Cardiovascular Events In Hypertensive Patients Research Articles

THE PROGNOSTIC VALUE OF FATTY LIVER INDEX FOR CARDIOVASCULAR EVENTS IN HYPERTENSIVE PATIENTS

Objective: The prevalence of on-alcoholic fatty liver disease (NAFLD) has been increasing rapidly worldwide affecting 25–30% of population. Fatty liver index (FLI) is a validated marker of NAFLD and can be used as a screening tool for hepatic steatosis. The purpose of the study was to evaluate the relationship between FLI and the risk of major cardiovascular events in hypertensive patients. Design and method: 903 hypertensive patients without history of cardiovascular disease participated in the study (mean age 52.7 ± 11.4 years; males 55%; baseline clinic BP 149.8 ± 15.2/95.5 ± 10.1 mmHg). Participants were prospectively evaluated for a mean follow-up period of 6.0 ± 3.3 years with at least one annual visit. The diagnosis of NAFLD was based on FLI and consequently patients were divided in two groups according to the presence of NAFLD. The primary endpoint was a composite of major cardiovascular events. Results: The incidence of cardiovascular events during the follow up was 8.5% (n = 77). Patients without NAFLD (n = 625) had better BP control compared to their counterparts with NAFLD (n = 278) during follow up (43% vs 33%, p = 0.02). A Cox-regression analysis indicated that age (HR 1.09 CI 1.04–1.13, p < 0.01), smoking (HR 2.4 CI 1.1–5.2, p = 0.03) and FLI (HR 2.7 CI 1.9–4.1, p < 0.001) were significant independent determinants of the outcome. The presence of NAFLD at baseline visit was also a significant independent determinant of the outcome (HR 5.2 CI 2.4–11.1, p < 0.001). Conclusions: FLI has an independent prognostic value for the incidence of cardiovascular events in hypertensive patients. Therefore, it could be useful in identifying patients at higher risk of cardiovascular events. Further studies will clarify whether the early treatment of NAFLD could reduce the incidence of cardiovascular disease.

Prognostic Value of Time in Blood Pressure Target Range Among Patients With Heart Failure

BackgroundBlood pressure (BP) is a continuous and dynamic measure. However, standard BP control metrics may not reflect the variability in BP over time. ObjectivesThis study assessed the prognostic value of time in BP target range among hypertensive patients with heart failure (HF). MethodsThe authors performed a post hoc analysis of data from the TOPCAT (Treatment of Preserved Cardiac Function HF with an Aldosterone Antagonist) trial and the BEST (Beta-Blocker Evaluation of Survival Trial). Time in target range (TTR) for each patient was calculated using linear interpolation across the study period with the target range of systolic BP between 120 and 130 mm Hg. ResultsA total of 4,789 hypertensive patients (n = 1,654 from BEST and n = 3,135 from TOPCAT) were included. The cumulative incidences of primary endpoint (ie, cardiovascular death or HF hospitalization) were highest among the top quartile of TTR with a dose-dependent manner across quartiles (Ptrend <0.005). The top quartile of TTR was significantly associated with a lower risk of primary outcome using adjusted Cox regression model (HR: 0.71; 95% CI: 0.60-0.82), cardiovascular mortality (HR: 0.68; 95% CI: 0.55-0.84), HF hospitalization (HR: 0.70; 95% CI: 0.58-0.85), all-cause mortality (HR: 0.69; 95% CI: 0.58-0.83), and any hospitalization (HR: 0.76; 95% CI: 0.67-0.85). Further analyses using restricted cubic spline indicated a linear relationship between TTR and primary outcome. Similar patterns were observed in the individual trial. Sensitivity analyses generated consistent results while redefining target range as 110 to 130 mm Hg for systolic BP or 70 to 80 mm Hg for diastolic BP. ConclusionsTTR could independently predict major adverse cardiovascular events in hypertensive patients with HF.

Design of a pragmatic clinical trial embedded in the Electronic Health Record: The VA's Diuretic Comparison Project

BackgroundRecent US guidelines recommend chlorthalidone over other thiazide-type diuretics for the treatment of hypertension based on its long half-life and proven ability to reduce CVD events. Despite recommendations most clinicians prescribe hydrochlorothiazide (HCTZ) over chlorthalidone (CTD). No randomized controlled data exist comparing these two diuretics on cardiovascular outcomes. MethodsThe Diuretic Comparison Project (DCP) is a multicenter, two-arm, parallel, Prospective Randomized Open, Blinded End-point (PROBE) trial testing the primary hypothesis that CTD is superior to HCTZ in the prevention of non-fatal CVD events and non-cancer death. Patients with hypertension taking HCTZ 25 or 50 mg were randomly assigned to either continue their current HCTZ or switch to an equipotent dose of CTD. The primary outcome is time to the first occurrence of a composite outcome consisting of a non-fatal CVD event (stroke, myocardial infarction, urgent coronary revascularization because of unstable angina, or hospitalization for acute heart failure) or non-cancer death. The trial randomized 13,523 patients at 72 VA medical centers. The study is conducted by a centralized research team with site procedures embedded in the electronic health record and all data collected through administrative claims data, with no study related visits for participants. The trial will have 90% power to detect an absolute reduction in the composite event rate of 2.4%. ResultsEnrollment ended in November 2021. There are 4128 participting primary care providers and 16,595 patients individually consented to participate, 13,523 of whom were randomized. ConclusionsDCP should provide much needed evidence as to whether CTD is superior to HCTZ in preventing cardiovascular events in hypertensive patients. Clinical trial registrationNCT02185417 [https://clinicaltrials.gov/ct2/show/NCT02185417].

Nebivolol and incident cardiovascular events in hypertensive patients compared with nonvasodilatory beta blockers.

Nonvasodilatory beta blockers are associated with inferior cardiovascular event reduction compared with other antihypertensive classes, and there is uncertainty about first-line use of beta blockers for hypertension in guidelines. The third generation vasodilatory beta blocker nebivolol has unique beneficial effects on central and peripheral vasculature. Our objective was to compare longitudinal cardiovascular outcomes of hypertensive patients taking nebivolol with those taking the nonvasodilatory beta blockers metoprolol and atenolol. We performed a retrospective cohort analysis of hypertensive adults in the University of Colorado health system, without preceding diagnosis of cardiovascular or cerebrovascular disease. The primary outcome was composite incident heart failure, stroke, myocardial infarction, angina, or coronary revascularization. Mahalanobis 1:2 distance matching and Cox proportional hazards regression was used. Matching and regression variables included baseline demographics, socioeconomic factors, medical insurance type, prescribing provider type, cardiovascular risk factors, Charlson comorbidity index, other medications, and follow-up duration. After matching, patients were predominantly women (54%, 3085 of 5705) and non-Hispanic Caucasian (79%, 4534 of 5705), with median age of 58. In matched Cox regression analysis, nebivolol was associated with 17% reduction in incident cardiovascular events compared with all nonvasodilatory beta blockers [hazard ratio 0.83, 95% confidence interval (CI) 0.74-0.94, P = 0.004], and 24% reduction compared with metoprolol (hazard ratio 0.76, CI 0.66-0.87, P = 0.0001). The vasodilatory beta blocker nebivolol was associated with reduced incident cardiovascular events compared with nonvasodilatory beta blockers. Additional study of other beta blockers is necessary to determine if this is a vasodilatory beta blocker class effect or is specific to nebivolol.

Clinical factors predictive of cardiovascular events at six months after acute coronary syndrome in hypertensive patient

Stratification of the risk of cardiovascular events after acute coronary syndrome is an important step, all the more so in hypertensive patients in order to optimize and orient therapeutic management in the acute phase or in the short-term. The objective of our work is identify the clinical factors predicting of the residual risk of cardiovascular events (reinfarction, ischemic recurrence, heart failure, major hemorrhage and rehospitalization) after acute coronary syndrome in the hypertensive patient after six months of follow-up. We recruited 302 patients hospitalized in intensive cardiology care unit who are treated according to the recommended protocols and followed in intra-hospital and after one year of discharge from the hospital, two groups of patients were individualized: acute coronary syndromes with history of hypertension and acute coronary syndromes without hypertension. We have (173) 57.3% hypertensive patients/(129) 42.7% non-hypertensive, 28.2% women/71.2% man, the mean of age was 63.1 years. Hypertensive patients were older, more of STEMI, non-smoker with a higher prevalence of women, diabetes, metabolic syndrome and more cardiovascular risk factors. There was more mortality and major cardiovascular events in the SCA with hypertension. The parameters related to the occurrence of cardiovascular events in hypertensive patients with SCA after logistic regression are; age ≥ 65 years (RR = 1.67; 95% CI = 1.10–2.57, P = 0.01), systolic blood pressure < 110 mmHg (RR = 1.97; 95% CI = 1.23–3.16, P < 0.01), diastolic blood pressure < 70 mmHg (RR = 2.16; 95% CI = 1.47–3.17, P < 0.01) and KILLIP ≥ 2 (RR = 5.32; 95% CI = 3.33–8.50, P < 0.01). The residual risk is greater in the hypertensive patient who is an acute coronary syndrome, the integration of clinical markers of prediction specific for the hypertensive population after an acute coronary syndrome makes it possible to orient the early practical attitude according to the risk.

Role of homoeopathic management in the reduction of microalbuminuria of essential hypertension

Hypertension is the most common risk factor for cardiovascular disease. The effect of elevated blood pressure has increased the death and disability rates in recent years. There is an increase frequency of cardiovascular events in hypertensive patients with microalbuminuria compared to those with normal urine albumin excretion. Microalbuminuria is a marker of target organ damage in hypertension, as it results in functional and structural changes. This study is an attempt to evaluate the role of homoeopathic medicines in reduction of microalbuminuria of essential hypertension.Objective: To evaluate the role of homoeopathic medicines in lowering Microalbuminuria in patients with Essential Hypertension.Methods: The study design adopted was quasi experimental prospective, non-randomized without control. Each case was subjected to systolic blood pressure (SBP), diastolic blood pressure (DBP) and Urine albumin excretion (UAE) at baseline, three months after the treatment and six months after the treatment.Result: All parameters showed significant ‘p’ values. There was a mean fall of SBP, DBP and Urine albumin level after 6months of homoeopathic treatment. Conclusion: In this study the Homoeopathic management is found to be effective in reducing the urine microalbumin of essential hypertension.

Triglyceride and Glucose Index and Sex Differences in Relation to Major Adverse Cardiovascular Events in Hypertensive Patients Without Diabetes.

IntroductionStudies from recent decades have suggested that women have a lower risk of cardiovascular disease than men due to their characteristics, but hyperglycemia and hyperinsulinemia caused by IR (insulin resistance) might reverse this gender-protective effect. This study examined whether there were sex differences in the relationship between IR [evaluated by triglyceride and glucose index (TyG index)] and major adverse cardiovascular events (MACEs) in hypertensive patients without diabetes.MethodsThis was a post-hoc analysis of the Systolic Blood Pressure Intervention Trial (SPRINT). We explored the relationship between TyG index and MACEs by multivariate Cox proportional hazard regressions and two-piecewise linear regression models. The primary endpoint was MACEs, same as SPRINT, defined as a composite of myocardial infarction, stroke, heart failure, and/or death from cardiovascular causes. We used multiple adjustment models for all regressions.ResultsA total of 9,323 patients from the SPRINT were included in our analysis. TyG index was significantly related to the risk of MACEs in every adjusted model. Each 1 unit increase in TyG index increased the risk of MACEs in total participants (HR, 1.40; 95% CI, 1.20–1.64; P<0.01) and men (HR, 1.42; 95% CI, 1.18–1.71; P=0.02). However, TyG index was not associated with MACEs among female hypertensive patients (HR, 1.33; 95% CI, 0.97–1.82; P=0.0776). There was no interaction between the sex and TyG index (P for interaction= 0.73). We also used the two-stage linear regression model and did not find any threshold effect. There was no significant interaction in other confounders.ConclusionWe found the TyG index was associated with MACEs in the hypertensive patients, and there was no gender difference between the TyG index and MACEs.

Association between oral health and cardiovascular outcomes in patients with hypertension: a nationwide cohort study.

Studies on the association of oral hygiene indicators with cardiovascular disease in hypertensive patients have been lacking. Oral hygiene is directly or indirectly associated with systemic inflammation, one of the essential mechanisms of cardiovascular disease. Therefore, we hypothesized that oral hygiene would be related to the risk of cardiovascular diseases in hypertensive patients. We included 52 677 hypertensive participants who completed oral health checkups from the Korean National Health Insurance Service-National Health Screening Cohort between 2003 and 2004. We collected data on periodontitis diagnosis and treatment history, number of teeth loss, number of dental caries, and frequency of tooth brushing from medical records of health claims and oral health examination. The primary outcome was defined as composite outcomes of stroke and myocardial infarction. Follow-up was done until the date of primary outcome, or 31 December 2015. During the 11.26 ± 2.39 years (mean ± standard deviation) of the study follow-up, 3292 participants developed primary outcomes [stroke (n = 2430), myocardial infarction (n = 862)]. In multivariable Cox regression analyses, participants with dental caries (≥ 5) were independently associated with occurrence of a primary outcome [adjusted hazard ratio: 1.37; 95% confidence interval (CI):1.10-1.72; P = 0.006]. Frequent tooth brushing (≥ 2 times/day) was significantly related to lower risk of primary outcomes (adjusted hazard ratio: 0.88; 95% CI: 0.81-0.96; P = 0.002). Our study demonstrated that multiple dental caries were related to the risk of cardiovascular diseases in hypertensive patients. Better oral hygiene may attenuate the risk of cardiovascular events in hypertensive patients.

Atrial fibrillation is an independent predictor of cardiovascular events in patients with primary aldosteronism

Abstract Background A higher risk of cardiovascular events has been reported in patients with hypertension due to primary aldosteronism (PA) than essential hypertension. This study sought to determine the independent predictors for the risk of cardiovascular events in hypertensive patients with PA. Methods The Japan Primary Aldosteronism Study (JPAS) has retrospectively recruited 3,654 patients with PA between January 2006 and January 2019 as a nationwide registry and we evaluated the differences between patients with and without AF from these data. The patients underwent general laboratory test, electrocardiography, echocardiography, diagnostic confirmatory tests including saline-loading, captopril-challenge, and upright furosemide-loading tests and adrenal venous sampling (AVS). We evaluated the cardiovascular events including myocardial infarction, stroke, heart failure and renal failure, with a mean follow-up duration of approximately 4 years. Results The prevalence of AF was 2.4% (88/ 3,654). PA patients with AF were older (60.3 vs 52.8 years old), more male (77.3% vs 46.6%) and had longer duration of hypertension (14.3 vs 8.3 years) than those without AF. Each prevalence of cerebral infarction (12.5% vs 3.5%), chronic kidney disease (12.5% vs 4.8%), coronary artery disease (CAD) (10.2% vs 1.7%), heart failure (5.7% vs 0.7%) and left ventricular hypertrophy evaluated by echocardiography (46.4% vs 31.9%) was higher in PA patients with AF. Patients with AF had more kinds of antihypertensive drugs (1.3 vs 1.1). There was no significant difference of basal plasma aldosterone concentration (PAC), plasma renin activity, each confirmatory tests, lateralized ratio in AVS after stimulation with adrenocorticotropic hormone (ACTH) and laterality between the 2 groups. Logistic regression analysis showed that age, cardiothoracic ratio (CTR), past history of CAD and heart failure were independent determinants for AF. PA patients with AF had higher rates of cardiovascular events compared to those without AF (Figure, P&amp;lt;0.005). Multivariate Cox regression analyses demonstrated AF in addition to adrenal PAC before ACTH stimulation, age, hypokalemia and duration of hypertension as independent prognostic factors for cardiovascular events (hazard ratio [HR] 1.993, 95% confidence interval [CI] 1.042–3.815, P&amp;lt;0.05; HR 1.ehab724.231608, 95% CI 1.ehab724.231604–1.ehab724.231612, P&amp;lt;0.0005; HR 1.03, 95% CI 1.012–1.048, P&amp;lt;0.005; HR 1.748, 95% CI 1.242–2.461, P&amp;lt;0.005; HR 1.029, 95% CI 1.013–1.044, P&amp;lt;0.0005, respectively). Conclusions This study provides evidence that comorbid AF is associated with older age, male sex, X-ray CTR and prevalence of CAD and heart failure. Furthermore, AF is an independent predictor of cardiovascular events in patients with PA, in addition to the adrenal venous concentration of aldosterone, hypokalemia, older age and duration of hypertension. Earlier recognition and intervention of AF can prevent cardiovascular events in PA. Funding Acknowledgement Type of funding sources: None. Figure 1

Lipoprotein (a), hypertension, and cardiovascular outcomes: a prospective study of patients with stable coronary artery disease.

Although emerging data suggest that circulating lipoprotein (a) [Lp (a)] could predict cardiovascular events (CVEs) in patients with cardiovascular disease, no study is currently available regarding the prognostic linkage of Lp (a) and hypertension in patients with coronary artery disease (CAD). This study sought to evaluate the association of Lp (a), hypertension and cardiovascular outcomes in patients with stable CAD. A total of 8668 patients with stable CAD were consecutively enrolled. Baseline Lp (a) concentrations were measured. All subjects were categorized according to Lp (a) levels of <10 (low), 10-30 (medium) and ≥30 mg/dL (high) and were further stratified by hypertension status. They were regularly followed-up for the occurrence of cardiovascular death, nonfatal myocardial infarction, and stroke. Over an average of 54.81 ± 18.60 months of follow-up, 584 (6.7%) CVEs occurred. Kaplan-Meier and multivariate Cox regression analyses showed that elevated Lp (a) levels had a significant association with CVEs in hypertensive patients, regardless of the control status of blood pressure, but not in normotensive subjects. Moreover, when analyzed by subgroups according to both Lp (a) category and hypertension status, the risk of CVEs was only significantly elevated in the high Lp (a) plus hypertension group compared with the reference group with low Lp (a) levels and normotension (hazard ratio: 1.80, 95% confidence interval: 1.11-2.91). Elevated Lp (a) was associated with an increased risk of CVEs in stable CAD patients with hypertension. Moreover, the coexistence of high Lp (a) concentrations and hypertension greatly worsened the clinical prognosis in patients with CAD, which may suggest a prognostic correlation between Lp (a) and hypertension.

Abstract 079: Nebivolol Associated With Reduced Incident Cardiovascular Events In Hypertensive Patients Compared With Non-vasodilatory Beta Blockers

Introduction: Beta blockers are not guideline-recommended first-line agents for hypertension, based on evidence that older generation beta blockers such as atenolol are associated with inferior reduction of some cardiovascular events compared to other antihypertensive classes. Vasodilatory beta blockers such as nebivolol have been found to have beneficial effects on peripheral vasculature through nitric oxide, endothelin-1, and tissue plasminogen activator pathways. The objective of this study is to compare longitudinal cardiovascular outcomes of hypertensive patients taking the vasodilatory beta blocker nebivolol with hypertensive patients taking the non-vasodilatory beta blockers atenolol and metoprolol. Hypothesis: Nebivolol will be associated with a reduction in odds of adverse cardiovascular outcomes compared with non-vasodilatory beta blockers. Methods: The study is a retrospective cohort analysis of de-identified data from adults in the University of Colorado health system with hypertension and on the vasodilatory beta blocker nebivolol or the non-vasodilatory beta blockers atenolol or metoprolol, without preceding diagnosis of cardiovascular or cerebrovascular disease. The primary outcome is incident cardiovascular hospitalization or diagnosis of cardiovascular event including heart failure, stroke, myocardial infarction, angina pectoris, or coronary revascularization based on diagnosis or procedure codes. Nearest-available propensity matching logistic regression was used, with each patient taking nebivolol matched to two control patients taking a non-vasodilatory beta blocker. Propensity matching variables included baseline demographics, cardiovascular risk factors, Charlson comorbidity index, other cardiovascular medications, and duration of follow-up. Results: There were 1395 patients taking nebivolol, and 20208 patients taking atenolol or metoprolol. Patients were predominantly female (54%, 11681 of 21603) and non-Hispanic white (75%, 16185 of 21603), with mean age of 60. The primary outcome occurred in 19% (259 of 1395) of those taking nebivolol, 29% (1891 of 6527) of those taking atenolol, and 40% (5500 of 13681) of those taking metoprolol. In propensity matched logistic regression, nebivolol is associated with reduced odds of incident cardiovascular events when compared to the non-vasodilatory beta blockers atenolol and metoprolol (OR 0.33, 95% CI 0.28 to 0.40). This association was also found with individual comparison with atenolol (OR 0.47, 95% CI 0.39 to 0.57) and metoprolol (OR 0.26, 95% CI 0.21 to 0.32). Conclusions: The vasodilatory beta blocker nebivolol is associated with reduced odds of incident cardiovascular events compared to non-vasodilatory beta blockers. Additional study of other beta blockers is necessary to determine if this is a vasodilatory beta blocker class effect, or is specific to nebivolol.

Long-term evolution of ambulatory blood pressure and cardiovascular events in hypertensive patients.

Ambulatory blood pressure monitoring (ABPM) is now considered the gold standard to evaluate BP, and predicts related cardiovascular risk. However, no study has reported the association of long-term changes in ABPM with the incidence of cardiovascular events, therefore the objective of this work. We included patients from the Bordeaux cohort of hypertensive patients, who had undergone at least two ABPM; the first was performed before or after antihypertensive treatment was started, and the second was the last recording available before any cardiovascular event. We included 591 patients (mean age, 54 years) with a 7-year average interval between the first and last ABPM, a 10-year average follow-up, and a total of 111 cardiovascular events. The patients were divided into four groups: G0, first and last 24 h systolic blood pressure (SBP) < 130; G1, first 24 h SBP ≥ 130, last 24 h SBP < 130; G2, first 24 h SBP < 130, last 24 h SBP ≥ 130; and G3, first 24 h SBP ≥ 130, last 24 h SBP ≥ 130 mmHg. Baseline ABPM better predicted future events than the last ABPM. G0 and G2 had similar survival. G1 and G3 had a worse prognosis than G0 and G2, while G1 had an intermediate risk between G0 and G3, indicating some benefit of treatment. In conclusion, our study showed the prognostic value of the first ABPM recorded in hypertensive patients and the persistence of risk when 24 h BP is controlled by antihypertensive treatment.

ASSESSMENT OF CARDIOVASCULAR EVENTS IN HYPERTENSIVE PATIENTS AT RISK FOR HEART FAILURE USING GERIATRIC NUTRITIONAL RISK INDEX

Objective: The management of hypertension in heart failure (HF) stage classification A/B is important to prevent the development of symptomatic HF. In addition, malnutrition is commonly prevalent in patients with HF. On the other hand, the relationship between malnutrition and cardiovascular prognosis in hypertensive patients at risk for HF stage A / B has not yet been fully validated. This study aimed to evaluate the association between the Geriatric Nutritional Risk Index (GNRI), one of the most commonly used nutritional indicators, and long-term outcomes in hypertensive patients at risk for HF stage A/B. Design and method: We retrospectively investigated 418 hypertensive patients at risk of HF stage A/B. GNRI was calculated at baseline as follows: GNRI = [14.89 × serum albumin (g/dl) + [41.7 × (body weight/body weight at body mass index of 22)]]. Patients were then stratified into tertiles based on GNRI. The study endpoint was a composite of cardiovascular (CV) event, including CV death, non-fatal myocardial infarction, and non-fatal stroke. Results: Over a 6.0-year median follow-up, 49 CV events occurred. Using Kaplan-Meier analysis, patients with lower GNRI group (&lt;103.2, n = 139) showed worse prognosis compared with those with middle GNRI group (103.2 to &lt; 111.1, n = 139) and higher GNRI group (&gt;111.1, n = 140) (Chi-square value 10.8; p = 0.005, log-rank test). In the multivariate Cox proportional hazards analysis, lower GNRI group was significantly associated with the incidence of CV events (hazard ratio 2.23, 95% confidence incidence interval 1.14–4.39, p = 0.02) compared with higher GNRI group after adjusting for confounding factors. Conclusions: GNRI was significantly associated with CV events in hypertensive patients at risk for heart failure stage A/B. The assessment of GNRI might be a useful index to predict CV events in hypertensive patients at risk for HF stage A/B.

IMPACT OF PERCUTANEOUS TRANSLUMINAL RENAL ANGIOPLASTY ON LEFT VENTRICULAR MASS AND ITS RELATIONSHIP TO CARDIOVASCULAR OUTCOME IN HYPERTENSIVE PATIENTS WITH RENAL ARTERY STENOSIS

Objective: Renal artery stenosis (RAS) is associated with secondary hypertension, which is often resistant to antihypertensive medication.The aim of the present study was to evaluate the impact of renal angioplastry on left ventricular (LV) mass, as measured by echocardiography, and further to determine whether LV mass reduction is associated with reduced rates of cardiovascular events in hypertensive patients with RAS. Design and method: A total of 144 hypertensive patients with RAS (mean age 69 years; 22.2% fibromuscular dysplasia [FMD]) who underwent angioplasty were included. Echocardiography was performed at baseline and after one year, and were thereafter followed up for a median of 5.6 years for the primary composite outcomes. The primary endpoint of this study was first occurrence of the composite of cardiovascular events including all-cause death, myocardial infarction, stroke, or adverse aortic event. Results: In both the FMD and atherosclerotic stenosis (ARAS) groups, LV mass decreased after angioplasty, but the decrease in LV mass index (-15.4 ± 18.3% versus -0.8 ± 27.8%, p &lt; 0.01) as well as the regression rate of LV hypertrophy was greater in FMD. Multiple logistic regression analysis indicated that FMD (odds ratio [OR] 2.94, p &lt; 0.01), severe RAS (greater than or equal to 90%) (OR 2.94, p &lt; 0.05), and higher LV mass index at baseline (OR 2.94 for 1 standard deviation increase, p &lt; 0.001) were independent predictors of LV mass index decrease of at least 20%. The primary composite outcomes occurred in 45 patients (31.3%). In FMD, lower LV mass index after one year (hazard ratio 2.81 for 1 standard deviation increase, p &lt; 0.05) or regression of LV mass (hazard ratio 0.75 for 5% decrease, p = 0.054) showed a tendency to be associated with better outcomes; however, these associations were not found in ARAS. Conclusions: Hypertensive patients with ARAS have less regression of LV mass in response to angioplasty than those with FMD, and LV mass regression is less useful as a surrogate marker of outcomes especially in ARAS.

Effects of inhibition of the renin-angiotensin system on hypertension-induced target organ damage: clinical and experimental evidence.

The dysregulation of renin-angiotensin-system (RAS) plays a pivotal role in hypertension and in the development of the related target organ damage (TOD). The main goal of treating hypertension is represented by the long-term reduction of cardiovascular (CV) risk. RAS inhibition either by angiotensin converting enzyme (ACE)-inhibitors or by type 1 Angiotensin II receptors blockers (ARBs), reduce the incidence of CV events in hypertensive patients. Actually, ACE-inhibitors and ARBs have been demonstrated to be effective to prevent, or delay TOD like left ventricular hypertrophy, chronic kidney disease, and atherosclerosis. The beneficial effects of RAS blockers on clinical outcome of hypertensive patients are due to the key role of angiotensin II in the pathogenesis of TOD. In particular, Angiotensin II through an inflammatory-mediated mechanism plays a role in the initiation, progression and vulnerability of atherosclerotic plaque. In addition, Angiotensin II can be considered the hormonal transductor of the pressure overload in cardiac myocytes, and through an autocrine-paracrine mechanism plays a role in the development of left ventricular hypertrophy. Angiotensin II by modulating the redox status and the immune system participates to the development of chronic kidney disease. The RAS blocker should be considered the first therapeutic option in patients with hypertension, even if ACE-inhibitors and ARBs have different impact on CV prevention. ARBs seem to have greater neuro-protective effects, while ACE-inhibitors have greater cardio-protective action.

Short-term blood pressure variability, arterial stiffness, and cardiovascular events: results from the Bordeaux cohort.

Short-term blood pressure variability derived from 24-h ambulatory monitoring is associated with poor cardiovascular prognosis. However, previous analyses of this have clearly been influenced by clinical cofounders, particularly blood pressure (BP) level. Arterial stiffness is a powerful marker of cardiovascular risk, which may influence BP variability. In this study, we assessed the prognostic value of BP variability based on 24-h ambulatory measurements and adjusted for arterial stiffness. Population: Bordeaux cohort of hypertensive patients. Inclusion criteria were 24-h ambulatory BP monitoring at baseline with measurements every 15' day and night, determination of wake-up time and bedtime, and assessment of arterial stiffness with monitoring of Korotkoff sound arrival time. A total of 969 patients (age 54 ± 14 years) with an average follow up of 120 ± 78 months and 178 cardiovascular recorded events were included. In univariate survival analyses, the standard deviations of day, night, and 24-h SBP were associated with the occurrence of cardiovascular events. The standard deviation of night-time SBP showed the strongest association with the outcome variable and was entered into multivariate analyses. In multivariate analyses, night-time SBP variability remained significantly associated with the occurrence of cardiovascular events after adjusting for major cardiovascular risk factors, 24-h SBP, and arterial stiffness. BP variability and arterial stiffness showed no significant association. Our results suggest that variability of night-time SBP is an important marker of the risk of cardiovascular events in hypertensive patients, independently of average 24-h BP and arterial stiffness.

Effect of Heart Rate on Major Adverse Cardiovascular Events in Hypertensive Patients with Different Ages and Genders.

What is already known on this topic? The increase of heart rate will increase blood pressure, and the cardiovascular risk will increase when heart rate >80 beats/min (bpm) in patients with hypertension. What is added by this report? Compared with patients who were female, <65 years old, and with hypertension, patients who were male, ≥65 years old, and with hypertension had the lowest risk of major adverse cardiovascular events (MACE) at baseline heart rate (HR) of 70–74 bpm. What are the implications for public health practice? Patients with hypertension should control their blood pressure well, and the HR of male and elderly patients should be managed well at the same time.

Abstract 13211: Atrial Fibrillation is an Independent Predictor for Cardiovascular Events in Hypertensive Patients Due to Primary Aldosteronism

Introduction: A higher risk of cardiovascular events has been reported in patients with hypertension due to primary aldosteronism (PA) than essential hypertension. Hypothesis: This study sought to determine the independent predictors for the risk of cardiovascular events in hypertensive patients with PA. Methods: The nation-wide PA registration study (JPAS/JRAS) included patients aged 20 years and older. Data were collected between January 2006 and January 2019, with a mean follow-up duration of approximately 4 years. Characteristics of patients with or without atrial fibrillation (AF) on the diagnosis of PA were compared. Patients were treated by surgery or MR antagonists and incident cardiovascular events were followed up. Results: A total of 3,647 patients with PA were included at the time of analysis. Prevalence of AF was 2.4% (87/ 3,647). PA patients with AF were older, more male and had longer duration of hypertension than those without AF. Each prevalence of cerebral infarction, chronic kidney disease, coronary artery disease, heart failure and left ventricular hypertrophy evaluated by echocardiography was higher in PA patients with AF than those without AF. Patients with AF had more kinds of antihypertensive drugs. There was no significant difference of basal plasma aldosterone concentration, plasma renin activity, unilateral subtype and rate of surgery between the 2 groups. PA patients with AF had higher rates of cardiovascular events compared to those without AF (14.9% vs 6.7%, P=0.002). Multivariate cox regression analyses demonstrated AF in addition to older age, male gender, duration of hypertension and surgery performance as an independent prognostic factor for cardiovascular events (HR, 1.950 [95%CI, 1.021-3.726], P&lt;0.05; HR, 1.023 [95%CI, 1.008-1.039], P=0.003; HR, 1.385 [95%CI 1.025-1.870], P&lt;0.05; HR, 1.023 [95%CI, 1.008-1.038], P=0.002; HR, 1.580 [95%CI, 1.168-2.138], P=0.003;respectively). Conclusions: Among patients with PA, male gender, older age, and longer duration of hypertension are the predisposing factors of AF in PA patients. In addition, AF was an independent risk factor for cardiovascular events in PA patients. It is warranted to prevent and to treat appropriately AF in patients with PA.

Abstract 15487: Combined Effects of Lipoprotein(a) and Hypertension in Predicting Cardiovascular Outcomes in Patients With Coronary Artery Disease

Introduction: Although emerging data have suggested that circulating lipoprotein(a) [Lp(a)] could predict cardiovascular events (CVEs) in patients with cardiovascular disease, no study is currently available regarding the prognostic significance of Lp(a) in patients with hypertension. Hypothesis: We assessed the hypothesis that there is a prognostic linkage between hypertension and Lp(a) concentrations in patients with coronary artery disease (CAD). Methods: A total of 8668 patients with stable CAD were consecutively enrolled. Baseline Lp(a) concentrations of them were measured. All subjects were categorized according to Lp(a) levels of &lt;10 (low), 10-30 (medium) and 30 mg/dL (high) and were further stratified by hypertension status. They were regularly followed-up for the occurrence of cardiovascular death, non-fatal myocardial infarction and stroke. Results: Over an average of 54.81±18.60 months follow-up, 584 (6.7%) CVEs occurred. Kaplan-Meier and multivariate Cox regression analyses showed that elevated Lp(a) levels had a significant association with CVEs in hypertensive patients, regardless of the control status of blood pressure, but not in normotensive subjects. Moreover, when subgrouping according to both Lp(a) categories and hypertension status, the risk for CVEs was only significantly elevated in high Lp(a) plus hypertension group compared with the reference group with low Lp(a) levels and normotension (hazard ratio: 1.85, 95% confidence interval: 1.19-2.85). Conclusions: In conclusion, elevated Lp(a) was associated with higher risk for CVEs in CAD patients with hypertension and the coexistence of high Lp(a) concentrations and hypertension greatly worsened the clinical prognosis. Our findings may present a prognostic linkage between hypertension and Lp(a) concentrations in patients with CAD.

Association of small dense LDL-cholesterol with disease severity, hypertension status and clinical outcome in patients with coronary artery disease.

Previous studies have demonstrated that small dense LDL-cholesterol (sdLDL-C) is related to the pathogenesis of coronary artery disease (CAD). However, its prognostic role in hypertensive patients with CAD has been undetermined. The aim of the study was to investigate the association between sdLDL-C with disease severity, hypertensive status and clinical outcome in patients with CAD. A total of 4594 patients with angiography-proven CAD were consecutively enrolled and categorized into subgroups according to blood pressure status. Serum sdLDL-C levels were measured by direct quantitative measurement using automated chemistry analyzers. The severity of coronary artery lesions were determined by Gensini score, Syntax score and the number of lesion vessels. The associations of sdLDL-C with disease severity, hypertensive status and cardiovascular events (CVEs) were evaluated. Patients with hypertension had higher sdLDL-C levels than ones without (P = 0.010). In hypertensive patients, sdLDL-C was positively associated with the severity of CAD (P < 0.05). In addition, hypertensive patients with poorly controlled hypertension had higher sdLDL-C levels than those with well controlled (P < 0.05). Moreover, 149 CVEs occurred in patients with poorly controlled hypertension and Cox regression analysis indicated that elevated sdLDL-C levels were independently associated with CVEs in hypertensive patients with poorly controlled hypertension (adjusted hazard ratio: 1.673, 95% confidence interval: 1.105-2.535, P = 0.015). The current data, for the first time, showed that serum sdLDL-C levels were correlated with hypertension control, disease severity and worse outcomes in hypertensive patients with CAD, suggesting that paying more attention on sdLDL-C in these patients were warranted.