Different forms of arterial hypertension: a comparative analysis of target-organ damage and cardiovascular outcomes

Aim . To perform a comparative analysis of clinical, laboratory, and instrumental data, and to evaluate the incidence of cardiovascular complications in patients with primary aldosteronism (PA), non-specific aortoarteritis (NAA, also known as Takayasu arteritis), and various types of true resistant hypertension (RH). Materials and Methods. Within an observational retrospective study, the medical records of patients treated between 2015 and 2018 at the 5th Clinical Department of the National Medical Research Centre of Cardiology named after academician E.I. Chazov were analyzed. The patients were divided into four groups: 25 patients with controlled resistant hypertension (cRH), 29 patients with uncontrolled resistant hypertension (uRH), 30 patients with non-specific aortoarteritis, and 26 patients with primary aldosteronism. The non-inclusion criteria were age over 65 years, body mass index (BMI) over 34.9 kg/m², psychiatric/oncological disorders, other secondary forms of arterial hypertension (except for PA and NAA), pregnancy, and lactation. Results . The median age of patients was 55 [48; 57] and 54 [49; 57] years in the controlled (cRH) and uncontrolled (uRH) resistant hypertension groups, and 45 [38; 61] and 52 [46; 59] years in the non-specific aortoarteritis (NAA) and primary aldosteronism (PA) groups, respectively. Gender distribution was uneven across the groups; however, they were comparable in terms of arterial hypertension (AH) duration. Regarding 24-hour ambulatory blood pressure monitoring (ABPM) averages, statistically significant differences in systolic blood pressure (SBP) were observed in the cRH cohort, where values were lower (p<0.001). The NAA group, consisting exclusively of women, demonstrated the most favorable metabolic profile, characterized by the lowest levels of glucose, uric acid, and body mass index (BMI) (p<0.0001, p<0.0014 and p<0.001, respectively). Conversely, the uRH cohort was predominantly composed of overweight men with hyperuricemia. The prevalence of target organ damage (TOD) in the form of left ventricular hypertrophy (LVH) was significantly lower in the cRH cohort (p<0.022). Concurrently, the PA group demonstrated the highest left ventricular mass index (LVMI) values, a high prevalence of LVH, and established cardiorenal associations. A distinctive feature of the NAA group was atherosclerotic involvement of the brachiocephalic arteries (p<0.001). Regarding cardiovascular complications, the development of atrial fibrillation (AF) and myocardial infarction (MI) was specifically characteristic of the PA group (p<0.023 and p<0.022), whereas the incidence of cerebrovascular events was comparable across all patient groups. Conclusion . Thus, each analyzed arterial hypertension (AH) phenotype is characterized by its own unique set of cardiovascular risk factors, diverse mechanisms of target organ damage (TOD), and a specific spectrum of complications. Achieving the target blood pressure (BP) level is not always accompanied by a reduction in cardiovascular risk (CVR) and appears insufficient as the sole requirement. For comprehensive risk stratification in patients with secondary and resistant hypertension, it is essential to consider the specific features of the underlying disease, myocardial structural changes, renal function, metabolic status, and vascular alterations in addition to traditional risk factors. Identifying factors with prognostic significance will optimize personalized assessment of cardiovascular complications and improve the long-term prognosis in these patient populations.