PREVALENCE AND SIMULTANEOUS OCCURENCE OF MRI ASSESSED CARDIAC AND CEREBRAL TARGET ORGAN DAMAGE AND MICROALBUMINURIA: 7A.07

Abstract

Objective: Target organ damage (TOD) contributes importantly to treatment decisions in patients with arterial hypertension. However, available evidence on the prevalence of multiple TOD is limited. We examined the prevalence and simultaneous occurrence of microalbuminuria (MA) and MRI assessed subclinical TOD of the heart and brain in patients with hypertension. Methods: Seventy-three patients with treated hypertension without known overt cardiovascular disease (41 women; 32 men; mean age ± sd, 44.5years ± 13.3; mean systolic blood pressure, 149.1 mmHg ± 23.9; mean diastolic blood pressure, 89.6 mmHg ± 13.1) were enrolled for the evaluation of subclinical TOD at our hypertension referral center. Patients underwent cardiac and cerebral MRI assessment in addition to standard evaluation including 24-h urine collection for MA. MA was used as a marker of renal TOD, increased left ventricular mass index (left ventricular hypertrophy -LVH- male >85.1 g/m2, female >66.9 g/m2) as marker for cardiac TOD, lacunar brain infarcts, periventricular and deep white matter hyperintensities (PWMH and DWMH) and brain-micro-bleeds (BMB) as markers for cerebral TOD. Results: In 49.3% of the patients TOD was observed. The prevalence of involvement of one, two or three organs was 38.8%, 9.0% and 1.5%, respectively. Microalbuminuria was present in 21.9% and LVH in 9.7% of the patients. Cerebral TOD was present in 30.1% of the patients defined as positive for at least one of following cerebral changes: PWMH (20.5%), SWMH (17.8%), lacunar brain infarcts (9.6%) and BMB (5.5%). The most frequent combinations were MA and cerebral TOD: 5.5% and LVH and cerebral TOD: 4.1%. Conclusions: This is the first time that clustering of MRI assessed TOD and MA are reported. Our results show that: (i) subclinical cerebral TOD is a frequently present phenotypic expression of hypertensive TOD; (ii) multiple target organ abnormalities were observed in approximately 10% of the patients, cerebral/renal and cerebral/cardiac being the most frequent combinations. Early recognition of patients developing organ damage with MRI should be further studied regarding treatment outcome since this may select a target population needing more intensive treatment.