Hypertension and nephrology

[Predictive factors for ischemic heart disease, diabetes mellitus and chronic kidney disease among hypertensive patients based on the data of the Hungarian Hypertension Registry 2011-2013-2015. Part I. Hypertensive population aged 35 to 64 years]

KÉKES Ede, PAKSY András, SZEGEDI János, JÁRAI Zoltán

DECEMBER 12, 2019

Hypertension and nephrology - 2019;23(06)

DOI: https://doi.org/10.33668/hn.23.029

[The association of hypertension with ischemic heart disease, diabetes and chronic kidney disease is the greatest therapeutic challenge because these associations significantly increase mortality and deteriorate life expectancy. It is important for the clinician to clarify the predictive factors of each association for successful prevention or slowing the progression of diseases. According to the database of the Hungarian Hypertension Registry 2011-2013-2015, 11,137 men and 11,112 women with hypertension and comorbidities (CHD, diabetes, CKD) aged between 35 and 64 were analyzed for the purpose of assessing the predictive value of the traditional risk factors in co-morbidity. We analyzed the predictive weight of each variable with single- and multi-variable stepwise logistic regression, and reported Odds ratio (OR, odds ratio). In patients with hypertension aged 35-64 (male / female), the prevalence of CHD was 41.6% / 35.8%, diabetes 27.1% / 23% and KVB 16.2% / 33.8%, respectively. The chance of developing CHD is highest in hypertensive individuals (male/female) who have diabetes (OR 1.30/1.48), who are obese (OR 1.22/1.21), who smoke (OR 1.50/1.51), and whose blood pressure >140/90 mmHg (OR 1.23/1.29). The dominant predictive factors of type 2 diabetes are obesity (visceral obesity) (OR 1.46/1.49), low HDL cholesterol (OR 1.32/1.35), and high triglyceride levels (OR 1.20/1.42); in women the uric acid level also showed high odds ratio (OR 1.39). There is a significant chance of developing chronic kidney disease in hypertension in both sexes, if abnormal uric acid levels (OR 1.73/1.46) and inadequate treatment of high blood pressure (>140Hgmm SBP) (OR 1.43/1.19) are present. In women, the abnormal triglyceride level) also showed a high odd (OR 1.81).]



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[The cerebral vascular damage caused by hypertension is manifested primarily in cognitive dysfunction, which is caused by hypoperfusion of brain tissue, ischemic, or bleeding stroke, or white matte injury. Hypertension may not only result in cerebral damage to the vascular background - dementia -, but may also contribute to the development and progression of classical gene-related Alzheimer’s disease. Blood pressure gradually increases in the elderly and in the very elderly, and the frequency of hypertension-mostly as isolated systolic hypertension - is 50% to 70%. High blood pressure predominately, or in full, means not only an increase in the circulatory resistance of the small children, but also, as part of the aging of the body, the rigidity (stiffness) of the arteries. At the same time, the incidence of dementia, along with age, rises sharply - up to 20% in those over 65 years of age, and over 40% in 80-90 years of age. The relationship between high blood pressure and dementia from the young age to the very old age may change as a function of current age. In the very old age of life, the varying influence of other pathological factors other than hypertension is becoming more and more important in the deterioration of both the vascular structure and the brain function. In this late stage of life, the very advanced rate of aging and nutritive blood flow often require higher perfusion pressure, and the not enough thought-out blood pressure reduction can be more damaging than a protective effect on brain condition or function. SPRINT MIND - the Intense Blood Pressure Reduction - hasn’t resolved the question, and we can legally assume that the 130-140 Hgmm SBP. Is the most favorable for dementia. The value of DBP 70 Hgmm is definitely unfavorable.]

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