ABSTRACT
Given the increased risk of cardiovascular events associated with resistant hypertension, predictive cardiovascular prognosis is extremely important. Ambulatory blood pressure monitoring (ABPM) is mandatory for resistant hypertension diagnosis, but its use for prognosis is scarce. This observational longitudinal study included 258 patients (mean age of 60.4 ± 11.2 years; 61.2% male), who underwent 24 h ABPM in a hypertension unit from 1999 to 2019. The outcomes were global cardiovascular events (cerebrovascular, coronary, and other cardiovascular events). The mean follow-up period was 6.0 ± 5.0 years. Sixty-eight cardiovascular events (61 nonfatal) were recorded. Patients who experienced cardiovascular events were generally older, with higher rates of chronic kidney disease and prior cardiovascular events. The 24 h systolic blood pressure (hazard ratio 1.44; 95% CI 1.10-1.88), night systolic blood pressure (1.35; 95% CI 1.01-1.80), and 24 h pulse pressure (2.07; 95% CI 1.17-3.67) were independent predictors of global cardiovascular events. Multivariate Cox analysis revealed a higher risk of future cardiovascular events, particularly in patients with a 24 h daytime and nighttime pulse pressure > 60 mm Hg with respective hazard ratios of 1.95; 95% CI 1.01-3.45; 2.15; 95% CI 1.21-3.83 and 2.07; 95% CI 1.17-3.67. In conclusion, APBM is a fundamental tool not only for the diagnosis of resistant hypertension, but also for predicting future cardiovascular events.
ABSTRACT
INTRODUCTION: Hypertension is one of the major risk factors for cardiovascular (CV) disease. Our aim was to assess and stratify the CV risk of two cohorts of hypertensive patients in Portugal attended in primary care (PC) or in outpatient hospital care (HC) using the global CV risk stratification model of the 2007 ESH/ESC guidelines. METHODS: We retrospectively analyzed the clinical data of hypertensive patients (aged 18-75 years) enrolled in other population studies and attended in PC (n = 2299, 66 +/- 11 years, 64% women) or in HC (n = 2028, 51 +/- 14 years, 54.7% women). Global risk stratification was performed according to the 2007 ESH/ESC guidelines. RESULTS: In patients attended in PC (67% treated with antihypertensive drugs, 31% with BP < 140/90 mmHg, 22% with dyslipidemia and 16% with diabetes), added global CV risk was average or low in 26%, moderate in 31%, high in 27% and very high in 16%; in patients attended in HC (77% treated with antihypertensive drugs, 16% with BP <140/90 mmHg, 47% with dyslipidemia and 26% with diabetes), added global CV risk was average or low in 16%, moderate in 30%, high in 28% and very high in 26%. CONCLUSIONS: The majority of hypertensiv patients attended in PC or HC have a high or very high global CV risk according to the 2007 ESH/ECS guidelines. Thus, global CV risk stratification should be undertaken in all hypertensive patients, as well as the implementation and reinforcement of strategies aimed at adequate control of hypertension and of all other modifiable CV risk factors.
