Abstract 9736: Identification of Phenotypes at Risk of Transition from Systo-Diastolic Hypertension to Isolated Systolic Hypertension

Background: Isolated Systolic Hypertension (ISH) is the most frequent subtype of uncontrolled hypertension in elderly patients and is associated with high cardiovascular (CV) risk. Little is known about the natural evolution towards this type of hypertension and the CV phenotype associated with its appearance. Aim of the present study was to detect predictors of evolution towards ISH in subjects with initial systo-diastolic hypertension (SDH). Methods: 6,027 individuals with SDH (age 53±11 years, 57% men, systolic blood pressure [SBP] 159±21, diastolic blood pressure [DBP] 99±10), without prevalent CV disease, MDRD-estimated glomerular filtrate ratio (eGFR)>30mL/mmHg/1.73 m2 , and with at least 6 month-follow up were selected from the CampaniaSalute registry. Echocardiography and carotid ultrasound were performed. The diagnosis of ISH was made at the end of follow up according to the ESH/ESC and JNCVII Guidelines (SBP ≥140 mmHg with DBP<90 mmHg). Results: After a mean follow up period of 55±44 months, 19% of the study population exhibited ISH (n=1122). Patients with ISH were older, more often women and more often diabetic, and exhibited higher initial SBP, HDL-cholesterol, left ventricular (LV) mass, relative wall thickness, pulse pressure/stroke index ratio (PP/SVi), more severe carotid atherosclerosis and lower values of eGFR (all p<0.001). These differences were studied using a multivariate proportional hazard model (Cox) including all variables that were found different at the descriptive analysis. Presence of ISH at follow up was independently predicted by older age (p<0.0001; HR=1.20/5 years; CI=1.12-1.28), female gender (p<0.004; HR=1.22; CI=1.06-1.40), baseline higher LV mass index (p=0.04;HR=1.04/5g*m-2.7; CI=1.01-1.05), higher carotid intima-media thickness (p=0.02; HR=1.12/mm; CI=1.02-1.22) and higher PP/SVi (p<0.0001;HR=1.35/Unit); CI=1.23-1.48). Conclusion: Factors influencing the transition from SDH to ISH are older age, female gender and signs of CV target organ damage. Thus, a prompt and aggressive therapy for arterial hypertension before the onset of target organ damage appears desirable to help lowering the prevalence of ISH especially in elderly female patients.