METABOLIC PREDICTORS OF TARGET ORGAN DAMAGE IN ESSENTIAL HYPERTENSION

Abstract

Objective: First, to verify the relationship between hypertension-mediated organ damage (HMOD) and measures of abdominal obesity in essential hypertension. Secondly, to evaluate which condition between overweight (BMI>25 kg/m2), high waist circumference (WC>80/94 cm in females/males) and waist-to-height ratio (WHtR>0.54) is more predictive of HMOD. Design and method: We selected a cohort of adult treated essential hypertensive subjects followed at our Hypertension Center. Blood pressure (BP), height, weight and WC were measured in all subjects. Various investigations were also performed to identify HMOD, such as echocardiography, carotid ultrasound, carotid-femoral pulse wave velocity (PWV) and fundoscopy. Results: 114 subjects were enrolled (46/68 females/males, mean age 69±2 years, mean BP 135/77±3/2 mmHg). WC and WHtR were higher in patients with all expressions of HMOD except for hypertensive retinopathy. In particular, left ventricular mass index (LVMi/BSA) correlates with WHtR (p<0.05), while in obese subjects, in which ventricular mass was indexed as LVMi/h2.7, both WC and WHtR significantly correlate (p<0.05). In subjects with WHtR>0.54, there was a significant risk of increased arterial stiffness by PWVs (OR = 2.479, p = 0.04). This data is confirmed in subjects with BMI>25 kg/m2 (OR = 2.888, p = 0.04) but not in subjects with BMI<25 kg/m2, while no significance was observed for high WC. In the presence of HMOD, a significantly higher number of metabolic syndrome factors (MetS) was observed (3.1 vs. 2.06, p = 0.0008). An OR of 7.55 (p = 0.01) for the presence of HMOD was observed in subjects diagnosed with MetS. Conclusions: In our population, the presence of abdominal obesity may indicate a greater risk of developing HMOD (especially left ventricular hypertrophy and increased arterial stiffness) in essential hypertensive patients. WHtR may be a more sensitive indicator than WC. Furthermore, the significant increase in the risk of HMOD in the presence of MetS may indicate that the synergy between multiple risk factors correlates more strongly with the development of HMOD. Therefore, in the management of essential hypertension, it is of great importance to combine drug therapy with a strategy of reduction of abdominal adipose tissue and the other MetS factors.