Characterization of participants with a disproportionate degree of hypertension-mediated organ damage: the Maastricht study

Background: Although there is a well established link between blood pressure (BP) levels and the severity of hypertension-mediated organ damage (HMOD), some patients with hypertension exhibit a disproportionate degree of HMOD relative to their BP. Objective: This study aims to define disproportionate degrees, relative to blood pressure, of left ventricular hypertrophy (LVH) measured by Sokolow–Lyon (SL) index and of arterial stiffness measured by carotid-femoral pulse wave velocity (PWV), and to assess the sex differences and characteristics of individuals with such disproportional SL index and PWV. Methods: SL index was analysed in 6487 participants of The Maastricht Study [50.9% men; 23.7% type 2 diabetes mellitus (T2DM)]. PWV was analysed in 6239 participants (51.3% men; 23.5% T2DM). The residuals of linear regression models for the relationship between SL index or PWV and 24 h mean arterial pressure (MAP) was used to define participants with disproportional SL index and PWV, respectively. Individuals with higher-than-expected (>90th percentile of the residuals) and lower-than-expected (<10th percentile) of SL index or PWV were defined as subclinical HMOD. A multinomial regression analysis was conducted to identify the clinical characteristics associated with subclinical HMOD. Results: Males and females with higher SL index than expected based on their 24 h MAP, were older, had a higher BMI and were more often living with type 2 diabetes in comparison to those in the as-expected and lower-than-expected groups. In line, men who are living with diabetes are 34% less likely to be in the group with lower-than-expected SL index while women living with prediabetes and type 2 diabetes are 40% more likely to be in the group with higher-than-expected SL index. Likewise, males and females with higher-than-expected PWV were older and more often living with type 2 diabetes than those in the as-expected and lower-than-expected groups. Conclusions: Persons who are older, or living with obesity and/or T2D are more likely to have subclinical HMOD, than would be expected based on their prevailing level of BP. Therefore, these clinical determinants would result in higher-than-expected HMOD. Treating those with overweight and obesity with prediabetes and diabetes more aggressively will likely reduce subclinical HMOD.