Prognosis and risk factors for the adverse course of the disease in patients with arterial hypertension and its resistant form

Abstract

Arterial hypertension (AH) is expected to contribute to approximately 13% of all deaths worldwide in the coming years. Objective — to perform retrospective analysis of the factors of the adverse course of the disease in patients with hypertension who were treated in a specialized department for secondary and pulmonary hypertension of the «NSC M. D. The Strazhesko Institute of Cardiology, Clinical and Regenerative Medicine » NAMS of Ukraine. Materials and methods. The analysis involved data from 524 patients who underwent the following standard examinations: measurement of office blood pressure (BP), 24h‑hours BP monitoring, echocardiography, electrocardiography. All patients received a questionnaire in five years after discharge from the hospital. It included questions about previous adverse events (myocardial infarction, stroke, unstable angina that required hospitalization, kidney failure, heart failure, newly diagnosed diabetes, hospitalization for another cardiovascular reason (aortic aneurysm, coronary artery bypass grafting, unstable angina pectoris, etc.). In case of death of a patient, relatives filled in the questionnaire. Adverse events or death were considered as a combined end point (CEP) of the study. Results. The following main factors, associated with the CEP occurrence in the examined patients, have been established: the age of the patient, systolic blood pressure level at discharge from the hospital, the level of pulse blood pressure (PBP) at discharge from the hospital, the presence of postinfarction cardiosclerosis, a history of stroke, increased size of the left atrium, reduced ejection fraction of the left ventricle, increased thickness of the interventricular septum, left ventricular myocardial mass index greater than 137 g/m2, disturbed daily profile of diastolic blood pressure (DBP), average daytime PBP level ≥ 64 mm Hg. The following risk factors were independent from other factors of CEP occurrence: the level of office PBP at discharge from the hospital ≥64 mmHg, reduced ejection fraction of the left ventricle ( 40%), thickening of the interventricular septum >1.2 cm, the mass index of the left ventricle > 137 g/m2, a decrease in BP during the night period<10%, average daytime BP during daily monitoring blood pressure ≥64 mmHg. Among the indicated factors, the following factors didn’t depend on the administered therapy: office PBP level ≥64 mmHg at discharge, left ventricular ejection fraction reduced by <40%, violation of the daily blood pressure profile (daily blood pressure index <10%) or average daily blood pressure higher than 64 mm Hg. Factors that significantly increased the CEP risk included systolic blood pressure level ≥160 mmHg (patients with resistant AH) and PBP ≥64 mmHg at discharge from the hospital; the CEP risk was increased by these factors was 84 and 66%, respectively. No significant effects on the frequency of occurrence of the combined end point were established for any group of antihypertensive drugs. Conclusions. Treatment‑resistant hypertension was a determining factor in the development of the combined end point. The degree of arterial pressure decrease was more significant for prognosis than the type of antihypertensive agent that lowered it.