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Hypertension-mediated Cardiac Damage Among Romanian Adult Hypertensive Patients: A Post-hoc Echocardiographic Analysis of the SEPHAR IV Epidemiological Survey Cover

Hypertension-mediated Cardiac Damage Among Romanian Adult Hypertensive Patients: A Post-hoc Echocardiographic Analysis of the SEPHAR IV Epidemiological Survey

Open Access
|Mar 2023

Figures & Tables

Figure 1

Study workflow in SEPHAR surveys. ABI – ankle-brachial index; BP – blood pressure; ECG – electrocardiogram
Study workflow in SEPHAR surveys. ABI – ankle-brachial index; BP – blood pressure; ECG – electrocardiogram

Characteristics of hypertensive subjects with and without LVH

Hypertensives with LVH (n=136)Hypertensives without LVH (n=306)p-value
Female, n (%)93 (68.4%)155 (50.7%)<0.001
Age (years)66.1 (10.3)57.6 (13.2)<0.001
Rural residence, n (%)66 (48.5%)164 (53.6%)0.33
Active smoking, n (%)20 (14.7%)73 (23.9%)0.03
Dyslipidemia, n (%)68 (50.0%)144 (47.1%)0.57
Diabetes, n (%)33 (24.3%)40 (13.1%)0.003
Obesity, n (%)71 (55.9%)165 (53.9%)0.70
Obstructive sleep apnea, n (%)6 (4.4%)11 (3.6%)0.68
Systolic BP (mm Hg)145 (18)138 (17)<0.001
Diastolic BP (mm Hg)88 (11)88 (10)0.99

Multinomial logistic regression for predicting various patterns of LV remodelling

Pattern of LV remodellingRisk factorBSEpOR (95% CI)
Concentric remodellingAge0.0270.0120.0261.028 (1.003 – 1.052)
Male sex−0.7310.2810.0090.481 (0.278 – 0.834)
Eccentric hypertrophyAge0.0640.017<0.0011.066 (1.030 – 1.103)
Male sex−0.9760.3550.0060.377 (0.188 – 0.755)
Concentric hypertrophyAge0.0560.0180.0021.058 (1.021 – 1.096)
Male sex−1.1310.3760.0030.323 (0.154 – 0.675)

Characteristics of hypertensive subjects with and without LV dysfunction

Hypertensives with DD (n=218)Hypertensives without DD (n=224)p-valueHypertensives with SD (n=27)Hypertensives without SD (n=415)p-value
Female, n (%)122 (56.0%)126 (56.3%)0.957 (25.9%)241 (58.1%)0.001
Age (years)63.3 (10.6)57.2 (14.3)<0.00164.2 (14.1)59.9 (12.9)0.13
Rural residence, n (%)103 (47.2%)127 (56.7%)0.0478 (29.6%)222 (53.5%)0.02
Active smoking, n (%)45 (20.6%)48 (21.4%)0.848 (29.6%)85 (20.5%)0.26
Dyslipidemia, n (%)107 (49.1%)105 (46.9%)0.6414 (51.9%)198 (47.7%)0.68
Diabetes, n (%)45 (20.6%)28 (12.5%)0.029 (33.3%)64 (15.4%)0.02
Obesity, n (%)123 (56.4%)113 (50.4%)0.2111 (40.7%)225 (54.2%)0.17
OSA, n (%)9 (4.3%)8 (3.6%)0.760 (0%)17 (4.1%)0.61
Systolic BP (mm Hg)142 (18)139 (16)0.056142 (22)140 (17)0.64
Diastolic BP (mm Hg)88 (11)88 (10)0.4788 (14)88 (10)0.96

Characteristics of hypertensive subjects with and without CAD

Hypertensives with CAD (n=148)Hypertensives without CAD (n=294)p-value
Female, n (%)78 (52.7%)170 (57.8%)0.31
Age (years)64.9 (12.2)57.8 (12.7)<0.001
Rural residence, n (%)84 (56.8%)146 (49.7%)0.16
Active smoking, n (%)30 (20.3%)63 (21.4%)0.78
Dyslipidaemia, n (%)88 (59.5%)124 (42.2%)<0.001
Diabetes, n (%)37 (25.0%)36 (12.2%)<0.001
Obesity, n (%)76 (51.4%)160 (54.4%)0.54
Obstructive sleep apnoea, n (%)10 (6.8%)7 (2.4%)0.02
Systolic BP (mm Hg)142 (19)139 (17)0.19
Diastolic BP (mm Hg)87 (11)89 (11)0.14

Multivariable logistic regression analysis for predictors of various forms of cardiac damage

LVHDiastolic dysfunctionSystolic dysfunctionCAD
VariableOR (95% CI)p-valueOR (95% CI)p-valueOR (95% CI)p-valueOR (95% CI)p-value
Age1.05 (1.03-1.08)<0.0011.04 (1.02-1.06)<0.0011.04 (0.99-1.08)0.1151.05 (1.02-1.07)<0.001
Female sex2.07 (1.24-3.45)0.0061.10 (0.71-1.69)0.6810.26 (0.10-0.71)0.0090.72 (0.45-1.14)0.161
Dyslipidemia1.20 (0.74-1.96)0.4650.98 (0.65-1.50)0.9411.31 (0.52-3.31)0.5641.89 (1.20-3.00)0.007
Diabetes1.63 (0.87-3.04)0.1271.31 (0.74-2.33)0.3612.20 (0.82-5.88)0.1171.52 (0.85-2.71)0.161
Smoking0.90 (0.64-1.25)0.5141.27 (0.97-1.67)0.0821.30 (0.72-2.35)0.3931.04 (0.77-1.40)0.804
OSA1.25 (0.41-3.86)0.6970.96 (0.33-2.76)0.9351.00 (0.99 -1.01)0.9980.30 (0.10-0.94)0.039
Systolic BP1.02 (1.01-1.04)0.0261.01 (0.99-1.02)0.4331.00 (0.97-1.03)0.9571.00 (0.99-1.02)0.621
Diastolic BP1.00 (0.97-1.03)0.8861.00 (0.98-1.03)0.9851.00 (0.94-1.06)0.9051.00 (0.97-1.03)0.730

Clinical and echocardiographic characteristics of the study population_

All subjects (n=976)Hypertensive subjects (n=442)Normotensive subjects (n=534)p-value
Female, n (%)580 (59.4%)248 (56.1%)332 (62.2%)0.055
Age (years)50.8 (16.6)60.2 (13.0)43.0 (15.1)<0.001
Rural residence, n (%)456 (46.7%)230 (52.1%)226 (42.3%)0.002
Active smoking, n (%)276 (28.3%)93 (21.0%)183 (34.3%)<0.001
Dyslipidemia, n (%)341 (34.9%)212 (48.0%)129 (24.2%)<0.001
Diabetes, n (%)91 (9.3%)73 (16.5%)18 (3.4%)<0.001
Obesity, n (%)391 (40.1%)236 (53.4%)155 (29.0%)<0.001
Obstructive sleep apnea, n (%)28 (2.9%)17 (3.8%)11(2.1%)0.10
Systolic BP (mm Hg)129 (19)141 (17)119 (12)<0.001
Diastolic BP (mm Hg)83 (10)88 (11)78 (8)<0.001
IVS (mm)9 (1)10 (1)9 (1)<0.001
LVPW (mm)9 (1)10 (1)9 (1)<0.001
LVEDD (mm)45 (5)46 (5)44 (5)<0.001
LVESD (mm)34 (6)35 (6)33 (5)<0.001
LA diameter (mm)34 (5)36 (5)32 (5)<0.001
Indexed LV mass (g/m2)84 (24)94 (25)76 (20)<0.001
LVH, n (%)187 (19.2%)136 (30.8%)51 (9.6%)<0.001
Mitral E/A wave ratio1.23 (0.40)1.08 (0.37)1.35 (0.37)<0.001
Diastolic dysfunction <0.001
First degree, n (%)268 (27.5%)174 (39.4%)94 (17.6%)
Second degree, n (%)87 (8.9%)40 (9.0%)47 (8.8%)
Third degree, n (%)6 (0.6%)4 (0.9%)2 (0.4%)
Systolic dysfunction, n (%)44 (4.5%)27 (6.1%)17 (3.2%)0.03
LVEF (%)58 (4)57 (4)59 (4)<0.001
Atrial fibrillation, n (%)80 (8.2%)55 (12.4%)25 (4.7%)<0.001
DOI: https://doi.org/10.2478/rjc-2023-0001 | Journal eISSN: 2734-6382 | Journal ISSN: 1220-658X
Language: English
Page range: 6 - 13
Published on: Mar 18, 2023
Published by: Romanian Society of Cardiology
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year

© 2023 Aura Vîjîiac, Cosmin Cojocaru, Oana Gheorghe-Fronea, Irinel Parepa, Călin Pop, Theodora Benedek, Roxana Darabont, Diana Stănciulescu, Laura Stănciulescu, Ioana Antonia Branea, Anamaria Vizitiu, Lucian Mihai Itu, Maria Dorobanţu, published by Romanian Society of Cardiology
This work is licensed under the Creative Commons Attribution 4.0 License.