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Target organ damage and control of cardiovascular risk factors in hypertensive patients

Evidence from the multicenter ESTher registry

Inzidenz von Endorganschäden und Kontrolle kardiovaskulärer Risikofaktoren bei hypertensiven Patienten

Daten des multizentrischen ESTher-Registers

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Abstract

Aims

This study investigated the incidence of hypertensive target organ damage (TOD), control of cardiovascular risk factors, and the short-term prognosis in hypertensive patients under contemporary guideline-oriented therapy.

Patients and methods

A total of 1,377 consecutive patients (mean age 58.2 ± 9.9 years, 82.2 % male) with arterial hypertension were included in the ESTher (Endorganschäden, Therapie und Verlauf – target organ damage, therapy, and course) registry at 15 rehabilitation clinics within the framework of the National Genome Research Network. Cardiovascular risk factors, medication, comorbidities, and glomerular filtration rate (GFR) were assessed. Left ventricular hypertrophy (LVH), left ventricular mass (LVM), left ventricular mass index (LVMI), and left ventricular ejection fraction (LVEF) were determined by two-dimensional echocardiography. The mean follow-up was 513 ± 159 days. Changes in continuous parameters were tested by the t test, changes in discrete characteristics are presented by means of transition tables and tested with the McNemar test.

Results

The mean LVEF was 59.3 ± 9.9 %, both mean LVM (238.6 ± 101.5 g) and LVMI (54.0 ± 23.6 g/m2.7) were increased while relative wall thickness (RWT, 0.46 ± 0.18) indicated the presence of concentric LVH. Of the patients, 10.2 % displayed renal dysfunction (estimated GFR < 60 ml/min/1.73 m2). The 1.5-year overall mortality was 1.2 %. Compared with discharge, at follow-up the proportion of patients with blood pressure (BP) values < 140/90 mmHg decreased from 68.7 % to 55.0 % (p < 0.001) and with low-density lipoprotein (LDL) values < 100 mg/dl from 62.6 % to 38.1 % (p < 0.001). At follow-up significantly more patients displayed a GFR value of < 60 ml/min/1.73 m2 (10.2 % vs. 16.0 %, p < 0.001).

Conclusion

A significant proportion of hypertensive rehabilitation participants displayed TOD including LVH and renal dysfunction. Even after stringent BP reduction, a considerable increase in nephropathy could be found after 18 months.

Zusammenfassung

Ziel

Die Studie diente der Untersuchung von Inzidenz und Dynamik hypertensiver Endorganschäden, kardiovaskulärer Risikofaktoren und der Kurzzeitprognose unter leitlinienorientierter Therapie.

Patienten und Methoden

In das multizentrische ESTher-Register an 15 Rehabilitationskliniken im Rahmen des Nationalen Genomforschungsnetzwerkes zur Kohorten-Phänotypisierung wurden 1377 konsekutive Patienten mit Hypertonie (58,2 ± 9,9 Jahre; 82,2 % männlich) eingeschlossen. Während der stationären Rehabilitation wurden demographische Daten, kardiovaskuläre Risikofaktoren und Medikation, Komorbiditäten sowie die glomeruläre Filtrationsrate (GFR) dokumentiert. Zur Erfassung einer hypertensiven Herzerkrankung („left ventricular hypertrophy“, LVH) wurden die linksventrikuläre Ejektionsfraktion (LVEF), der LV-Masseindex (LVMI) und die relative Wandstärke bestimmt. Die mittlere Nachbeobachtungszeit betrug 513 ± 159 Tage. Veränderungen kontinuierlicher Parameter wurden mit dem t-Test, Veränderungen diskreter Parameter mit dem McNemar-Test ermittelt.

Ergebnisse

Die mittlere LVEF betrug 59,3 ± 9,9 %. Sowohl die mittlere linksventrikuläre Masse (LVM; 238,6 ± 101,5 g) als auch der LVMI (54,0 ± 23,6 g/m2,7) waren erhöht bei bestehender konzentrischer Hypertrophie (relative Wanddicke 0,46 ± 0,18). 10,2 % der Patienten wiesen eine Nierenfunktionsstörung (geschätzte GFR < 60 ml/min/1,73 m2) auf. Die 1,5-Jahres-Gesamtmortalität betrug 1,2 %. Im Vergleich zur Entlassung reduzierte sich der Anteil von Patienten mit Blutdruckwerten < 140/90 mmHg von 68,7 auf 55,0 % (p < 0,001), der Anteil mit LDL(„low density lipoproteins“)-Werten < 100 mg/dl von 62,6 auf 38,1 % (p < 0,001). Zum Follow-up-Zeitpunkt wiesen signifikant mehr Patienten eine GFR < 60 ml/min/1,73 m2 auf: 10,2 vs. 16,0 % (p < 0,001).

Schlussfolgerung

Ein signifikanter Anteil hypertensiver Patienten weist während einer stationären Rehabilitation Endorganschäden auf, so u. a. eine LVH und eine Nierenfunktionsstörung. Auch nach stringenter Blutdrucksenkung kann es nach 18 Monaten zu einem erheblichen Anstieg der Nephropathie kommen.

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Acknowledgments

The ESTher registry was carried out in cooperation with the German Society for Prevention and Rehabilitation of Cardiovascular Diseases (DGPR). This work was supported by a grant from the Federal Ministry of Education and Research, National Genome Research Network plus (grant number 01GS0839), Germany. We thank all the investigators. We are particularly grateful to H. Buhlert and K. Stolze, who were responsible for central data management.

Compliance with ethical guidelines

Conflict of interest. R.K. Reibis, M. Huber, M. Karoff, W. Kamke, R. Kreutz, K. Wegscheider, and H. Völler state that there are no conflicts of interest. The accompanying manuscript does not include studies on humans or animals.

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Authors and Affiliations

  1. Cardiological Outpatient Clinic Am Park Sanssouci Potsdam, Zimmerstrasse 7a, 14471, Potsdam, Germany

    R.K. Reibis MD

  2. Department of Cardiology, Klinik am See, Rehabilitation Center of Cardiovascular Diseases, Berlin, Germany

    R.K. Reibis MD & H. Völler

  3. Institute of Clinical Pharmacology and Toxicology, Charité, Universitätsmedizin Berlin, Berlin, Germany

    M. Huber & R. Kreutz

  4. Klinik Königsfeld der DRV-Westfalen, University of Witten/Herdecke, Ennepetal, Germany

    M. Karoff

  5. MediClin Reha-Zentrum Spreewald, Burg, Germany

    W. Kamke

  6. Department of Medical Biometry and Epidemiology, University Medical Centre, Hamburg-Eppendorf, Hamburg, Germany

    K. Wegscheider

  7. Department of Clinical Rehabilitation, University of Potsdam, Potsdam, Germany

    H. Völler

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  1. R.K. Reibis MD
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  3. M. Karoff
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Correspondence to R.K. Reibis MD.

Additional information

This study was presented in part at the annual congress of the European Society of Cardiology in 2007.

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Reibis, R., Huber, M., Karoff, M. et al. Target organ damage and control of cardiovascular risk factors in hypertensive patients. Herz 40 (Suppl 2), 209–216 (2015). https://doi.org/10.1007/s00059-014-4189-8

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  • DOI: https://doi.org/10.1007/s00059-014-4189-8

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