THE ASSOCIATION BETWEEN HYPERTENSION SUBTYPES DEFINED BY HOME BLOOD PRESSURE IN HYPERTENSIVE PATIENTS AND INCIDENCE OF HYPERTENSION MEDIATED ORGAN DAMAGE

Abstract

Objective: To investigate the association between different hypertension subtypes, based on home blood pressure measurements, and new-onset hypertension mediated organ damage (HMOD). Design and method: A retrospective cohort study was conducted from January 2019 to March 2023. Patients, who aged at least 18 years and did not have HMOD, were categorized into normotension, isolated diastolic hypertension (IDH), isolated systolic hypertension (ISH), and combined systolic-diastolic hypertension (SDH) based on the average 7-consecutive-day home blood pressure. The primary outcome was a composite of the first following events of HMOD, including ischemic heart disease, heart failure, stroke, chronic kidney disease, new-onset proteinuria, and death. The secondary outcomes consisted of each HMOD and change of estimated glomerular filtration rate (eGFR). Results: The total of 2,351 patients were screened and the 1,314 patients were finally enrolled. The median follow-up period was 24.10 ± 12.54 months. Most of them were women (65.91%) and did not have diabetes mellitus (81.66%). The overall baseline eGFR was 87.75 ± 15.57 ml/min/1.73m2. The average home systolic and diastolic blood pressure were 121.76 ± 7.49/ 73.37 ± 7.10 mmHg in normotensive group, 127.84 ± 5.02/ 88.20 ± 3.48 mmHg in IDH group, 140.60 ± 6.14/ 74.79 ± 7.17 mmHg in ISH group, and 143.45 ± 9.09/ 91.74 ± 5.67 mmHg in SDH group. Multivariable Cox proportional analysis demonstrated that patients with IDH, ISH, and SDH had a similar risk of the composite primary outcome compared to normotensive individuals (adjusted HR of 1.12, 95% CI (0.52 to 2.45), p-value = 0.770 in IDH; adjusted HR of 1.25, 95% CI (0.74 to 2.10), p-value = 0.406 in ISH; adjusted HR of 0.81, 95% CI (0.34 to 1.91), p-value = 0.633 in SDH). However, ISH was significantly associated with an increased risk of slope of eGFR decline (mean change was -2.48 ml/min/1.73m2/year, 95% CI (-3.71 to -1.25), p-value < 0.001). No significant associations were observed for the other secondary endpoints. Conclusions: Although hypertension subtypes defined by home blood pressure might not increase the incidence of composite HMOD, patients with ISH had significantly higher rate of annual renal function loss.