Abstract
ObjectiveThis study compared clinical, echocardiographic, and prognostic characteristics among patients with aortic dissection (AD) with (HypHist) and without (No-HypHist) hypertension history and evaluated the association of blood pressure (BP) at presentation with 1-year mortality, left ventricular (LV) remodeling and renal dysfunction.MethodsWe investigated clinical and echocardiographic characteristics and 1-year mortality among 367 patients with AD (81% HypHist, 66% Type-A) from three Brazilian centers.ResultsPatients with No-HypHist were more likely to have Marfan syndrome, bicuspid aortic valve, to undergo surgical therapy, were less likely to have LV hypertrophy and concentricity, and had similar mortality compared with HypHist patients. Adjusted restricted cubic spline analysis showed that systolic BP (SBP) and diastolic BP (DBP) at presentation had a J-curve association with mortality among patients with No-HypHist, but did not associate with death among patients with HypHist (p for interaction = 0.001 for SBP and = 0.022 for DBP). Conversely, the association between SBP at presentation and mortality was influenced by previous use of antihypertensive medications in the HypHist group (p for interaction = 0.002). Results of multivariable logistic regression analysis comprising the whole sample showed direct associations of SBP and DBP at presentation with LV hypertrophy (p = 0.009) and LV concentricity (p = 0.015), respectively, and an inverse association between pulse pressure at presentation and estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2 (p = 0.008).ConclusionCombined information on BP at presentation, previous diagnosis of hypertension, and use of antihypertensive medications might be useful to predict mortality risk and to estimate extra-aortic end-organ damage among patients with AD.
Highlights
Patients with aortic dissection (AD) have high mortality risk and usually present high rates of alternative organ damage with prognostic value, including left ventricular (LV) remodeling and renal dysfunction [1,2,3,4]
Results of multivariable Cox-regression analysis adjusted for age, sex, center, calendar time, history of controlled hypertension prior to AD, AD type, in-hospital treatment modality, AD presentation, estimated glomerular filtration rate (eGFR), previous beta-blocker use, and LV geometric patterns confirmed no association between hypertension and 1-year mortality [hazard ratio (HR), 0.66; 95% CI, 0.39–1.14; p = 0.14]
We evaluated the relationship between Blood pressure (BP) components and 1-year mortality by multivariable restricted cubic splines analysis adjusted for age, sex, center, calendar time, history of controlled hypertension prior to AD, AD type, in-hospital treatment modality, AD presentation, eGFR, previous beta-blocker use, LV geometric patterns, and patients with a history of hypertension (HypHist) status (Figure 2)
Summary
Patients with aortic dissection (AD) have high mortality risk and usually present high rates of alternative organ damage with prognostic value, including left ventricular (LV) remodeling and renal dysfunction [1,2,3,4]. Low BP values at presentation are associated with higher mortality [10, 11], even though a Jcurve relationship between systolic BP (SBP) and in-hospital mortality has been suggested in alternative AD populations [12]. It is unknown whether the impact of BP at presentation on prognosis is influenced by a previous diagnosis of hypertension. Whether BP at presentation could be a marker of alternative organ damage in patients with AD remains to be established
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