Impact of Hypertension History and Blood Pressure at Presentation on Cardiac Remodeling and Mortality in Aortic Dissection

Abstract

ObjectiveThis study compared clinical, echocardiographic, and prognostic characteristics among patients with aortic dissection (AD) with (HypHist) and without (No-HypHist) hypertension history and evaluated the association of blood pressure (BP) at presentation with 1-year mortality, left ventricular (LV) remodeling and renal dysfunction.MethodsWe investigated clinical and echocardiographic characteristics and 1-year mortality among 367 patients with AD (81% HypHist, 66% Type-A) from three Brazilian centers.ResultsPatients with No-HypHist were more likely to have Marfan syndrome, bicuspid aortic valve, to undergo surgical therapy, were less likely to have LV hypertrophy and concentricity, and had similar mortality compared with HypHist patients. Adjusted restricted cubic spline analysis showed that systolic BP (SBP) and diastolic BP (DBP) at presentation had a J-curve association with mortality among patients with No-HypHist, but did not associate with death among patients with HypHist (p for interaction = 0.001 for SBP and = 0.022 for DBP). Conversely, the association between SBP at presentation and mortality was influenced by previous use of antihypertensive medications in the HypHist group (p for interaction = 0.002). Results of multivariable logistic regression analysis comprising the whole sample showed direct associations of SBP and DBP at presentation with LV hypertrophy (p = 0.009) and LV concentricity (p = 0.015), respectively, and an inverse association between pulse pressure at presentation and estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2 (p = 0.008).ConclusionCombined information on BP at presentation, previous diagnosis of hypertension, and use of antihypertensive medications might be useful to predict mortality risk and to estimate extra-aortic end-organ damage among patients with AD.

The influence of sex on left ventricular remodeling in patients with aortic dissection

“…Individuals with self-reported diagnosis of hypertension or reported use of antihypertensive medications or with SBP at least 140 mmHg or DBP at least 90 mmHg at admission were defined as having hypertension. 10 Coronary heart disease was defined as a documentation of myocardial ischemia by coronary angiography or noninvasive tests (stress test, stress echocardiography, or myocardial perfusion scintigraphy), or a history of previous myocardial infarction. Data collected during hospitalization included information on the modality of definitive aortic dissection treatment (medical therapy, open surgery, or endovascular therapy), stent-graft implantation in the descending aorta (exclusively for patients with Stanford-A aortic dissection who underwent surgery), and aortic valve replacement.…”

“…Death was determined by medical chart review or by the national social security number database. 9,10 Statistical analysis Continuous variables are shown as mean AE standard deviation and categorical variables are presented as numbers and proportions. Differences in the studied variables between men and women were assessed by unpaired ttest for continuous variables and x 2 test for categorical variables.…”

“…Previous studies showed that SBP at the time of aortic dissection diagnosis was directly associated with LVH in aortic dissection patients. 10 In this context, we assessed whether there might be differences in the relationship between SBP at the time of aortic dissection diagnosis and LVH between men and women using logistic regression analysis adjusted for confounding factors (Fig. 1).…”

“…3,4 Patients with either Stanford-A or Stanford-B aortic dissection have a high prevalence of left ventricular structural alterations, including left ventricular hypertrophy (LVH) and left ventricular concentricity. [5][6][7][8][9][10] Importantly, both LVH and left ventricular concentricity have been associated with adverse prognosis in aortic dissection patients. 8,9 However, hypertension does not seem to fully justify the adverse left ventricular remodeling in patients with aortic dissection, indicating that alternative mechanisms may be involved in this regard.…”

“…Arterial hypertension is the most important risk factor for the development of aortic dissection and is a main determinant of left ventricular remodeling 3,4 . Patients with either Stanford-A or Stanford-B aortic dissection have a high prevalence of left ventricular structural alterations, including left ventricular hypertrophy (LVH) and left ventricular concentricity 5–10 . Importantly, both LVH and left ventricular concentricity have been associated with adverse prognosis in aortic dissection patients 8,9 .…”