Predictive Factors for Target Organ Injuries in Hypertensive Individuals

Abstract

Background The causal relationship between systemic arterial hypertension and target organ damage (TOD) is well known, as well as the association with cardiovascular risk factors (CV). Ambulatory blood pressure monitoring (ABPM) is important in monitoring hypertension and assessing the risk of TOD. Objective To evaluate the relationship between blood pressure (BP) and clinical and biochemical parameters in the development of TOD in hypertensive patients. Methods This was a retrospective cohort study with 162 hypertensive patients followed for an average period of 13 years. The TOD investigated were left ventricular hypertrophy (LVH), microalbuminuria, coronary artery disease (CAD) and stroke. Blood pressure was assessed by ABPM and LVH using echocardiogram and electrocardiogram, respectively. Biochemical-metabolic tests and 24-hour microalbuminuria were performed at baseline and follow-up. The P-value <0.05 was considered significant. Results The average age was 69±11.8 years, with a predominance of women (64.8%), white ethnicity (79.6%) and diabetics (78.4%). ABPM showed a significant reduction in BP values during follow-up, although without association with TOD (microalbuminuria, stroke, and CAD), except for LVH that showed a correlation with sleep BP ≥120/70 mmHg (P=0.044). The most frequent TODs were LVH (29.6%), microalbuminuria (26.5%), CAD (19.8%) and stroke (17.3%). In the follow-up, there was an association between LVH and diabetes; microalbuminuria was associated with diabetes and triglycerides; stroke was associated with HDL-cholesterol (HDL-c), microalbuminuria and carotid disease. CAD showed a relationship with age and HDL-c. Conclusion Predictive factors for TOD are age, microalbuminuria, diabetes, HDL-c, triglycerides and carotid disease. Nocturnal BP is correlated with LVH. The absence of a relationship between ABPM and other TODs can be explained by the use of effective drugs, improvement of metabolic and blood pressure parameters.

Editorial: The importance of the central hemodynamic in the cardiovascular diseases development

“…Lastly, Chao et al assessed the risk of TOD (LVH, IMT, eGFR, and urine albumin/creatinine ratio) in individuals with different phenotypes of peripheral BP and cfPWV. Similarly, the prevalence rates of TOD were close to other studies ( 10 , 14 , 15 ). They found that the increase in cfPWV or elevation in peripheral systolic BP alone had different effects on TOD.…”

“…They evaluated the carotid intima-media thickness (IMT) and/or carotid plaque, left ventricular hypertrophy (LVH), and kidney alterations [urine albumin/creatinine and/or estimated glomerular filtration rate (eGFR)] as TOD. The prevalence of TOD was 47.3% for elevated IMT, 25.6% for LVH, and 20.5% for microalbuminuria, these values are closed to those found by our group in hypertensive patients followed up in a specialized outpatient clinic ( 10 ). They also demonstrated that peripheral BP obtained by 24 h monitoring exhibited better correlation with TOD than office BP and 24 h central BP, this data was also found in a Spanish study ( 11 ).…”

“…Somehow, this data shows that TOD may be influenced by many factors, and not just BP or cfPWV. In a recent study carried out in a Brazilian hypertensive population, this association with other factors became evident ( 10 ). It demonstrated that age, microalbuminuria, triglycerides, high density lipoprotein cholesterol, and diabetes and the presence of carotid disease were related to TOD.…”

“…It demonstrated that age, microalbuminuria, triglycerides, high density lipoprotein cholesterol, and diabetes and the presence of carotid disease were related to TOD. Moreover, only nocturnal BP (by ABPM) was correlated with LVH ( 10 ). As previously described, the correlation between central BP and TOD was not better than peripheral BP ( Hu et al ).…”