Baseline abnormalities of endothelial function and thrombogenesis in relation to prognosis in essential hypertension.

Abstract

The present study was designed to test the hypothesis that markers of a hypercoagulable state predict subsequent cardiovascular events in hypertensives. To do this, we performed a prospective follow-up analysis of 178 patients (86 male; mean age, 54 years (standard deviation, 15); mean blood pressure, 188/103 mmHg) recruited from a hypertension clinic in a city-centre teaching hospital serving a multi-ethnic population. The main outcome measures were clinical and echocardiographic details, and laboratory markers of thrombosis and haemostasis (fibrinogen, fibrin D-dimer, plasminogen activator inhibitor, soluble P-selectin, von Willebrand factor, and viscosity) that were measured at baseline. After a mean follow-up of 45 months (interquartile range, 37-54), 30 subjects experienced one of a number of endpoints that included death or adverse cardiovascular event. These patients were older (P<0.001) and had significantly higher plasma von Willebrand factor (P=0.015) and fibrin D-dimer levels (P=0.005) compared with those 148 who were free of endpoints at follow-up. There were no statistically significant differences in mean blood pressure, other measured parameters, and the left ventricular mass index between the groups. Using univariate 'time to event' analysis, only high (> or = median) baseline systolic blood pressures were associated with a shortened event-free survival (log rank test, P= 0.0078). We conclude that hypertensive patients who experienced a new cardiovascular event were much older and had more endothelial dysfunction and thrombogenesis than those who were free of complications. However, only high baseline systolic blood pressures were associated with a shortened event-free survival.