Prevalence and Correlates Of High Normal Blood Pressure

Transcription

1 Slide ١ Prevalence and Correlates Of High Normal Blood Pressure MAGDY ABDEL HAMID, MD Associate Professor of Cardiology Cairo University

2 Slide ٢

3 Slide ٣ Prevalence of High Normal BP In the US, 13 % of the adult population have high normal BP Approximately 60% of American adults have prehypertension In Egypt, 17% of the studied population had high normal blood pressure (NHP,1999)

4 Slide ٤ Target Organ Damage Begins Before hypertension is Diagnosed As blood pressure increase,signs of target organ damage (worsening renal function & high LV mass index) increase : - 7% of patients with optimal BP - 13% of patients with normal BP - 23% of patients with high normal BP Fesler, AHA,2003

5 Slide ٥ Target Organ Damage in High Normal Blood Pressure Parameter LVH (Echo) LVH ( ECG) MI Heart failure ESRD Stroke PVD Retinopathy(III) Number (n= 294) Percentage (% ) Egyptian NHP, 1999

6 Slide ٦ Rates of progression to hypertension over 4 years in individuals <65 years BP class Optimum (<120/80 mm Hg) Normal ( /80 129/ mm Hg) High-normal ( /85 139/ mm Hg) Number of patients year rate of hypertension* (95% CI) 5.3% ( ) 17.6% ( ) 20.3) 37.3% ( ) *Hypertension defined as 140/90 mm Hg Vasan RS et al. Lancet 2001:358(9294);1682-6

7 Slide ٧ Rates of progression to hypertension over 4 years in individuals 65 years BP class Optimum (<120/80 mm Hg) Normal ( /80 129/ mm Hg) High-normal ( /85 139/ mm Hg) Number of patients year rate of hypertension*(95% CI) 16.0% ( ) 20.9) 25.5% ( ) 49.5% ( ) *Hypertension defined as 140/90 mm Hg Vasan RS et al. Lancet 2001:358(9294);1682-6

8 Slide ٨ High-normal blood pressure progression to hypertension in the Framingham Heart Study The probability of individuals with blood pressure in the high-normal range developing hypertension is twofold to threefold higher than in those with normal blood pressure For men with high-normal blood pressure, systolic blood pressure and change in weight were identified as risk factors for future hypertension Vasan RS et al. Lancet 2001:358(9294);1682-6

9 Slide ٩ Relationship of Blood Pressure To 25-year Mortality Due to CAD, CVD & all cause Mortality in Young Adult Men Classification Adjusted RR for CHD mortality (95% CI) Adjusted RR for CVD mortality (95% CI) RR for all-cause mortality (95% CI) Optimal Stage 1 Hypertension 1.39 ( ; p=ns) 1.00 (reference) Normal 1.00 (reference) High normal 1.37 ( ( ; p=ns) 2.13; p<0.1) 1.62 ( ; p<0.05) 1.28 ( ; p=ns) 1.50 ( ; p<0.1) 1.29 ( ; p=ns) 1.00 (reference) 1.15 ( ; p=ns) 1.31 ( ; p<0.05) Miura et al. Arch Int Med 2001; 161:

10 Slide ١٠ The Strong Heart Study : Association of Prehypertension with LV structure & Function Variable LV mass (g) Normal BP 144 ± 32 PreHTN 155 ± 35* Stage 1 HTN 167 ± 42* Stage 2 HTN 181 ± 49* LVH (%) * 32.3 * 48.4 * Concentric LVH (%) * Eccentric LVH (%) * 29.1* 42.3* Concentric remodeling (%) *p < p< 0.01 JACC,2004., 43 (5 suppl A) :513A

11 Slide ١١ High-Normal Blood Pressure and Microalbuminuria Substudy from NHANES III (9,462 normotensive individuals without diabetes ) Results : Compared with optimal blood pressure,high-normal BP was significantly associated with increased Odds of microalbuminuria Conclusion : Microalbuminuria may be a biomarker of the increased cardiovascular risk in this population Am J Kidney Dis. 2003;41:

12 Slide ١٢ Metabolic Syndrome Metabolic syndrome increases risk for CHD, CVA, ESRD and T2DM Lowering of BP to normal levels could prevent approximately 28% of CHD events in men and 13% of CHD events in women, while control to optimal levels would prevent about 28% of CHD events in men and 45% of CHD events in women Am J Cardiol ,91:

13 Slide ١٣ Young Men With High - Pressure Have : Normal Blood Smaller LDL size Lower Serum Adiponectin Higher Elevated Heart Rate Kazumi et al, Diabetes Care, 2002

14 Slide ١٤ Conclusions The BP relationship to risk of CVD is continuous, consistent, and independent of other risk factors High normal BP often progress to hypertension High normal BP increases the risk of cardiovascular death and nonfatal cardiovascular events Global risk assessment is mandatory in individuals with high normal blood pressure