Comparative importance of target organ damage for risk stratification in hypertension

Introduction: Arterial hypertension (HT) is a major risk factor for cardiovascular and cerebrovascular di-seases, along with other factors such as smoking, dia-betes, obesity, hypercholesterolemia and that can initi-ate and aggravate endothelial dysfunction. As a result, the increase in the number of people affected by HT and its consequences have become a problem of public health management and economic impact for popula-tions where the frequency is statistically significant. In order to prevent or stop the progression of endothelial dysfunction in hypertensive patients without target or-gan damage (TOD) but with cumulative cardiovascular risk factors, it is important to identify which circulating markers are more clinically relevant and which non-in-vasive techniques are those more efficient.
Methods: The prospective study included 223 hyper-tensive patients divided into 2 groups depending on the presence or absence of TOD: 140 patients with TOD (group 1) and 83 without TOD (group 2), compared with a control group of 74 healthy age-matched sub-jects (CON). The protocol included clinical, biochemi-cal assessment, vascular ultrasound and echocardio-graphy parameters. Statistical analysis was made using SPSSv17, test one way (ANOVA) the Pearson linear correlation coefficient and of the probability p.
Results: The proportion of patients from group 2 with family history of cardiovascular diseases is significantly higher than those in the other two groups (p=0.001). DBP values are significantly elevated in group 2 com-pared to group 1 (p<0.001). Body mass index (BMI) was significantly increased for the group 1 compared to group 2 and CON (p<0.001). The mean blood glucose level for the group 1 was significantly higher than the mean values for the other two groups (p<0.001). To-tal cholesterol (TC) values were significantly elevated in group 2 (p<0.001). Triglycerides (TG) values were significantly elevated in group 1 compared to group 2 (p=0.031). The heart rate, TC, high sensitive C-reactive Protein (hs-PCR), BMI and left ventricular myocar-dial thickness (LVMT) values were significantly low in the control group versus the hypertensive patients (p<0.001). HDL and ejection fraction were significantly increased in the control group compared with the other two groups (p<0.001). LDL was significantly reduced in the control group compared to group 2 (p=0.02). Fi-brinogen was significantly increased in group 1 com-pared with group 2 and CON; and for group 2 versus CON (p<0.001).
Conclusions: Hypertensive patients with TOD have more pathogenic changes than patients without. Fi-brinogen and hs-PCR, correlated with renal damage and lipid profile are useful parameters that could be included in a multi-marker stratification algorithm for hypertensive patients. Echocardiography parameters correlated with markers of inflammation could be used in the clinic for the early diagnosis of subclinical athe-rosclerosis. Hypertensive patient management should be centered on the overall assessment and control of all cardiovascular risk factors, prevention and therapeutic conduct should be personalized according to the profi-le and characteristics of each patient.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
ESC search engine
CODE: 379
CME Credits: 10 (Romanian College of Physicians)