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Cardiovascular Risk and Atherosclerosis Progression in Hypertensive Persons Treated to Blood Pressure Targets.
- Source :
-
Hypertension (Dallas, Tex. : 1979) [Hypertension] 2019 Dec; Vol. 74 (6), pp. 1436-1447. Date of Electronic Publication: 2019 Nov 04. - Publication Year :
- 2019
-
Abstract
- Arterial hypertension promotes atherosclerosis and cardiovascular events. We evaluated how cardiovascular risk and atherosclerosis progression are associated with blood pressure, antihypertensive treatment, and treatment efficacy. In 3555 participants of the population-based Heinz Nixdorf Recall study without previous cardiovascular disease (mean±SD; age, 58.9±7.6 years, 46.9% men), we analyzed associations of baseline antihypertensive treatment efficacy (normotension without antihypertensives, normotension with antihypertensives, hypertension without antihypertensives, hypertension with antihypertensives, based on 140/90 mmHg cutoffs) with incident coronary artery calcification (CAC) and CAC progression during 5-year-follow-up and with incident cardiovascular events during 13.5-year-follow-up. We further evaluated associations of incident arterial hypertension and efficacy of new antihypertensive treatment at the 5-year-follow-up with subsequent cardiovascular events. At baseline, 1706 participants had normotension without antihypertensives, 553 normotension with antihypertensives, 786 hypertension without antihypertensives, and 510 hypertension with antihypertensives. Six hundred forty-seven participants experienced rapid CAC progression. One hundred seven, 132, and 249 had incident stroke, coronary event, and cardiovascular event, respectively. Compared with normotensives without antihypertensives, normotensives with antihypertensives had an elevated stroke (hazard ratio, 2.33 [95% CI, 1.19-4.55]), coronary (2.04 [95% CI, 1.20-3.45]), and cardiovascular (2.23 [95% CI, 1.48-3.36]) risk, and increased baseline CAC, but not increased CAC progression. Participants without hypertension at baseline, who were newly hypertensive but achieved normotension with antihypertensives at the 5-year-follow-up, again exhibited elevated stroke (4.80 [95% CI, 1.38-16.70]) and cardiovascular (2.99 [95% CI, 1.25-7.16]) risk, whereas coronary risk was less elevated (2.24 [95% CI, 0.70-7.18]). Normotensives with antihypertensives have an elevated cardiovascular risk. They are characterized by elevated baseline CAC but show no signs of increased CAC progression.
- Subjects :
- Age Factors
Aged
Analysis of Variance
Blood Pressure Determination methods
Cardiovascular Diseases physiopathology
Cohort Studies
Comorbidity
Coronary Artery Disease physiopathology
Female
Germany
Humans
Hypertension diagnosis
Male
Middle Aged
Prevalence
Proportional Hazards Models
Prospective Studies
Registries
Risk Assessment
Sex Factors
Statistics, Nonparametric
Vascular Calcification epidemiology
Vascular Calcification physiopathology
Antihypertensive Agents therapeutic use
Cardiovascular Diseases epidemiology
Coronary Artery Disease epidemiology
Disease Progression
Hypertension drug therapy
Hypertension epidemiology
Subjects
Details
- Language :
- English
- ISSN :
- 1524-4563
- Volume :
- 74
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Hypertension (Dallas, Tex. : 1979)
- Publication Type :
- Academic Journal
- Accession number :
- 31679426
- Full Text :
- https://doi.org/10.1161/HYPERTENSIONAHA.119.13827