未经治疗的动脉高血压的早期发作与心血管(CV)疾病的风险增加有关。高血压介导的器官损伤(HMOD)的评估有助于估计CV风险。我们首先调查了年轻人的HMOD发病率,诊断和从未治疗过的收缩期动脉高血压(SH)患者,以根据HMOD的存在确定高CV风险患者。
CV危险因素[吸烟,肥胖(体重指数,BMI)],高脂血症和5HMODs[动脉僵硬度(脉搏波速度,PWV),左心室舒张功能障碍[(DD(E/Ea)],心脏肥大(左心室质量指数,LVMI),冠状动脉微循环(CFR),和颈动脉内膜中层厚度(cIMT)]在治疗开始前对220例患者进行了评估,年龄≤50岁[中位数(四分位数间距,IQR)年龄=43(38-47)],通过动态血压监测(24小时ABPM)诊断为SH。
在年轻高血压患者中发现吸烟(40%)和肥胖[中位数(IQR)BMI=30(26-32)kg/m2](40%)。在50%的高血压患者中发现了HMOD(10%的HMOD≥2)。最普遍的HMOD增加了cIMT(32%)和PWV(19%),LVH(9%),CFR(6%)和DD(1%)受损。只有PWV(β=0.27,p<0.001)和LVMI(β=0.41,p<0.001)与收缩压负荷相关。在亚组分析中,≥2HMOD的患者年龄较大,办公室血压和24小时ABPM升高,血脂受损,并增加LVMI,PWV,CFR,和cIMT与其他高血压患者相比。
存在≥2的研究HMOD(PWV,LVMI,cIMT,E/Ea,年轻高血压患者的CFR)是“高危人群”的特征。动脉僵硬度代表了整个人群和“高危人群”中占主导地位的HMOD。
Early onset of untreated arterial hypertension is associated with an increased risk for cardiovascular (CV) diseases. The evaluation of hypertension-mediated organ damage (HMOD) helps estimating CV risk. We investigated the incidence of HMOD in young first, diagnosed and nevertreated patients with systolic arterial hypertension (SH) to identify high CV-risk patients based on the presence of HMOD.
CV risk factors [smoking, obesity (body mass index, BMI)], hyperlipidemia and 5 HMODs [arterial stiffness (pulse wave velocity, PWV), left ventricular diastolic dysfunction [(DD (E/Ea)], cardiac hypertrophy (left ventricular mass index, LVMI), coronary artery microcirculation (CFR), and carotid intima-media thickness (cIMT)] were evaluated before treatment initiation in 220 patients, aged ≤50 years [median (interquartile range, IQR) age=43(38-47)], with SH diagnosed by ambulatory blood pressure monitoring (24-h ABPM).
Smoking (40%) and obesity [median (IQR) BMI=30(26-32) kg/m2](40%) were found in young hypertensives. HMOD was found in 50% of hypertensives (10% had ≥2 HMOD). The most prevalent HMODs were increased by cIMT (32%) and PWV (19%), LVH (9%), impaired CFR (6%) and DD (1%). Only PWV (beta=0.27, p<0.001) and LVMI (beta=0.41, p<0.001) were associated with systolic BP burden. In a subgroup analysis, patients with ≥2 HMOD were older with increased office BP and 24- h ABPM, impaired lipid profile, and increased LVMI, PWV, CFR, and cIMT compared with the rest of the hypertensives.
The presence of ≥2 of the studied HMOD (PWV, LVMI, cIMT, E/Ea, CFR) in young hypertensives characterizes a \"high-risk population\". Arterial stiffness represents the predominant HMOD and in the whole population and \"high-risk population\".