Metabolic abnormalities predict severe hypertension

By Eleanor McDermid, Senior medwireNews Reporter

Components of the metabolic syndrome, as well as a family history of hypertension, identify people at risk of developing severe hypertension, say researchers.

The study by Christina Westerdahl (Lund University, Sweden) and colleagues involved 18,200 participants of the 2002–2006 follow-up phase of the Malmö Preventive Project. At this point, at the age of about 70 years, 1.6% of the cohort was diagnosed with severe hypertension, defined as blood pressure higher than 180/100 mmHg.

At the baseline assessment, 28 years previously in 1972–1992, participants who later developed severe hypertension differed from normotensive controls (matched 2:1 by age and gender) in several aspects, most notably family history of hypertension and variables related to the metabolic syndrome.

Severe hypertension patients had an average body mass index (BMI) of 25.3 kg/m², compared with 23.3 kg/m² in controls, and had increased fasting glucose and triglyceride levels. Women with severe hypertension had an increased rate of maternal family history of hypertension, whereas men more often had hypertension in their paternal family and were more likely than male controls to smoke.

Patients with severe hypertension received antihypertensive treatment from the point of diagnosis, yet they had an increased mortality and morbidity risk compared with normotensive study participants during 3 years of follow-up. In all, 9.7% versus 4.8% died, and severe hypertension patients had double the rate of coronary events, stroke and atrial fibrillation, as well as a tripled rate of new-onset diabetes, at 3.3% versus 0.8%.

“This indicates that the risk status was not fully reversed by a diagnosis of severe hypertension followed by intensive treatment of [blood pressure]”, write the researchers in the Journal of Hypertension.

After accounting for baseline age, gender, BMI, cholesterol, fasting glucose and smoking, the rate of coronary events remained a significant 2.31-fold higher in patients with severe hypertension versus controls, and the rate of atrial fibrillation remained 2.04-fold higher, while the associations with stroke and mortality were only borderline significant.

“The high remaining risk in severe hypertension calls for earlier screening, detection and treatment, especially in offspring to parents with hypertension”, concludes the team.

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