title: Association of various blood pressure variables and vascular phenotypes with coronary, stroke and renal deaths: Potential implications for prevention.
abstract: The relationship between blood pressure (BP) and cardiovascular diseases has been extensively documented. However, the benefit of anti-hypertensive drugs differs according to the type of cardiovascular event. Aortic stiffness is tightly intertwined with BP and aorta cross-talk with small arteries. We endeavored to elucidate which BP component and type of vessel remodeling was predictive of the following outcomes: fatal myocardial infarction (MI), fatal stroke, renal -, coronary- or cerebrovascular-related deaths. Large vessel remodeling was estimated by an aortography-based aortic atherosclerosis score (ATS) while small vessel disease was documented by the presence of a hypertensive retinopathy. We included 1031 subjects referred for hypertension workup and assessed outcomes 30 years later. After adjustment for major risk factors, ATS and pulse pressure (PP) were predictive of coronary events while mean BP (MBP) and retinopathy were not. On the contrary, MBP was predictive of cerebrovascular and renal related deaths while ATS and PP were not. Retinopathy was only predictive of cerebrovascular related deaths. Lastly, the aortic atherosclerosis phenotype and increased PP identified patients prone to develop fatal MI whereas the retinopathy phenotype and increased MBP identified patients at higher risk of fatal stroke. These results illustrate the particular feature of the resistive coronary circulation comparatively to the brain and kidneys' low-resistance circulation. Our results advocate for a rational preventive strategy based on the identification of distinct clinical phenotypes. Accordingly, decreasing MBP levels could help preventing stroke in retinopathy phenotypes whereas targeting PP is possibly more efficient in preventing MI in atherosclerotic phenotypes.
authors.affiliation: Cardiology Department, European Society of Hypertension Excellence Center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France; Génomique Fonctionnelle de l'Hypertension Artérielle, Université Lyon-1, F-69100, Villeurbanne, France; Hôpital Nord Ouest, F-69400, Villefranche-sur-Saône, France. Electronic address: bharbaoui@gmail.com.
authors.forename: Brahim
authors.initials: B
authors.lastname: Harbaoui
authors.affiliation: Cardiology Department, European Society of Hypertension Excellence Center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France; Génomique Fonctionnelle de l'Hypertension Artérielle, Université Lyon-1, F-69100, Villeurbanne, France; Hôpital Nord Ouest, F-69400, Villefranche-sur-Saône, France.
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Courand
authors.affiliation: Cardiology Department, European Society of Hypertension Excellence Center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France.
authors.forename: Hughes
authors.initials: H
authors.lastname: Milon
authors.affiliation: Nephrology Department, Hôpital Edouard Herriot, Hospices Civils de Lyon, F-69004, Lyon, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Fauvel
authors.affiliation: Cardiology Department, European Society of Hypertension Excellence Center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France.
authors.forename: Fouad
authors.initials: F
authors.lastname: Khettab
authors.affiliation: Neurology Department, Hôpital Pierre Wertheimer, F-69500, Bron, France.
authors.forename: Laura
authors.initials: L
authors.lastname: Mechtouff
authors.affiliation: Hôpital Nord Ouest, F-69400, Villefranche-sur-Saône, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Cassar
authors.affiliation: Inserm U1116, Centre d'Investigations Cliniques- 1433, Institut Lorrain du Cœur et des Vaisseaux, Vandoeuvre lès Nancy, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Girerd
authors.affiliation: Cardiology Department, European Society of Hypertension Excellence Center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France; Génomique Fonctionnelle de l'Hypertension Artérielle, Université Lyon-1, F-69100, Villeurbanne, France; Hôpital Nord Ouest, F-69400, Villefranche-sur-Saône, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Lantelme
mesh_terms: D000328:Adult; D000368:Aged; D001011:Aorta / Q000473:pathology; D050197:Atherosclerosis / Q000175:diagnosis; D001794:Blood Pressure; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications / Q000401:mortality* / Q000517:prevention & control; D006801:Humans; D006973:Hypertension / Q000150:complications*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009887:Ophthalmoscopy; D010641:Phenotype; D051437:Renal Insufficiency / Q000150:complications / Q000401:mortality* / Q000517:prevention & control; D012164:Retinal Diseases / Q000150:complications / Q000175:diagnosis; D012307:Risk Factors; D020521:Stroke / Q000150:complications / Q000401:mortality* / Q000517:prevention & control; D066253:Vascular Remodeling
keywords: Calcifications; Coronary artery disease; Hypertension; Retinopathy; Stiffness; Stroke