Key result
Three sites of hypertension-mediated organ damage linked to ~2.6-fold higher MACE risk.
Why the study?
Chronic pressure overload causes hypertension-mediated organ damage (HMOD) across multiple districts, but the prognostic impact of HMOD at multiple sites along with blood pressure and metabolic control needed evaluation.
Does the presence of multiple sites of hypertension-mediated organ damage increase the risk of major adverse cardiovascular events in hypertensive patients?
Cohort (n=7,237)
Yes
Does the presence of multiple sites of hypertension-mediated organ damage increase the risk of major adverse cardiovascular events in hypertensive patients?
The risk of major adverse cardiovascular events in hypertensive patients increases progressively with the number of organ damage sites, highlighting the need for comprehensive screening beyond just blood pressure control.
Multiple HMOD sites may support risk stratification in hypertension; leaves open whether targeted interventions improve outcomes.
Aims: Chronic pressure overload determines functional and structural alterations, leading to hypertension-mediated organ damage (HMOD), affecting multiple districts. We aim at evaluating the prognostic impact of the absence vs. presence of HMOD in one or more sites and of blood pressure (BP) and metabolic control in hypertensive patients. Methods and results: The study included 7237 hypertensive patients from the Campania Salute Network Registry, followed up for 5.3 ± 4.5 years. As HMOD, we analysed the presence of left ventricular hypertrophy, carotid plaques, and chronic kidney disease (CKD-EPI ≥3 stage) and evaluated the impact of zero vs. one vs. two vs. three sites of HMOD on the occurrence of major adverse cardiovascular events (MACEs). Blood pressure control and Metabolic Score for Insulin Resistance (METS-IR) were also considered. Optimal BP control was achieved in 57.3% patients. Major adverse cardiovascular events occurred in 351 (4.8%) patients. The MACE rate in patients without HMOD was 2.7%, whereas it was 4.7, 7.9, and 9.8% in patients with one, two, and three sites with HMOD, respectively. By using Cox multivariate models, adjusted for age, BP control, mean heart rate, mean METS-IR, number of HMOD sites, and drugs, MACE was found to be significantly associated with ageing, mean METS-IR, anti-platelet therapy, and multiple sites with HMOD, whereas a negative association was found with renin-angiotensin system inhibitor drugs. Conclusion: In hypertensive patients, the risk of MACE increases with the incremental number of districts involved by HMOD, independent of BP control and despite the significant impact of metabolic dysregulation. Hypertension-mediated organ damage involving multiple sites is the deleterious consequence of hypertension and dysmetabolism but, when established, it represents an independent cardiovascular risk factor for MACE occurrence.
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Lembo et al. (2023) conducted a cohort in Arterial hypertension (n=7,237). Hypertension-mediated organ damage (HMOD) in 3 sites vs. Absence of HMOD (0 sites) was evaluated on Major adverse cardiovascular events (MACE) (HR 2.61, 95% CI 1.39-4.93, p=0.003). The presence of three sites of hypertension-mediated organ damage significantly increased the risk of major adverse cardiovascular events compared to patients with no organ damage (HR 2.61).
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