Target organ damage assessment in French hypertensive patients without established cardiovascular or renal disease

Rossignol, Patrick; Hosseini, K.; Tropeano, Anne‐Isabelle; Fay, Renaud; Tsatsaris, Anne; Guillemin, Françis; Mounier‐Véhier, Claire

doi:10.1097/hjh.0b013e32835a34bb

Cited by 11 publications

(4 citation statements)

References 7 publications

(11 reference statements)

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“…However, in our subgroup analysis, black women have a similar response to surgery as black men, with significantly higher MAP compared to non‐black women. Many of the long‐term detrimental effects of PA are secondary to prolonged exposure of the vasculature and target organs to elevated aldosterone that may lead to vascular remodeling and irreversible changes . In our cohort, black patients presented both with a longer duration of hypertension and larger burden of comorbid disease.…”

Section: Discussionmentioning

confidence: 93%

Clinical presentation and surgical outcomes in primary aldosteronism differ by race

Gershuni

Ermer

Kelz

et al. 2019

Journal of Surgical Oncology

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Background: Primary aldosteronism (PA) is the most common cause of secondary hypertension; early diagnosis and intervention correlate with outcomes. We hypothesized that race may influence clinical presentation and outcomes.Methods: We conducted a retrospective analysis of patients with PA (1997PA ( -2017 who underwent adrenal vein sampling (AVS). Patients were classified by self-reported race as black or non-black. Improvement was defined as postoperative decrease in mean arterial pressure (MAP), antihypertensive medications (AHM), or both.Results: Among patients undergoing AVS (n = 443), 287 underwent adrenalectomy. Black patients (28.2%) had higher body mass index (33.9 vs 31.8 kg/m 2 ; P = .01), longer median duration of hypertension (12 vs 10 years; P = .003), higher modified Elixhauser comorbidity index (2 vs 1; P = .004), and lower median income ($47 134 vs $78 280; P < .001). Black patients had similar aldosterone:renin ratios (150 vs 135.6 [ng/dL]/[ng·mL· −1 hr −1 ]; P = .23) compared to non-blacks. At long-term follow-up, black patients had a similar requirement for AHM (1 vs 0; P = .13) but higher MAP (100.6 vs 95.3 mm Hg; P = .004).Conclusion: Black patients present with longer duration of hypertension and more comorbidities. They are equally likely to lateralize on AVS, suggesting similar disease phenotype. However, black patients demonstrate less improvement with adrenalectomy; this may reflect a delay in diagnosis or concomitant essential hypertension.adrenal, aldosteronoma, disparities, hypertension, primary aldosteronism, race 1 | INTRODUCTION Primary aldosteronism (PA) is the most common etiology of secondary hypertension, affecting 3% to 20% of hypertensive patients 1-4 and 14%to 21% of patients with resistant hypertension. 5 Hyperaldosteronism is associated with end organ dysfunction and cardiovascular morbidity and mortality, independent of level of hypertension. 6-8 As compared to those with essential hypertension, patients with PA have increased risk of myocardial infarction, atrial fibrillation, and stroke, in excess of the projected risk related to degree of hypertension alone. 9 Effective control of blood pressure (BP) and aldosterone level lead to improved cardiovascular outcomes. 10 Therefore, early diagnosis and appropriate treatment of PA is essential to improve cardiovascular outcomes and minimize end organ dysfunction. Subtype differentiation of PA is an essential component of early diagnosis and treatment. Unilateral causes of PA include aldosteroneproducing adenoma and unilateral hyperplasia, which are potentially The authors have no disclosures.surgically curable, while bilateral adrenal hyperplasia (BAH) is managed medically with mineralocorticoid antagonists. 11 Shorter duration of disease has been associated with improved operative outcomes in multiple studies of subjects with unilateral PA. 12,13 An extensive literature exists on race and hypertension, particularly as it pertains to black patients. 14,15 Racial disparities in diagnosis, prevalence, treatment, and outcomes, a...

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Section: Discussionmentioning

confidence: 93%

Clinical presentation and surgical outcomes in primary aldosteronism differ by race

Gershuni

Ermer

Kelz

et al. 2019

Journal of Surgical Oncology

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“…Sin embargo, en la práctica, menos del 15% de los clínicos investigan el daño cerebral producido por la HA. [4] El cerebro es una diana temprana del daño por HA. [1,5] Las lesiones cerebrovasculares subclínicas o silentes se detectan frecuentemente en pacientes asintomáticos mediante la neuroimagenología.…”

Section: Introductionunclassified

“…Como la HA es tan frecuente, los clínicos buscan cuidadosamente signos de daño en los órganos. Actualmente existen numerosas evidencias acerca del papel crucial del daño subclínico en los órganos, [1,4,7] bien establecido para las enfermedades cardiovasculares y renales debido a que las técnicas aplicadas están ampliamente disponibles. En cambio, la detección del deterioro temprano del cerebro requiere de técnicas de imagenología muy escasas y costosas para ser usadas de forma rutinaria en la práctica médica general.…”

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Blood-Based Biomarkers Could Help Identify Subclinical Brain Damage Caused by Arterial Hypertension

2016

MEDICC Review

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“…The most common target organ damage associated with hypertension is left ventricular hypertrophy (LVH) [1][2][3]. An epidemiologic study revealed that the incidence rate of LVH in hypertension in the Chinese population is up to 42.7% [4].…”

Section: Introductionmentioning

confidence: 99%

Relationship between Nocturnal Blood Pressure and Left Ventricular Hypertrophy in Hypertensive Patients

Liu¹

2013

J Hypertens

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Objective: Left ventricular hypertrophy (LVH) is the most common target organ damage in hypertension. However, the association of LVH and circadian rhythm of blood pressure (BP) is unknown. The objective of the present study was to explore the relationship between circadian rhythm of BP and LVH using ambulatory blood pressure monitoring (ABPM). Study design:A total of 325 untreated hypertensive patients were recruited. The patients were divided into two groups: hypertensive patients with LVH (n=121) and without LVH (n=204). Twenty-four-hour ABPM was performed in all the patients to collect the following parameters: 24-hour average systolic and diastolic pressure, daytime average systolic and diastolic pressure, nocturnal average systolic and diastolic pressure, and night to day BP ratio. The relationship between LVH and the various ABPM parameters was analyzed. Results:We found that the average nocturnal systolic blood pressure (SBP) in hypertensive patients with LVH was higher than that in hypertensive patients without LVH (145 ± 16.1 mmHg versus 136 ± 12.7 mmHg, P<0.05). The average night to day SBP ratio in hypertensive patients with LVH was also higher than that in hypertensive patients without LVH (0.93 ± 0.04 versus 0.86 ± 0.04, P<0.05). Multiple regression analysis indicate that the average nocturnal SBP and the night to day SBP ratio were associated with LVH (Odds ratio (OR) 1.67, 95% CI: 1.31-3.21; OR: 1.88, 95% CI: 1.56-3.78) by adjustment for traditional covariates. Conclusion:The average nocturnal SBP and the average night-day SBP ratio are independent risk factors of LVH in patients with hypertension.

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Target organ damage assessment in French hypertensive patients without established cardiovascular or renal disease

Cited by 11 publications

References 7 publications

Clinical presentation and surgical outcomes in primary aldosteronism differ by race

Clinical presentation and surgical outcomes in primary aldosteronism differ by race

Blood-Based Biomarkers Could Help Identify Subclinical Brain Damage Caused by Arterial Hypertension

Relationship between Nocturnal Blood Pressure and Left Ventricular Hypertrophy in Hypertensive Patients

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