pressure reduction (especial pulse pressure) was important for prognosis.
Рекомендації Українського товариства кардіологів з профілактики та лікування артеріальної гіпертензії. — Київ, 2001 — 54 с.
Сіренко Ю.М. Артеріальна гіпертензія: Посібник для лікарів. — К.: Морион, 2009. — 239 с.
1999 WHO — ISH guidelines for the management of hypertension // J. Hypertension. — 1999. — Vol. 11. — P. 905-916.
2003 European Society of Hypertension — European Society of Cardiology guidelines for management of arterial hypertension // J. Hypertension. — 2003. — Vol. 21. — P. 1011-1053.
Brown D., Giles W., Croft J. et al. Left Ventricular Hypertrophy as a Predictor of Coronary Heart Disease Mortality and the Effect of Hypertension // Am. Heart J. — 2000. — Vol. 140. — P. 1212-1223.
Clement D., Buyzere M., Bacquer D. et al. Prognostic value of ambulatory blood pressure recording in patients with treated hypertension // N. Engl J. Med. — 2003. — Vol. 348. — P. 2407-2415.
Hasson L., Zanchetti A., Carruthers S. et al. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomized trial // Lancet. — 1998. — Vol. 351. — P. 1755-1762.
Kannel W. Blood pressure as a cardiovascular risk factor: prevention and treatment // JAMA. — 1996. — Vol. 275. — P. 1571-1576.
Kannel W., Levy D., Cupples L. Left ventricular hypertrophy and risk of cardiac failure: insights from the Framingham Study // J. Cardiovasc. Pharmacol. — 1987. — Vol. 10, Suppl. 6. — P. 135-140S.
Kannel W., Wolf P.A., Verter J., McNamara P.M. Epidemiologic assessment of the role of blood pressure in stroke: the Framingham Study. 1970 // JAMA. — 1996. — Vol. 276. — P. 1269-1278.
Lakka T., Salonen R., Kaplan G., Salonen J. Blood pressure and the progression of carotid atherosclerosis in middle-aged men // Hypertens. — 1999. — Vol. 34. — P. 51-56.
Left ventricular hypertrophy / Ed. by D.J. Sheridan. — London: Chirchill Livingstone, 1998. — 209 p.
Lenter C. Geigy Scientific Tables. — CIBA-GEIGY Corporation: Basel, 1990. — 278 p.
Levy D., Larson M., Vasan R. et al. The progression from hypertension to congestive heart failure // JAMA. — Vol. 275. — P. 1557-1562.
Makino Yu., Kawano Yu., Minami J. et al. Risk of Stroke in relation to level of blood pressure and other risk factors in treated hypertensive patients // Stroke. — 2000. — Vol. 31. — P. 48-52.
Miura K., Dyer A., Greenland P. et al. Pulse pressure compared with other blood pressure indexes in the prediction of 25-year cardiovascular and all-cause mortality rates // Hypertens. — 2001. — Vol. 38. — P. 232-237.
Pastor-Barriuso R., Banegas J., Damian J. et al. Systolic blood pressure, diastolic blood pressure and pulse pressure: an evaluation of their joint effect on mortality // Ann. Intern. Med. — 2003. — Vol. 139. — P. 731-739.
Pfeffer M., Braunwald E., Moye L. et al. Effect of captopril om mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction, resulrs of the survival and ventricular enlargement trial // N. Engl. J. Med. — 1992. — Vol. 327. — P. 669-677.
The SOLVD investigators. Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure // N. Engl. J. Med. — 1991. — Vol. 325. — P. 293-302.
The SOLVD investigators. Effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection fractions // N. Engl. J. Med. — 1992. — Vol. 327. — P. 685-691.
Torp-Pedersen C., Kober L., Carlsen J. Angiotensin-converting enzyme inhibition after myocardial infarction: the trandolapril Cardiac Evaluation study // Am. Heart J. — 1996. — Vol. 132. — P. 235-243.
Verdechia P., Schillaci G., Borgioni C. et al. Ambulatory pulse pressure. A potent predictor of total cardiovascular risk in hypertension // Hypertens. — 1998. — Vol. 32. — P. 983-
Kanegae H., Oikawa T., Suzuki K., Okawara Y., Kario K. Developing and validating a new precise risk-prediction model for new-onset hypertension: The Jichi Genki hypertension prediction model (JG model) // J. Clin. Hypertens (Greenwich). — 2018, Mar 31. doi: 10.1111/jch.13270.
Sundström J., Gulliksson G., Wirén M. Synergistic effects of blood pressure-lowering drugs and statins: systematic review and meta-analysis // BMJ Evid. Based Med. — 2018 Apr. — 23(2). — Р. 64-69. doi: 10.1136/bmjebm-2017-110888. Epub 2018, Mar 14.
Okumura N., Kondo T., Matsushita K., Osugi S., Shimokata K., Matsudaira K., Yamashita K., Maeda K., Murohara T. Associations of proteinuria and the estimated glomerular filtration rate with incident hypertension in young to middle-aged Japanese males // Prev. Med. — 2014 Mar. — 60. — Р. 48-54. doi: 10.1016/j.ypmed.2013.12.009. Epub 2013, Dec 14.
Wu J., Li T., Song X., Sun W., Zhang Y., Liu Y., Li L., Yu Y., Liu Y., Qi C., Liu B. Prevalence and distribution of hypertension and related risk factors in Jilin Province, China 2015: a cross-sectional study // BMJ Open. — 2018. — Vol. 28. — 8(3). — e020126. doi: 10.1136/bmjopen-2017-020126.
Figliuzzi I., Presta V., Citoni B., Miceli F., Simonelli F., Battistoni A., Coluccia R., Ferrucci A., Volpe M., Tocci G. Achievement of multiple therapeutic targets for cardiovascular disease prevention: Retrospective analysis of real practice in Italy // Clin. Cardiol. — 2018. — Vol. 31. doi: 10.1002/clc.22955. Epub ahead of print
Mancia G., Fagard R., Narkiewicz K. et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension. The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) // J. Hypertens. — 2013. — Vol. 31, № 7. — P. 1281-1357.
James P.A., Oparil S., Carter B.L. et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint Na tional Committee (JNC 8) // Jama. — 2014. — Vol. 311(5). — P. 507-520.
Ostchega Y., Zhang G., Hughes J., Nwankwo T. Factors Associated with Hypertension Control in U.S. Adults Using 2017 ACC/AHA Guidelines: National Health and Nutrition Examination Survey 1999-2016 // Am. J. Hypertens. — 2018, Mar 29. doi: 10.1093/ajh/hpy047. Epub ahead of print
Ioannidis J.P.A. Diagnosis and Treatment of Hypertension in the 2017 ACC/AHA Guidelines and in the Real World // JAMA. — 2018. — Vol. 9. — 319(2). — Р. 115-116.
Copyright (c) 2018 HYPERTENSION
This work is licensed under a Creative Commons Attribution 4.0 International License.
Our edition uses the copyright terms of Creative Commons for open access journals.
Authors, who are published in this journal, agree with the following terms:
- The authors retain rights for authorship of their article and grant to the edition the right of first publication of the article on a Creative Commons Attribution 4.0 International License, which allows others to freely distribute the published article, with the obligatory reference to the authors of original works and original publication in this journal.
- Directing the article for the publication to the editorial board (publisher), the author agrees with transmitting of rights for the protection and using the article, including parts of the article, which are protected by the copyrights, such as the author’s photo, pictures, charts, tables, etc., including the reproduction in the media and the Internet; for distributing; for the translation of the manuscript in all languages; for export and import of the publications copies of the writers’ article to spread, bringing to the general information.
- The rights mentioned above authors transfer to the edition (publisher) for the unlimited period of validity and on the territory of all countries of the world.
- The authors guarantee that they have exclusive rights for using of the article, which they have sent to the edition (publisher). The edition (the publisher) is not responsible for the violation of given guarantees by the authors to the third parties.
- The authors have the right to conclude separate supplement agreements that relate to non-exclusive distribution of their article in the form in which it had been published in the journal (for example, to upload the work to the online storage of the journal or publish it as part of a monograph), provided that the reference to the first publication of the work in this journal is included.
- The policy of the journal permits and encourages the publication of the article in the Internet (in institutional repository or on a personal website) by the authors, because it contributes to productive scientific discussion and a positive effect on efficiency and dynamics of the citation of the article.
- The rights to the article are deemed transferred by the authors to the edition (the publisher) since the moment of the publication of the article in the printed or electronic version of journal.