J Korean Med Sci.  2020 Dec;35(48):e400. 10.3346/jkms.2020.35.e400.

Hypertension-Mediated Organ Damage and Long-term Cardiovascular Outcomes in Asian Hypertensive Patients without Prior Cardiovascular Disease

• Oh JS
• Lee CH
• Park Ji
• Park HK
• Hwang JK

• KMID: 2509525
• DOI: http://doi.org/10.3346/jkms.2020.35.e400

Abstract

Background
Hypertension-mediated organ damage (HMOD), comprising structural and functional changes in arteries or end organs, is a marker of cardiovascular (CV) disease. However, there are limited data on evaluation of risk of CV disease regarding HMOD, especially in Asians. We sought to investigate the association between CV events and HMOD, and we tried to determine the most important diagnostic marker among the component of HMOD for prevention of mortality and CV events in treated Korean hypertensive patients.
Methods
From January 2008 to December 2010, a total of 35,000 hypertensive Vietnamese War veterans who consecutively visited our hospital for medical check-up were reviewed, and 6,158 patients without established CV disease were enrolled. The patients were divided into two groups as follows: HMOD group (n = 766) and non-HMOD group (n = 5,392). The primary outcome was all-cause death.
Results
Median age was 63.3 years (interquartile range [IQR], 61.4–65.4), and median follow-up was 6.6 years (IQR, 5.9–7.2). Patients with old age, diabetes, and chronic kidney disease were more prevalent in the HMOD group than in the non-HMOD group (all P < 0.05).The lipid profiles were not significantly different between the two groups. Nephropathy was the most prevalent (54.7%) organ damage in the HMOD group. The 6-year incidence of all-cause death was higher in the HMOD group than in the non-HMOD group (22.5% vs.9.0%; adjusted hazard ratio [HR], 1.42; 95% confidence interval [CI], 1.01–2.00; P = 0.04). The incidence of cardiac death, ischemic heart disease, and ischemic and hemorrhagic stroke were also significantly higher in the HMOD group than in the non-HMOD group (P < 0.05, respectively). In multivariate analysis, proteinuria (adjusted HR, 2.21; 95% CI, 1.52–3.20; P < 0.001) was the most powerful independent risk factor to predict all-cause death among components of HMOD. As the degree of proteinuria increased, the rate of all-cause death also increased (long-rank P < 0.001).
Conclusion
HMOD was associated with increased risk of mortality and CV events. Proteinuria was the most powerful independent risk factor for all-cause death, and the degree of proteinuria and mortality rate were proportional. Our data suggest that monitoring of the proteinuria is important to predict long-term CV events in hypertensive patients.

Keyword

Defoliants; Hypertension; Organ Damage; Nephropathy; Proteinuria

Figure

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  Fig. 1 Study scheme.VHSMC = Veterans Health Service Medical Center, HMOD = hypertension-mediated organ damage.

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  Fig. 2 Proportion of hypertension-mediated organ damage.

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  Fig. 3 Cumulative incidence of cardiovascular event between two groups. Comparison of (A) all-cause death, (B) cardiac death, (C) ischemic heart disease, (D) ischemic stroke, (E) hemorrhagic stroke, and (F) MACCE between the two groups.HMOD = hypertension-mediated organ damage, MACCE = major adverse cardiac and cerebrovascular events.

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  Fig. 4 Subgroup analysis for the primary outcome.HMOD = hypertension-mediated organ damage, HR = hazard ratio, CI = confidence interval, CKD = chronic kidney disease.

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  Fig. 5 Cumulative incidence of all-cause death according to degree of proteinuria.

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