R Nazário Leão1, P Marques da Silva2, R Marques Pocinho3, M Alves4, D Virella4, R Palma Dos Reis5. 1. Unidade Funcional Medicina 2, Hospital São José, Centro Hospitalar Lisboa Central-EPE, Lisboa, Portugal; NOVA Medical School, Universidade NOVA de Lisboa, Lisboa, Portugal. Electronic address: rodrigoromaoleao@gmail.com. 2. NOVA Medical School, Universidade NOVA de Lisboa, Lisboa, Portugal; Núcleo de Investigação Arterial, Unidade Funcional Medicina 4, Hospital Santa Marta, Centro Hospitalar Lisboa Central-EPE, Lisboa, Portugal. 3. Unidade Funcional Medicina 2, Hospital São José, Centro Hospitalar Lisboa Central-EPE, Lisboa, Portugal. 4. Gabinete de Análise Epidemiológica e Estatística, Centro de Investigação, Centro Hospitalar Lisboa Central-EPE, Lisboa, Portugal. 5. NOVA Medical School, Universidade NOVA de Lisboa, Lisboa, Portugal; Unidade de Cardiologia, Hospital Pulido Valente, Centro Hospitalar Lisboa Norte-EPE, Lisboa, Portugal.
Abstract
INTRODUCTION: The progression of hypertensive heart disease leads to the left ventricular diastolic dysfunction (LVDD), which is associated with increased cardiovascular morbidity and mortality. The purpose of this analysis is to explore the determinants for LVDD in patients with hypertension. METHODS: This is a secondary analysis of data of Impedance Cardiography in the Evaluation of Left Ventricular Diastolic Dysfunction in Patients with Arterial Hypertension (IMPEDDANS) Study. Mann-Whitney and Chi-square tests were used for univariable analysis. Multiple logistic regression was used to model for LVDD occurrence and discriminative capacity of the model assessed by the value of the area under the curve given by the receiver-operating characteristic curve. RESULTS: Older age (65 vs. 58 years, p<0.001), longer duration of hypertension (160 vs. 48 months, p<0.001), uncontrolled hypertension (59.8 vs. 15.9%, p<0.001), tobacco smoking (17.8 vs. 3.8%, p=0.016), higher systolic blood pressure (133 vs. 124mmHg, p=0.001) and slower heart rate (62 vs. 66bpm, p=0.023) were associated with LVDD. Multivariate model identified uncontrolled hypertension (AdjOR 36.90; 95% CI 7.94-171.58; p<0.001), smoking (AdjOR 6.66; 95% CI 1.63-27.26; p=0.008), eccentric hypertrophy (AdjOR 3.59; 95% CI 0.89-14.39; p=0.072), duration of hypertension (AdjOR 1.03; 95% CI 1.02-1.05; p<0.001) and concentric remodeling (AdjOR 0.19; 95% CI 0.04-0.93; p=0.041) as the more determinant for occurrence of LVDD. The discriminative capacity of the model was AUC=0.95 (95% CI 0.91-0.98). CONCLUSION: The occurrence of LVDD in hypertensive patients was strongly associated to long-lasting, uncontrolled hypertension, tobacco smoking, concentric remodeling and eccentric hypertrophy.
INTRODUCTION: The progression of hypertensive heart disease leads to the left ventricular diastolic dysfunction (LVDD), which is associated with increased cardiovascular morbidity and mortality. The purpose of this analysis is to explore the determinants for LVDD in patients with hypertension. METHODS: This is a secondary analysis of data of Impedance Cardiography in the Evaluation of Left Ventricular Diastolic Dysfunction in Patients with Arterial Hypertension (IMPEDDANS) Study. Mann-Whitney and Chi-square tests were used for univariable analysis. Multiple logistic regression was used to model for LVDD occurrence and discriminative capacity of the model assessed by the value of the area under the curve given by the receiver-operating characteristic curve. RESULTS: Older age (65 vs. 58 years, p<0.001), longer duration of hypertension (160 vs. 48 months, p<0.001), uncontrolled hypertension (59.8 vs. 15.9%, p<0.001), tobacco smoking (17.8 vs. 3.8%, p=0.016), higher systolic blood pressure (133 vs. 124mmHg, p=0.001) and slower heart rate (62 vs. 66bpm, p=0.023) were associated with LVDD. Multivariate model identified uncontrolled hypertension (AdjOR 36.90; 95% CI 7.94-171.58; p<0.001), smoking (AdjOR 6.66; 95% CI 1.63-27.26; p=0.008), eccentric hypertrophy (AdjOR 3.59; 95% CI 0.89-14.39; p=0.072), duration of hypertension (AdjOR 1.03; 95% CI 1.02-1.05; p<0.001) and concentric remodeling (AdjOR 0.19; 95% CI 0.04-0.93; p=0.041) as the more determinant for occurrence of LVDD. The discriminative capacity of the model was AUC=0.95 (95% CI 0.91-0.98). CONCLUSION: The occurrence of LVDD in hypertensivepatients was strongly associated to long-lasting, uncontrolled hypertension, tobacco smoking, concentric remodeling and eccentric hypertrophy.
Keywords:
Determinantes de la disfunción diastólica del ventrículo izquierdo; Diastolic dysfunction determinants; Disfunción diastólica del ventrículo izquierdo; Hipertensión arterial; Hypertension; Left ventricular diastolic dysfunction
Authors: Sameer Al-Ghamdi; Faisal Khalid Alzubaidi; Sultan Abdulrahman Alharthai; Meshal Saleh Alzahim; Fahad Mohammed Al Bahily; Mohammed Ibrahim Alsifaee; Hiaallah Ali Alshehri; Muath Salman Anazi Journal: Pan Afr Med J Date: 2021-11-16