The presence of hypertension-mediated organ damage increased the risk of cardiovascular disease (384 events among 5,865 participants) compared with its absence at every BP category above optimal.
Cohort (n=7,898)
Does the presence of hypertension-mediated organ damage (HMOD) increase cardiovascular disease risk across different blood pressure categories in a community cohort?
The presence of hypertension-mediated organ damage provides incremental prognostic information for cardiovascular disease risk across all blood pressure categories above optimal.
BACKGROUND: Guidelines emphasize screening people with elevated BP for the presence of end-organ damage. METHODS: We characterized the prevalence, correlates, and prognosis of hypertension-mediated organ damage (HMOD) in the community-based Framingham Study. 7898 participants (mean age 51.6 years, 54% women) underwent assessment for the following HMOD: electrocardiographic and echocardiographic left ventricular hypertrophy, abnormal brain imaging findings consistent with vascular injury, increased carotid intima-media thickness, elevated carotid-femoral pulse wave velocity, reduced kidney function, microalbuminuria, and low ankle-brachial index. We characterized HMOD prevalence according to blood pressure (BP) categories defined by four international BP guidelines. Participants were followed up for incidence of cardiovascular disease. RESULTS: The prevalence of HMOD varied positively with systolic BP and pulse pressure but negatively with diastolic BP; it increased with age, was similar in both sexes, and varied across BP guidelines based on their thresholds defining hypertension. Among participants with hypertension, elevated carotid-femoral pulse wave velocity was the most prevalent HMOD (40%-60%), whereas low ankle-brachial index was the least prevalent (<5%). Left ventricular hypertrophy, reduced kidney function, microalbuminuria, increased carotid intima-media thickness, and abnormal brain imaging findings had an intermediate prevalence (20%-40%). HMOD frequently clustered within individuals. On follow-up (median, 14.1 years), there were 384 cardiovascular disease events among 5865 participants with concurrent assessment of left ventricular mass, carotid-femoral pulse wave velocity, kidney function, and microalbuminuria. For every BP category above optimal (referent group), the presence of HMOD increased cardiovascular disease risk compared with its absence. CONCLUSIONS: The prevalence of HMOD varies across international BP guidelines based on their different thresholds for defining hypertension. The presence of HMOD confers incremental prognostic information regarding cardiovascular disease risk at every BP category.
Vasan et al. (Mon,) conducted a cohort in Hypertension-mediated organ damage (n=7,898). Hypertension-mediated organ damage (HMOD) vs. Absence of HMOD was evaluated on Incidence of cardiovascular disease. The presence of hypertension-mediated organ damage increased the risk of cardiovascular disease (384 events among 5,865 participants) compared with its absence at every BP category above optimal.