Journal
HYPERTENSION
Volume 79, Issue 3, Pages 505-515Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1161/HYPERTENSIONAHA.121.18502
Keywords
blood pressure; cardiovascular diseases; epidemiology; hypertension; prevalence
Categories
Funding
- National Heart, Lung, and Blood Institute [NO1-HC-25195, HHSN268201500001I, 75N92019D00031]
- National Institutes of Health (NIH) from the National Heart, Lung, and Blood Institute [HL080124, HL071039, HL077447, HL126136, HL107385, HL60040, HL70100, HL131532, HL134168]
- Evans Medical Foundation
- Jay and Louis Coffman Endowment from the Department of Medicine, Boston University School of Medicine
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This study examined the prevalence, correlates, and prognosis of hypertension-mediated organ damage (HMOD) in a community-based study. The findings showed that the prevalence of HMOD varied across different blood pressure guidelines and that the presence of HMOD increased the risk of cardiovascular disease.
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.
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