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Hypertension-Mediated Organ Damage: Prevalence, Correlates, and Prognosis in the Community
Ramachandran S Vasan1,2,3, Rebecca J Song3, Vanessa Xanthakis1,2,4
1Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (R.S.V., V.X., A.B.).
Insights
Hypertension-mediated organ damage (HMOD) is common and increases cardiovascular disease risk. Early screening for HMOD is crucial for better risk prediction and management in hypertensive patients.
Area of Science:
- Cardiology
- Nephrology
- Neurology
- Public Health
Background:
- Clinical guidelines recommend screening for end-organ damage in individuals with elevated blood pressure (BP).
- Hypertension-mediated organ damage (HMOD) represents a critical indicator of cardiovascular risk.
- Understanding HMOD prevalence and prognosis is essential for effective hypertension management.
Purpose of the Study:
- To determine the prevalence, correlates, and prognostic significance of HMOD in a community-based cohort.
- To assess HMOD across different blood pressure categories defined by international guidelines.
- To evaluate the association between HMOD and subsequent cardiovascular disease (CVD) events.
Main Methods:
- The Framingham Study cohort (7898 participants) was analyzed for various HMOD markers.
- HMOD assessments included left ventricular hypertrophy, brain imaging, carotid artery measures, pulse wave velocity, kidney function, microalbuminuria, and ankle-brachial index.
- Prevalence was examined across BP categories, and participants were followed for CVD incidence.
Main Results:
- HMOD prevalence increased with age and systolic BP, and varied by guideline definitions of hypertension.
- Among hypertensive participants, elevated carotid-femoral pulse wave velocity was most common (40%-60%), while low ankle-brachial index was least common (<5%).
- HMOD presence significantly increased CVD risk across all BP categories, independent of BP levels.
Conclusions:
- The prevalence of HMOD differs based on international blood pressure guidelines.
- HMOD provides significant prognostic information for cardiovascular disease risk at all blood pressure levels.
- Screening for HMOD is vital for refining cardiovascular risk assessment in hypertensive individuals.
Background:
Guidelines emphasize screening people with elevated BP for the presence of end-organ damage.
Methods:
We characterized the prevalence, correlates, and prognosis of hypertension-mediated organ damage (HMOD) in the community-based Framingham Study. 7898 participants (mean age 51.6 years, 54% women) underwent assessment for the following HMOD: electrocardiographic and echocardiographic left ventricular hypertrophy, abnormal brain imaging findings consistent with vascular injury, increased carotid intima-media thickness, elevated carotid-femoral pulse wave velocity, reduced kidney function, microalbuminuria, and low ankle-brachial index. We characterized HMOD prevalence according to blood pressure (BP) categories defined by four international BP guidelines. Participants were followed up for incidence of cardiovascular disease.
Results:
The prevalence of HMOD varied positively with systolic BP and pulse pressure but negatively with diastolic BP; it increased with age, was similar in both sexes, and varied across BP guidelines based on their thresholds defining hypertension. Among participants with hypertension, elevated carotid-femoral pulse wave velocity was the most prevalent HMOD (40%-60%), whereas low ankle-brachial index was the least prevalent (<5%). Left ventricular hypertrophy, reduced kidney function, microalbuminuria, increased carotid intima-media thickness, and abnormal brain imaging findings had an intermediate prevalence (20%-40%). HMOD frequently clustered within individuals. On follow-up (median, 14.1 years), there were 384 cardiovascular disease events among 5865 participants with concurrent assessment of left ventricular mass, carotid-femoral pulse wave velocity, kidney function, and microalbuminuria. For every BP category above optimal (referent group), the presence of HMOD increased cardiovascular disease risk compared with its absence.
Conclusions:
The prevalence of HMOD varies across international BP guidelines based on their different thresholds for defining hypertension. The presence of HMOD confers incremental prognostic information regarding cardiovascular disease risk at every BP category.
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