Abstract 2595: Small Artery Structure is an Independent Predictor of Cardiovascular Events in Essential Hypertension
AIM: To investigate the prognostic significance for cardiovascular outcome of small artery structural changes in uncomplicated essential hypertension.
BACKGROUND: Small artery media-lumen ratio (M:L) is an important pathophysiological factor in essential hypertension. High M:L of small arteries isolated from subcutaneous gluteal skin biopsies has recently been shown to predict cardiovascular outcome in a heterogeneous high risk group of patients with type-2 diabetes, primary and secondary hypertension. However, since the abnormal M:L in diabetes is pressure-independent, the relevance of those findings to essential hypertension has been uncertain.
METHODS: We conducted a follow-up survey of a homogenous low-to-medium risk group of 159 patients with uncomplicated essential hypertension who had been included in clinical treatment studies. Mean follow-up was 10.4 years. All patients had an initial assessment of M:L using myography before starting therapy.
RESULTS: Thirty patients suffered a documented predefined cardiovascular event during follow-up. Increased relative risk (RR) was associated with M:L ≥ 0.083 (mean level of the hypertensive cohort), RR = 2.34 (95% CI: 1.11– 4.95), and with M:L ≥ 0.098 (mean level of a normotensive control group ± 2 SD), RR= 2.49 (95% CI: 1.21–5.11). Both results remained significant (RR = 2.19, 95% CI: 1.04 - 4.64, and RR = 2.20, 95% CI: 1.06 - 4.56, respectively) when adjusted for Heart Score level (10-year mortality risk-estimate, integrating age, gender, systolic blood pressure, cholesterol and smoking).
CONCLUSION: Resistance artery M:L predicts cardiovascular events in essential hypertensive patients at low to moderate risk independently of the Heart Score risk estimate.