Risk profile in hypertension genesis: A five-year follow-up study

Pathogenesis of primary hypertension remains unclear, because many heterogeneous factors (diet, physiologic, and psychological factors) are simultaneously involved. We have conducted an original analysis to study the influence of the combination of these factors on BP evolution.

Seven homogeneous clusters were constituted from 213 healthy normotensive subjects taking into account 10 variables. Those variables used to cluster homogeneous "risk profiles" are usually considered as potential risk factors for hypertension: age, body mass index, alcohol consumption, sodium/potassium urinary ratio, systolic blood pressure (SBP) and heart rate response to mental stress, baroreflex sensitivity (BRS), job demand, job latitude, and behavioral pattern (personality score). Five-year BP evolution (DeltaSBP or Deltadiastolic BP [DBP]) was compared between risk profiles.

Four clusters of subjects representing about 50% of the population had a significantly higher 5-year DeltaSBP (>or=5 mm Hg) compared to the 5-year DeltaSBP of the two clusters in which SBP did not increase. These four clusters had a low BRS. Two profiles that group six unfavorable risk factors had the most detrimental 5-year DeltaSBP. Interestingly, perceived high job demand in a cluster of younger subjects with a high personality score and a low BRS had also a detrimental SBP evolution.

The major interest of this study is to highlight that hypertension development is not univocal between subjects and that different combinations of factors could explain differential BP evolution in groups of subjects sharing the same risk profile. A lower BRS was a consistent predictor for detrimental 5-year BP evolution.