Prehypertension is Associated With Abnormalities of Cardiac Structure and Function in the Atherosclerosis Risk in Communities Study.
BACKGROUND
Prehypertension (blood pressure (BP) of 120-139 mm Hg systolic and/or 80-89 mm Hg diastolic) is highly prevalent and is associated with increased cardiovascular risk. Our goal was to investigate the extent to which prehypertension is associated with end-organ alterations in cardiac structure and function in a large biracial cohort of older men and women.


METHODS
We studied 4,871 participants of the Atherosclerosis Risk in Communities (ARIC) study who attended visit 5 (2011-2013) and underwent two-dimensional echocardiography while free of prevalent coronary heart disease or heart failure. We categorized participants into 3 groups: optimal BP (BP <120 mm Hg and <80 mm Hg) (n = 402), prehypertension (n = 537), and hypertension (n = 3,932).


RESULTS
Individuals with prehypertension (75±5 years) had higher left ventricular (LV) mass index and wall thickness, and higher prevalence of abnormal LV geometry than those with optimal BP (74±5 years), but lower than those with frank hypertension (76±5 years). In addition, participants with prehypertension had impairment of diastolic parameters (E/A, E' and E/E'), and had higher prevalence of mild and moderate-severe diastolic dysfunction compared to those with optimal BP, but no differences in systolic parameters. These differences in cardiac structure and function remained significant after adjusting for important clinical covariates.


CONCLUSIONS
In the ARIC cohort at visit 5, prehypertension was associated with increased LV remodeling and impaired diastolic function, but not systolic function, suggesting that even mildly elevated BP within the normal range is associated with cardiac end-organ damage.
Brigham and Women's Hospital, Boston, Massachusetts, USA; Cardiology Division, Universidade Federal of Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil;
Angela B S
AB
Santos
Brigham and Women's Hospital, Boston, Massachusetts, USA; Vanderbilt University Medical Center, Nashville, Tennessee, USA;
Deepak K
DK
Gupta
Brigham and Women's Hospital, Boston, Massachusetts, USA; Columbia University Medical Center, Brooklyn, New York, USA;
Natalie A
NA
Bello
Brigham and Women's Hospital, Boston, Massachusetts, USA; Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy (MG);
Mauro
M
Gori
Brigham and Women's Hospital, Boston, Massachusetts, USA;
Brian
B
Claggett
Cardiology Division, Universidade Federal of Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil;
Flavio D
FD
Fuchs
Brigham and Women's Hospital, Boston, Massachusetts, USA;
Amil M
AM
Shah
Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Josef
J
Coresh
Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
A Richey
AR
Sharrett
Brigham and Women's Hospital, Boston, Massachusetts, USA;
Susan
S
Cheng
Brigham and Women's Hospital, Boston, Massachusetts, USA; ssolomon@rics.bwh.harvard.edu.
Scott D
SD
Solomon
D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D003430:Cross-Sectional Studies; D003971:Diastole; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D058246:Prehypertension / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling
blood pressure; cardiovascular pathophysiology; echocardiography; prehypertension.