Risk of heart failure depending on the structure and subclinical target organ damage in patients with hypertension

Abstract

Aim. To determine the risk of heart failure (HF) in patients with hypertension (HTN) depending on the structure of subclinical target organ damage (TOD). Material and methods. The study included 234 patients with HTN without signs of HF. The mean age was 45,96±8,54 years. The patients underwent echocardiography with an assessment of myocardial mass index, ejection fraction, left ventricular diastolic function. Volumetric sphygmoplethysmography with determination of cardio-ankle vascular index (CAVI1) and carotid-femoral pulse wave velocity (PWVcf). Cystatin C blood concentration with the calculation of the glomerular filtration rate (GFR) was performed. NT-proBNP blood levels was also determined. Patients were divided into 4 groups depending on the presence and structure of subclinical TOD. The first group consisted of 74 (31,6%) patients without documented subclinical TOD; the second group — 99 (42,3%) patients with one subclinical TOD; the third group — 42 (18,0%) patients with two TOD; the fourth group -19 (8,1%) patients with three TOD. Results. Patients in the groups differed significantly in blood NT-proBNP concentration (p<0,001). As the amount of TOD increased, NT-proBNP increased above the reference value 125 pg/ml (p=0,010). The odds ratio (OR) and relative risk (RR) of HF, determined by NT-proBNP concentration >125 pg/ml, were significantly associated with the TOD structure compared to the group without confirmed TOD (p=0,035, p=0,21, p=0,044, respectively). Correlation analysis revealed direct relationships between the NT-proBNP level and TOD amount (r=0,56; p<0,005), LVH (r=0,33; p<0,005), cystatin C level (r=0,31; p<0,005), CAVI1 and PWVcf (r=0,23; p<0,005 and r=0,26; p<0,005, respectively). Conclusion. The risk of HF in patients with hypertension depends on the presence and structure of subclinical TOD. With the involvement of one target organ, OR and RR for HF were 4,23 and 3,74, respectively (95% CI for OR, 1,09-19,19; for RR, 1,08-16,03); with the involvement of two target organs — 5,57 (95% CI, 1,2328,51) and 4,70 (95% CI, 1,21-21,84), respectively; with the multiple TOD — 6,31 (95% CI, 1,4-40,83) and 5,19 (95% CI, 1,04-27,95), respectively.