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Abdominal Aorta Remodeling in Hypertensive Patients: The Campania Salute Network
Costantino Mancusi1, Ilaria Fucile1, Daniela Pacella2
1Department of Advanced Biomedical Science, Federico II University, Naples, Italy.
Insights
Hypertension can lead to abdominal aortic (AA) remodeling. AA dilatation (≥ 25 mm) in hypertensive patients is linked to increased cardiovascular risk and major adverse cardiovascular events (MACE).
Area of Science:
- Cardiovascular Medicine
- Vascular Biology
- Hypertension Research
Background:
- Current guidelines do not recommend routine abdominal aorta (AA) assessment.
- Hypertension is a significant risk factor for abdominal aortic aneurysm development.
Purpose of the Study:
- To investigate correlations and predictive factors of AA dimension in hypertensive patients.
- To assess the prognostic impact of AA dilatation on cardiovascular risk.
Main Methods:
- Analysis of AA ultrasound data from 3083 hypertensive patients (age ≥ 18).
- Definition of AA dilatation as AA diameter ≥ 25 mm.
- Exploration of correlations with demographics and metabolic profiles, multivariable regression, propensity score modeling, and Kaplan-Meier survival analysis.
Main Results:
- Increased AA diameter was independently associated with older age, male sex, smoking, blood pressure parameters, LV mass index, and aortic root dimension.
- Baseline use of β-blockers and calcium channel blockers showed significant effects.
- AA dilatation (≥ 25 mm) was associated with a significantly higher risk of major adverse cardiovascular events (MACE) during follow-up.
Conclusions:
- Abdominal aorta remodeling is significantly influenced by cardiovascular risk factors and hypertension-related target organ damage.
- Abdominal aorta dilatation is a contributing factor to increased cardiovascular risk in treated hypertensive patients.
Introduction:
Routine assessment of abdominal aorta (AA) is not currently advised by the available guidelines, although hypertension is a major risk factor for the development of AA aneurysm.
Aim:
In the present study, we assessed correlations and predictive factors of AA dimension in a cohort of hypertensive patients.
Methods:
3083 Patients ≥ 18 years old with available AA ultrasound were included. AA dilatation was defined as an AA diameter ≥ 25 mm. Correlations of AA dimension and dilatation with demographics and metabolic profile were explored. Multivariable regression was also used to identify potential confounders influencing univariate correlations. To evaluate the prognostic impact of AA dilatation a propensity score model was implemented, and survival probability curves were constructed using the Kaplan-Meier method.
Results:
Increased AA diameter was independently associated with older age, male sex, active smoking, higher diastolic and lower systolic blood pressure, higher LV mass index and aortic root dimension and less use of β-blockers at baseline (all p < 0.05). A significant effect of baseline use of β-blockers and calcium channel blockers therapy were found (all p < 0.01). During a mean follow-up of 4.76 ± 2.91 years, 32 MACE occurred. Kaplan-Meier analysis showed that having AA ≥ 25 mm is associated with significant risk of MACE compared to patients with AA < 25 mm.
Conclusions:
AA remodeling is strongly influenced by the cardiovascular (CV) risk profile and hypertension mediated target organ damage and AA dilatation contributes to increased CV risk in treated hypertensive patients.
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