Abstract P219: Risk factors for Accelerated Vascular Aging in Resistant Hypertension: Should we screen our patients earlier?

Abstract

Background: There is an increase in Cardiovascular disease(CVD) mortality rates among young adults worldwide. Patients with resistant hypertension (RHTN) are at particularly high risk for CVD compared to those with more easily controlled hypertension (HTN). RHTN is defined as blood pressure above goal despite using ≥3 antihypertensive medications. The role of accelerated vascular aging (AVA) in this group has not been well investigated. Our study aims to evaluate risk factors for AVA and its role in RHTN. Methods: We conducted a cross-sectional analysis of a large cohort of 965 black and white patients with RHTN referred to the RHTN Clinic at the University of Alabama at Birmingham. Patients with HTN served as a control group. Results: The most compelling data was seen in young patients (age 41-55 yrs). Those with RHTN had significantly higher arterial stiffness than patients with HTN (pulse pressure: 63.3±17.9 vs 51.2 ±11.7 mm Hg, p=<0.001) earlier onset of HTN (34.2 ±7.3 vs 39.4±10.3 yrs, p=0.001) and longer duration (15.5±9.6 vs 10.7±9.0 yrs, p=0.001), higher BMI (35.4±8.3 vs 31.9±6.6 kg/m2), higher Aldosterone Renin Ratio (12.4±13.2 vs 7.9±12.9, p=0.026), and 24-hour urinary sodium excretion (217.2±104.6 vs 182.8±77.2 mmol, p=0.036). Conclusion: Younger patients with RHTN, when compared with HTN, seem to have AVA as evidenced by higher prevalance of obesity, arterial stiffness, overactivation of the renin-angiotensin-aldosterone system, and higher salt intake. Earlier screening, starting at the age of 35 yrs, may help detect AVA quicker and prevent complications associated with RHTN in younger adults