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

Matheus F R A Oliveira1, Walter E M Rocha1, Julia D Soares2

  • 1Department of Internal Medicine, School of Medical Sciences, State University of Campinas, São Paulo, Brazil.

Frontiers in Cardiovascular Medicine
|February 7, 2022
PubMed

Insights

Blood pressure at presentation impacts aortic dissection outcomes differently based on hypertension history. Understanding these factors aids in predicting mortality and organ damage in aortic dissection patients.

Area of Science:

  • Cardiovascular Medicine
  • Hypertension Research
  • Aortic Dissection Studies

Background:

  • Aortic dissection (AD) poses significant mortality risks.
  • The role of baseline blood pressure (BP) and hypertension history in AD prognosis requires further clarification.
  • Left ventricular (LV) remodeling and renal dysfunction are critical complications of AD.

Purpose of the Study:

  • To compare clinical, echocardiographic, and prognostic features of AD patients with and without a history of hypertension (HypHist vs. No-HypHist).
  • To evaluate the association of presenting BP with 1-year mortality, LV remodeling, and renal dysfunction in AD.
  • To investigate the influence of hypertension history and antihypertensive medication use on BP-mortality relationships in AD.

Main Methods:

  • A cohort of 367 AD patients (81% HypHist, 66% Type-A) from three Brazilian centers was analyzed.
  • Clinical and echocardiographic characteristics were collected and compared between HypHist and No-HypHist groups.
  • Statistical analyses included multivariable logistic regression and restricted cubic spline analysis to assess BP associations with outcomes.

Main Results:

  • No-HypHist patients were more likely to have Marfan syndrome or bicuspid aortic valve and less LV hypertrophy.
  • A J-curve association between presenting systolic and diastolic BP and mortality was observed in No-HypHist patients, but not in HypHist patients.
  • Presenting BP was directly associated with LV hypertrophy and concentricity, and pulse pressure inversely associated with reduced eGFR in the overall AD cohort.

Conclusions:

  • Presenting BP, hypertension history, and antihypertensive medication use are crucial for predicting mortality risk in AD.
  • These factors may also help estimate the extent of extra-aortic end-organ damage in AD patients.
  • Tailored risk stratification for AD should consider the interplay between baseline BP, hypertension status, and treatment history.
Abstract

Keywords:
aortic dissectionblood pressurehypertensionleft ventricular remodelingmortality

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