Echocardiographic predictors of progression from prehypertension to hypertension

Prehypertension (PHT) was recently introduced by replacing former categories of high-normal and above-optimal blood pressure (BP). The rationale for redefining this new category was to emphasize the excess cardiovascular risk associated with BP in this range and to focus high risk for developing hypertension (HT). However, no clear definite markers to identify prehypertensive patients at high risk of progressing to HT have been established yet. Accordingly, we aimed to establish echocardiographic predictors of progression from PHT to HT.

The study population consisted of 98 eligible prehypertensive patients. All patients underwent echocardiographic examination including coronary flow reserve (CFR) at baseline. Twenty-nine (30%) patients developed HT during the 3-year follow-up period. Creatinine level, left ventricular mass index (LVMI), mitral Em and Em/Am had a trend towards a significant crude odds ratio (OR) for the development of HT; however, only baseline SBP [OR = 1.18, 95% confidence interval (CI) = 1.06-1.31; P = 0.002), having metabolic syndrome (OR = 3.75, 95% CI = 1.43-9.78; P = 0.007), high-density lipoprotein (HDL) cholesterol (OR = 0.92, 95% CI = 0.86-0.98; P = 0.01), presence of microalbuminuria (OR = 3.53, 95% CI = 1.11-11.2; P = 0.03) and CFR (OR = 0.65, 95% CI = 0.53-0.77; P = 0.02) were significant independent predictors of progression of PHT into HT. The best cutoff value of CFR to predict incident HT was 1.98 with 94% sensitivity and 79% specificity.

This prospective study suggested that baseline SBP, having metabolic syndrome, HDL cholesterol level, presence of microalbuminuria and CFR reflecting coronary microvascular function, but not left ventricular diastolic function parameters, were significant independent markers to identify participants with PHT at high risk for incident HT.