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• W4211081528 abstract "HomeHypertensionVol. 79, No. 3Interrelations Between High Blood Pressure, Organ Damage, and Cardiovascular Disease: No More Room for Doubt Free AccessEditorialPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyRedditDiggEmail Jump toFree AccessEditorialPDF/EPUBInterrelations Between High Blood Pressure, Organ Damage, and Cardiovascular Disease: No More Room for Doubt Karri Suvila and Teemu J. Niiranen Karri SuvilaKarri Suvila https://orcid.org/0000-0002-3543-9350 Department of Medicine, Turku University Hospital and University of Turku, Finland (K.S., T.J.N.). Search for more papers by this author and Teemu J. NiiranenTeemu J. Niiranen Correspondence to: Teemu J. Niiranen, Department of Medicine, University of Turku, Kiinamyllynkatu 4–8, 20014 University of Turku, Finland. Email E-mail Address: [email protected] https://orcid.org/0000-0002-7394-7487 Department of Medicine, Turku University Hospital and University of Turku, Finland (K.S., T.J.N.). Department of Public Health Solutions, Finnish Institute for Health and Welfare, Turku, Finland (T.J.N.). Search for more papers by this author Originally published9 Feb 2022https://doi.org/10.1161/HYPERTENSIONAHA.121.18786Hypertension. 2022;79:516–517This article is a commentary on the followingHypertension-Mediated Organ Damage: Prevalence, Correlates, and Prognosis in the CommunityHypertension inflicts structural alterations in various organs resulting in organ dysfunction. Numerous studies to date have demonstrated the relation between high blood pressure (BP) and different types of hypertension-mediated organ damage (HMOD).1,2 Unless treated, target organ disease gradually progresses from asymptomatic to symptomatic, ultimately leading to overt cardiovascular disease (CVD) events.3,4 Current hypertension guidelines recommend assessment of HMOD in the clinical evaluation for all patients with hypertension, and established HMOD impacts the management strategies in these individuals.5,6 On the other hand, detected asymptomatic HMOD may also reveal undiagnosed hypertension. In this issue of Hypertension, Vasan et al7 provide a comprehensive synopsis about the relative prevalence and BP associations of 8 different HMOD types using data from the Framingham Heart study.See related article, pp 505–515In their analyses, Vasan et al7 studied the impact of HMODs using data from the four Framingham cohorts (Offspring, Gen3, Omni-1 and Omni-2). The sample included a total of 7898 participants with at least one HMOD for cross-sectional analyses, 2874 participants for the HMOD co-clustering analyses, and 5865 participants for analyses on the relation of 4 combined HMODs and incident CVD. The participants were categorized based on BP thresholds from 4 current and former hypertension guidelines. The authors observed that the most prevalent HMOD among individuals with hypertension was increased carotid-femoral pulse wave velocity, while the prevalence of low ankle brachial index was the lowest. However, the implication of this finding may be debated as increased pulse wave velocity correlates strongly with hypertension and is known to precede, instead of succeed, BP elevation.8 Left ventricular hypertrophy, increased carotid intima-media thickness, reduced kidney function, albuminuria, and brain imaging abnormalities were intermediately prevalent. The authors demonstrate that systolic BP and pulse pressure were related to increased odds for all HMOD types expect for reduced kidney function. In contrast, these associations were weak, nonexistent, and even negative for diastolic BP. A total of 384 CVD events were detected during 14.1 years of median follow-up. The cumulative CVD incidence increased linearly by BP category and presence of HMOD with hazard ratios ranging from 1.48 to 2.95, compared with those with normal BP and absence of HMOD.The study by Vasan et al7 has several strengths, such as a relatively large study sample from a well-established cohort study with a prospective study design. Most importantly, the researchers simultaneously assessed the prevalence and BP associations of 8 different types of HMOD. The researchers therefore systematically considered every known HMOD in their study, expect for hypertensive retinopathy, coronary artery calcification, and cognitive function.5,6 Although these findings have previously been published separately, even by the Framingham investigators themselves,9,10 these comprehensive data that include several HMODs along with thorough analysis provide important evidence about the clustering effects of HMODs. However, the predictive value of each individual HMOD for CVD was not assessed, which could have better informed future guidelines on the optimal strategy for assessing HMODs in the hypertensive patient. The strengths of this study also include the use of BP thresholds from several different international guidelines in their analyses to increase the applicability of their results. Antihypertensive medication use was also taken into account in the analyses, which is important as previous studies have suggested that several HMODs are reversable with antihypertensive treatment.11 The study also has some limitations, including the use of only office BP measurements, instead of increasingly common home BP measurements that have been shown to relate more closely to HMOD, especially for left ventricular hypertrophy.12 Additionally, BP was measured on a single-occasion for each participant, despite previous studies suggesting that longitudinal BP measures are superior in predicting HMOD.13–15 Yet, the authors conducted a subgroup analysis, which indicated that HMOD prevalence was higher in those with ≥5 years of hypertension duration compared with those with <5 years duration with same BP stage. Finally, given the mean baseline age of 52 years, the results from this study are mainly generalizable to middle-aged individuals.This study by Vasan et al7 provides an excellent summary about the relative prevalence of different HMODs and their associations with BP. In addition, as this study demonstrates that HMOD prevalence clearly differs based on whether American or European hypertension thresholds are used, investigators and clinicians need to take this finding into account when interpreting the results of future studies. The authors also elucidate that the association between diastolic BP and TOD in middle-aged individuals is often nonexistent or negative. However, several aspects of the interrelations between BP, HMOD, and CVD outcomes still need further clarification. With longer follow-up and availability of additional CVD events, the Framingham data could be used for comparing the predictive value of different HMOD types. These prospective data could also help clarify which individuals would benefit the most from HMOD screening. Nevertheless, the findings from this study further emphasize the importance of maintaining normal or optimal BP and the need for active screening and aggressive treatment of HMODs to reduce the risk of CVD morbidity and mortality.Article InformationDisclosuresNone.FootnotesThe opinions expressed in this article are not necessarily those of the American Heart Association.For Disclosures, see page 517.Correspondence to: Teemu J. Niiranen, Department of Medicine, University of Turku, Kiinamyllynkatu 4–8, 20014 University of Turku, Finland. Email teemu.[email protected]fiReferences1. Cuspidi C, Sala C, Tadic M, Gherbesi E, Facchetti R, Grassi G, Mancia G. High-normal blood pressure and abnormal left ventricular geometric patterns: a meta-analysis.J Hypertens. 2019; 37:1312–1319. doi: 10.1097/HJH.0000000000002063CrossrefMedlineGoogle Scholar2. Juhola J, Magnussen CG, Berenson GS, Venn A, Burns TL, Sabin MA, Srinivasan SR, Daniels SR, Davis PH, Chen W, et al.. Combined effects of child and adult elevated blood pressure on subclinical atherosclerosis: the International Childhood Cardiovascular Cohort Consortium.Circulation. 2013; 128:217–224. doi: 10.1161/CIRCULATIONAHA.113.001614LinkGoogle Scholar3. Lorenz MW, Markus HS, Bots ML, Rosvall M, Sitzer M. Prediction of clinical cardiovascular events with carotid intima-media thickness: a systematic review and meta-analysis.Circulation. 2007; 115:459–467. doi: 10.1161/CIRCULATIONAHA.106.628875LinkGoogle Scholar4. Sehestedt T, Jeppesen J, Hansen TW, Wachtell K, Ibsen H, Torp-Pedersen C, Torp-Petersen C, Hildebrandt P, Olsen MH. Risk prediction is improved by adding markers of subclinical organ damage to SCORE.Eur Heart J. 2010; 31:883–891. doi: 10.1093/eurheartj/ehp546CrossrefMedlineGoogle Scholar5. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, Clement DL, Coca A, de Simone G, Dominiczak A, et al.; ESC Scientific Document Group. 2018 ESC/ESH Guidelines for the management of arterial hypertension.Eur Heart J. 2018; 39:3021–3104. doi: 10.1093/eurheartj/ehy339CrossrefMedlineGoogle Scholar6. Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, et al.. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.J Am Coll Cardiol. 2018; 71:e127–e248. doi: 10.1016/j.jacc.2017.11.006CrossrefMedlineGoogle Scholar7. Vasan R, Song R, Health P, Xanthakis V, Beiser A, Health P, Decarli C. Hypertension-mediated organ damage: prevalence, correlates, and prognosis in the community.Hypertension. 2022; 79:505515. doi: 10.1161/HYPERTENSIONAHA.121.18502LinkGoogle Scholar8. Kaess BM, Rong J, Larson MG, Hamburg NM, Vita JA, Levy D, Benjamin EJ, Vasan RS, Mitchell GF. Aortic stiffness, blood pressure progression, and incident hypertension.JAMA. 2012; 308:875–881. doi: 10.1001/2012.jama.10503CrossrefMedlineGoogle Scholar9. Maillard P, Seshadri S, Beiser A, Himali JJ, Au R, Fletcher E, Carmichael O, Wolf PA, DeCarli C. Effects of systolic blood pressure on white-matter integrity in young adults in the Framingham Heart Study: a cross-sectional study.Lancet Neurol. 2012; 11:1039–1047. doi: 10.1016/S1474-4422(12)70241-7CrossrefMedlineGoogle Scholar10. Levy D, Garrison RJ, Savage DD, Kannel WB, Castelli WP. Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study.N Engl J Med. 1990; 322:1561–1566. doi: 10.1056/NEJM199005313222203CrossrefMedlineGoogle Scholar11. Schmieder RE. Reversal of left ventricular hypertrophy in essential hypertension.JAMA. 1996; 275:1507. doi: 10.1001/jama.1996.03530430051039CrossrefMedlineGoogle Scholar12. Bliziotis IA, Destounis A, Stergiou GS. Home versus ambulatory and office blood pressure in predicting target organ damage in hypertension: a systematic review and meta-analysis.J Hypertens. 2012; 30:1289–1299. doi: 10.1097/HJH.0b013e3283531eafCrossrefMedlineGoogle Scholar13. Kishi S, Teixido-Tura G, Ning H, Venkatesh BA, Wu C, Almeida A, Choi EY, Gjesdal O, Jacobs DR, Schreiner PJ, et al.. Cumulative blood pressure in early adulthood and cardiac dysfunction in middle age: The CARDIA Study.J Am Coll Cardiol. 2015; 65:2679–2687. doi: 10.1016/j.jacc.2015.04.042CrossrefMedlineGoogle Scholar14. Zhang T, Li S, Bazzano L, He J, Whelton P, Chen W. Trajectories of childhood blood pressure and adult left ventricular hypertrophy: The Bogalusa Heart Study.Hypertension. 2018; 72:93–101. doi: 10.1161/HYPERTENSIONAHA.118.10975LinkGoogle Scholar15. Suvila K, McCabe EL, Lehtonen A, Ebinger JE, Lima JAC, Cheng S, Niiranen TJ. Early onset hypertension is associated with hypertensive end-organ damage already by MidLife.Hypertension. 2019; 74:305–312. doi: 10.1161/hypertensionaha.119.13069LinkGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsRelated articlesHypertension-Mediated Organ Damage: Prevalence, Correlates, and Prognosis in the CommunityRamachandran S. Vasan, et al. Hypertension. 2022;79:505-515 March 2022Vol 79, Issue 3Article InformationMetrics © 2022 American Heart Association, Inc.https://doi.org/10.1161/HYPERTENSIONAHA.121.18786PMID: 35138870 Originally publishedFebruary 9, 2022 PDF download Advertisement SubjectsHypertension" @default.
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