SPC365

Peripheral pulse wave velocity and hypertensive response to exercise in predicting development of resistant hypertension

Session: Posters (Sessão 3 - Écran 3) - Fatores de risco cardiovascular
Speaker: Bruno Bragança

Congress: CPC 2023
Topic: J. Preventive Cardiology
Theme: 28. Risk Factors and Prevention
Subtheme: 28.14 Risk Factors and Prevention - Other
Session Type: Pósters Electrónicos
FP Number: ---
Authors: Bruno Bragança; Isabel Cruz; Rafaela G. Lopes; Inês Oliveira; Inês G. Campos; Joel P. Monteiro; Conceição Queirós; Paula Pinto; Aurora Andrade

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Arial&quot;,sans-serif">Background:</span></strong><span style="font-family:&quot;Arial&quot;,sans-serif"> Resistant hypertension (RH) is strongly associated with the occurrence of major cardiovascular events and death. Hypertensive response to exercise (HRE) and arterial stiffness estimated by pulse wave velocity (PWV) are surrogate markers of incident hypertension. However, the predictive value and accuracy of these markers in RH development remains uncertain. &nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Arial&quot;,sans-serif">Methods: </span></strong><span style="font-family:&quot;Arial&quot;,sans-serif">Comparison of HRE and PWV in predicting the development of RH was performed in retrospective study with a cohort of 207 patients with known coronary artery disease (CAD). The patients performed at least two Bruce protocol stress tests (STs) between 01/2009 and 12/2022. The first ST was used to assess HRE and estimated PWV (ePWV) in predicting occurrence of apparent treatment-resistant hypertension (aTRH). ePWV was calculated by previously published equations using age and blood pressure<sup>1</sup>. HRE response was defined either as systolic BP (SBP)&thinsp;&gt;&thinsp;210 mmHg or difference between peak and baseline &gt; 60mmHg for men (&gt;190 mmHg or 50 mmHg in women)<sup>2</sup>. aTRH was identified as resting SBP above 140mmHg in the last ST despite simultaneous use of 3 or more different antihypertensive agents. The follow-up period between STs was 4.2&plusmn;2.8 years. Predictors of RH were analyzed with multiple linear and logistic regression models. Data presented as: mean &plusmn; standard deviation; 95% confidence interval (CI) for odds ratios (OR); significance between groups <em>p</em>&lt;0.05.&nbsp; </span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Arial&quot;,sans-serif">Results:</span></strong><span style="font-family:&quot;Arial&quot;,sans-serif"> The incidence of aTRH between STs was 15% (n=30), with 48% of them (n=14) receiving 4 or more anti-hypertensive drugs. aTRH vs non-aTRH patients were similar at baseline for sex (89% male, p=0.67), hypertension (HT, 62%,p=0.08), dyslipidemia (79%, p=0.86), smoke (46%, p=0.50), chronic kidney disease (13%, p=0.39), myocardial infarction (75%, <em>p</em>=0.39), heart failure (HF) (4.5%, <em>p</em>=0.40), but not for body mass index (30&plusmn;3 vs 28&plusmn;3 kg/m2, <em>p</em>=0.012) and diabetes (60.0 vs 28.6%, <em>p</em>=0.003) that were higher in the aTRH group. The average ePWV was 9.3&plusmn;1.6 m/s (9.14&plusmn;1.5 vs 10.2&plusmn;1.7 m/s, non-aTRH vs aTRH p=0.001); 22.6% patients had HRE (36.0% vs 20.4%, aTRH vs non-TRH, p=0.084). Baseline ePWV positively correlated with resting SBP (Pearson&#39;s r = 0.365, p&lt;0.0001) at the last ST. In contrast to HRE (adjusted OR=1.34, CI 0.42-4.30, <em>p</em>=0.624), ePWV was significantly associated with aTRH (adjusted OR=2.0, CI 1.09-4.1, <em>p</em>=0.024) after correcting for age, comorbidities and anti-HT drugs, with an area under the ROC curve of 0.67 (CI 0.56-0.78). </span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Arial&quot;,sans-serif">Conclusion:</span></strong><span style="font-family:&quot;Arial&quot;,sans-serif"> Data show ePWV as a simple and robust marker that outperforms HRE in predicting aTRH in CAD patients. Higher ePWV values are independently associated with aTRH. This study also highlights the importance of developing new strategies to control arterial stiffness in the prevention and treatment of RH.</span></span></span></p>

<ol>
	<li style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">&nbsp;<span style="font-size:9.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Vlachopoulos C, &nbsp;et al., JAMA Netw Open. </span></span><span style="font-size:9.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Oct 2;2(10):e1912831 (2019). 2 - Kim, D., et al., Clin Hypertens 22, 17 (2016). </span></span></span></span></li>
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