G.D. Radchenko, L.O. Mushtenko.Clinical course of arterial hypertension depending on concomitant ischemic heart disease

The aim – to evaluate arterial hypertension (AH) course in patients with and without ischemic heart disease (IHD) who were treated in a specialized hypertension department.
Material and methods. Depending on concomitant IHD, 524 patients were divided into two groups: the 1st – 184 patients with signs of IHD (angina, history of myocardial infarction, positive exercise tolerance test or coronary angiography), the second one – 340 patients without IHD signs. The course of disease was evaluated using curves Kaplan – Meier’s and Cox regressive analysis with adjusted and non-adjusted relative risk (OR) with confidential interval (CI) 95 %.
Results. Concomitant IHD increased risk of combined endpoint by 1.68 (P=0.02; CI 1.21–2.34), myocardial infarction by 3.9 (P=0.003; 95 % CI 1.58–9.7), unstable angina by 2.5 (P=0.009; CI 1.26–4.9), any coronary event by 2.2 (P=0.005; 95 % CI 1.89–3.82). It didn’t affect the frequency of stroke, heart failure and chronic renal insufficiency appearance. The structure of fatal events was different in the compared groups: the patients without IHD died from stroke 3.38 times more frequent than patients with IHD. At the same time, the patients with IHD died from coronary events 3.11 times more frequent than the patients without IHD. The 1st group patients were more often using angiotensin-converting enzyme inhibitors, diuretics and acetylsalicylic acid.
Conclusions. The patients having IHD and AH were older, with higher percentage of males, with more frequent complications and diabetes mellitus, worse renal function, more severe left ventricular hypertrophy and systolic dysfunction, compared to patients without IHD. They had significantly lower level of diastolic blood pressure and higher level of day time pulse pressure. Concomitant IHD was associated with increased risk of coronary events and all-cause death and impacted death structure.

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