INCREASED ARTERIAL STIFFNESS ASSOCIATED WITH BLOOD PRESSURE IS THE PREVALENT HYPERTENSION MEDIATED ORGAN DAMAGE IN YOUNG PATIENTS WITH FIRST DIAGNOSED SYSTOLIC HYPERTENSION

Abstract

Objective: Early onset arterial hypertension (AH) is associated with a considerably increased risk for cardiovascular (CV) disease if left untreated. Hypertension mediated organ damage (HMOD) evaluation is necessary in order to estimate cardiovascular risk in each hypertensive patient. We investigated the incidence of HMOD in young first diagnosed and never-treated patients with systolic arterial hypertension (SH) trying to identify those young patients in high CV risk based on the presence of HMOD. Design and method: In 220 patients, <50 years [median (IQR) age = 43(38-47) years], with SH diagnosed by ambulatory blood pressure monitoring (24-h ABPM), CV risk factors [smoking, obesity (BMI), hyperlipidemia] and 5 HMOD [arterial stiffness (PWV), left ventricular diastolic dysfunction [(DD (EEa)], cardiac hypertrophy (LVMI), coronary arteries microcirculation (CFR), and carotid intima-media thickness (cIMT)] were evaluated before treatment initiation. Results: Smoking (40%) and obesity [median (IQR) BMI = 30(26-32) kg/m2] were found in young hypertensives. HMOD were found in 50% of hypertensives (>1 HMOD while 10% had > 2 HMOD. The most prevalent HMOD were the increased cIMT (32%), PWV (19%), LVH (9%), impaired CFR (6%) and DD (1%). Only PWV (beta = 0.27, p<0.001) and LVMI (beta = 0.41, p<0.001) were associated to systolic BP burden (Figure). In a subgroup analysis, the population with >2 any studied HMOD was older with increased office BP and 24-h ABPM, impaired lipid profile and increased levels of LVMI, PWV, CFR and cIMT compared to the rest of the hypertensives. Conclusions: The presence of >2 any studied HMOD (PWV, LVMI, cIMT, E/Ea, CFR) in young hypertensives characterizes a truly “high-risk population”. Arterial stiffness represents the predominant HMOD in the whole population as well as in the “high-risk hypertensive population”.