Abstract 3668: Predictors of Four-Year Incident Arterial Hypertension From Initial Prehypertension: The Strong Heart Study.
Background: Pre-hypertension (defined by JNC-VII) frequently evolves to arterial hypertension (HTN) and is recently shown to increase cardiovascular risk, especially in diabetics. It is unclear which metabolic and cardiac characteristics predict development of HTN in pre-hypertensive subjects.
Methods: 627 pre-hypertensive participants in the Strong Heart Study, free of anti-hypertensive treatment and without prevalent cardiovascular disease or significant valve disease, were studied (64% women; 41% diabetic; 58±7 yrs). All participants underwent complete echocardiographic, anthropometric and laboratory testing. We evaluated 4-year incidence of HTN using anthropometric and metabolic profile as first predictors, and echocardiographic indices thereafter.
Results: Four-year incidence of HTN was 41%. Preliminary analysis identified diabetes (DM by ADA criteria) as a significant predictor of incident HTN (53% among participants with DM vs 33% in non DM; OR= 2.02, 95% CI=1.42–2.88; p<0.001). Accordingly, additional analysis was performed separately in participants with or without baseline DM. After adjusting for age, gender, and heart rate, strongest predictor of HTN in DM was baseline systolic blood pressure (OR= 1.07/mmHg, 95% CI=1.03–1.12; p=0.001) with weaker effect of echocardiographic relative wall thickness (p=0.03). In non-DM, independent predictors of HTN were systolic blood pressure (HR= 1.08/mmHg, 95% CI=1.04–1.12; p<0.001), non-HDL cholesterol (HR= 1.01/mg*dL-1, 95% CI=1.00–1.01; p=0.01) and high LV mass index (OR=1.04 g/m2.7, 95% CI=1.01–1.07; p= 0.007). Higher Doppler stroke volume and total peripheral resistance also entered alternative models without LV mass (each p<0.05).
Conclusion: In a population of pre-hypertension adults we demonstrate high incidence of HTN (41%). Independent predictors of HTN at 4-year follow-up are presence of diabetes and higher baseline systolic blood pressure. In non-DM, LV mass index is an indipendent predictor of incident HTN in addition to baseline systolic blood pressure and non-HDL cholesterol.