Risk profile of hypertensive patients

Czech version

Authors: J. Bulas; M. Ilčík; K. Kozlíková; J. Murín
Authors‘ workplace: I. interná klinika Lekárskej fakulty UK a FNsP Bratislava, Slovenská republika, prednostka doc. MUDr. Soňa Kiňová, PhD.
Published in: Vnitř Lék 2010; 56(8): 832-837
Category: 50th Birthday - Jindřich Špinar, MD, CSc., FESC

Overview

Introduction:
Arterial hypertension is an important component of global cardiovascular risk profile of an individual patient. Estimation of global cardiovascular risk besides the blood pressure level incorporates all risk factors (RF), preclinical cardiovascular diseases (hypertension – induced target organ disease – TOD) and associated clinical conditions, and it should influence the therapy and long‑term patient management. A group of metabolic risk factors comprizes several modifyable risk factors, detection of which influences the antihypertensive drug selection. The main goal of antihypertensive therapy is to achieve maximum reduction in the long‑term total risk of cardiovascular disease, treating all modifyable risk factors in hypertensive patients.

Patients and methods:
In this work we present the results of group of 60 hypertensive patients examined for different risk factors detection and subsequent total cardiovascular risk estimation.

Results:
The mean number of risk factors per patient was 4,1 (3% of patients had two RF, 22% of patients had three RF, 37% patients had four factors and 38% patients had five RF present). The ischaemic heart disease was found more frequently among hypertensives with higher number of RF. Metabolic syndrom (MS) was present in 53% of patients. Hypertensives with MS have higher rate of RF (4.9 per person) comparing to thouse without MS (3.6 RF per person).

Conclusion:
We found a quite high number of RF per individual hypertensive patient; the serious unfavourable consequence of this finding was the increased rate of coronary heart disease with the increasing number of risk factors found.

Key words:
arterial hypertension – cardiovascular risk factors – cardiovascular diseases – metabolic syndrome

Sources

1. Stamler J, Stamler R, Neaton JD. Blood pressure, systolic and diastolic, and cardiovascular risks. US population data. Arch Intern Med 1993; 153: 598–615.

2. Devereux RB, Alderman MH. Role of preclinical cardiovascular disease in the evolution from risk factor exposure to development of morbid events. Circulation 1993; 88: 1444–1455.

3. 2007 Guidelines for the Management of Arterial Hypertension. The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2007; 25: 1105–1187.

4. 1999 World Health Organisation‑International Society of Hypertension Guidelines for the Management of Hypertension. Guidelines Subcommittee. J Hypertens 1999; 17: 151–183.

5. 2003 European Society of Hypertension – European Society of Cardiology Guidelines for the management of arterial hypertension. J Hypertens 2003; 21: 1011–1053.

6. Vasan RS, Larson MG, Leip EP et al. Impact of high‑normal blood pressure on the risk of cardiovascular disease. N Engl J Med 2001; 345: 1291–1297.

7. Wilson K. Hypertension, other risk factors and the risk of cardiovascular disease. In: Laragh JH, Brenner BM (eds). Hypertension: Patophysiology, Diagnosis and Management I. New York: Raven Press 1995: 99–114.

8. Lewington S, Clarke R, Qizilbash N et al. Age-specific relevance of usual blood pressure to vascular mortality: a meta‑analysis of individual data for one million adults in 61 prospective studies. Prospective Studies Collaborators. Lancet 2002; 360: 1903–1913.

9. Kannel WB. Update on hypertension as a cardiovascular risk factor. In: Macia G (ed). Manual of Hypertension. London: Churchill Livingstone 2002: 4–19.

10. Reaven GM. Insulin resistance and compensatory hyperinsulinemia: role in hypertension, dyslipidemia and coronary heart disease. Am Heart J 1999; 121: 1283–1288.

11. Kaplan WB. Risk stratification in hypertension: New insight From the Framingham study. Am J Hypertens 2000; 13: 3S–10S.

12. Jacobs DR Jr, Adachi H, Mulder I et al. Cigarette smoking and mortality risk: twenty-five‑year follow‑up of the Seven Countries Study. Arch Intern Med 1999; 159: 733–740.

13. Mortality after 16 years for participants randomized to the Multiple Risk Factor Interventional Trial. Circulation 1996; 94: 946–951.

14. Ecological analyses of the association between mortality and major risk factors of cardiovascular diseases. The World Health Organization MONICA Project. Int J Epidemiol 1994; 23: 505–516.

15. Verschuren WM, Jacobs DR, Bloemberg BP et al. Serum total cholesterol and long‑term coronary heart disease mortality in different cultures. Twenty‑five‑year follow‑up of the Seven Countries Study. JAMA 1995; 274: 131–136.

16. Kannel WB, Neaton JD, Wentworth D et al. Overall and coronary heart disease mortality rates in relation to major risk factors in 325, 348 men screened for the MRFIT. Am Heart J 1986; 112: 825–836.

17. Martin MJ, Hulley SB, Browner WS et al. Serum cholesterol, blood pressure and mortality: implications from a cohort of 361 662 men. Lancet 1986; 2: 933–936.

18. Executive summary of the third report of the NCEP expert panel on detection, evaluation and treatment of high blood cholesterol in adults (adult treatment panel III). JAMA 2001; 285: 2486–2497.

19. Fabryová Ľ. Ateroskleróza. In: Kreze A, Langer P, Klimeš I et al (eds). Všeobecná a klinická endokrinológia. Bratislava: Academic Electronic Press 2004: 553–566.

20. Wilson PW, Garrison RJ, Castelli WP et al. Prevalence of coronary heart disease in the Framingham Offspring Study: role of lipoprotein cholesterols. Am J Cardiol 1980; 46: 649–654.

21. International Diabetic Federation: The IDF consensus worldwide definition of the metabolic syndrome. Update 2006. Available from: http://www.idf.org/webdata/docs/MetS_def_update2006.pdf

22. Tkáč I, Klimeš I, Krahulec B et al. Diagnóza a možnosti liečebného ovplyvnenia metabolického syndrómu. Vyjadrenie stanoviska panelu expertov odborných spoločností. Intern Med 2005; 5: 239–242.

23. Leoncini G, Ratto E, Viazzi F et al. Metabolic syndrome is associated with early signs of organ damage in nondiabetic hypertensive patients. J Intern Med 2005; 257: 454–460.

24. Mancia G, Parati G, Borghi C et al. SMOOTH investigators. Hypertension prevalence, awareness, control and association with metabolic abnormalities in the San Marino population: the SMOOTH study. J Hypertens 2006; 24: 837–843.

25. Souček M. Metabolický syndróm. Vnitř Lék 2005; 51: S61–S66.

26. Alberti KG, Eckel RH, Grundy SM et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the study of Obesity. Circulation 2009; 120: 1640–1645.

27. Navarro J, Redón J, Cea‑Calvo L et al. Metabolic syndrome, organ damage and cardiovascular disease in treated hypertensive patients. The ERIC‑HTA study. Blood Press 2007; 16: 20–27.

28. Empana JP, Duciemetiere P, Balkau B et al. Contribution of the metabolic syndrome to sudden death risk in asymptomatic men: the Paris Prospective Study I. Eur Heart J 2007; 28: 1149–1154.

29. Ho JS, Cannaday JJ, Barlow CE et al. Relation of the number of metabolic syndrome risk factors with all‑cause and cardiovascular mortality. Am J Cardiol 2008; 102: 689–692.

30. Conroy RM, Pyörälä PK, Fitzgerald AP et al. SCORE project group. Estimation of ten‑year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J 2003; 24: 987–1003.

31. Widimský J et al. Hypertenze. Praha: Triton 2008.

32. Kannel WB, Gordon T. Evaluation of cardiovascular risk in the elderly: the Framingham study. Bull N Y Acad Med 1978; 54: 573–591.

33. Daniels SR, Kimball TR, Khoury P et al. Correlates of the hemodynamic determinants of blood pressure. Hypertension 1996; 28: 37–41.

34. Stamler J. Epidemiologic findings on body mass and blood pressure in adults. Ann Epidemiol 1991; 1: 347–362.

35. Neter JE, Stam BE, Kok FJ et al. Influence of weight reduction on blood pressure: a meta‑analysis of randomized controlled trials. Hypertension 2003; 42: 878–884.

36. Després JP. Abdominal obesity: the most prevalent cause of the metabolic syndrome and related cardiometabolic risk. Eur Heart J 2006; 8 (Suppl B): B4–B12.

37. Hrnčiar J. Nové pohľady na obezitu. Obezita ako dominantný fenomén v etiopatogenéze metabolického syndrómu. Intern Med 2007; 7: 473–480.

38. Epstein M, Sowers JR. Diabetes mellitus and hypertension. Hypertension 1992; 19: 403–418.

39. Grossman E, Messerli FH. Diabetic and hypertensive heart disease. Ann Intern Med 1996; 125: 304–310.

40. Bøg‑Hansen E, Lindblad U, Gullberg B et al. Metabolic disorders associated with uncontrolled hypertension. Diabetes Obes Metab 2003; 5: 379–387.

41. Martell N, Mateo J, Fernández C et al. Metabolic syndrome and insulin resistance in newly diagnosed hypertensive’s, treated hypertensive’s and normotensives. J Hypertens 2004; 22 (Suppl 2): A368.

42. Mulè G, Nardi E, Cottone S et al. Influence of metabolic syndrome on hypertension‑related target organ damage. J Intern Med 2005; 257: 503–513.

43. Špinar J, Vítovec J. Metabolický syndrom a kardiovaskulární onemocnění. Vnitř Lék 2009; 55: 653–658.

44. Galajda P, Mokáň M, Prídavková D et al. Prevalencia metabolického syndrómu na Slovensku. Intern Med 2007; 6: 325–331.

45. Redon J, Cífková R, Narkiewicz K. Hypertension in the metabolic syndrome: summary of the new position statement of the European Society of Hypertension. Pol Arch Med Wewn 2009; 119: 255–260.