TY - JOUR
T1 - Impact of vascular biomarkers and supine hypertension on cardiovascular outcomes in hypertensive patients
T2 - first results from the Cardiovascular Prognostic COUPLING Study in Japan
AU - Kario, Kazuomi
AU - Hoshide, Satoshi
AU - Kabutoya, Tomoyuki
AU - Nishizawa, Masafumi
AU - Yamagiwa, Kayo
AU - Kawashima, Akihiro
AU - Fujiwara, Takeshi
AU - Nakazato, Jun
AU - Yoshida, Tetsuro
AU - Negishi, Keita
AU - Matsui, Yoshio
AU - Sekizuka, Hiromitsu
AU - Abe, Yasuhisa
AU - Fujita, Yumiko
AU - Hashizume, Toshikazu
AU - Morimoto, Tomoko
AU - Nozue, Ryoko
AU - Kanegae, Hiroshi
N1 - Publisher Copyright:
© The Author(s), under exclusive licence to The Japanese Society of Hypertension 2024.
PY - 2024
Y1 - 2024
N2 - The prognostic impact of vascular biomarkers and supine blood pressure (BP) is not well understood. The multicenter, prospective Coupling study determined the prognostic impact of vascular biomarkers and supine BP in outpatients aged ≥30 years with ≥1 cardiovascular risk factor. Occurrence of major cardiovascular events during follow-up was recorded. The primary outcome was time to onset of a major cardiovascular event. Office and supine BP, the cardio-ankle vascular index (CAVI), and the ankle-brachial index (ABI) were determined annually. Of the 5109 participants in the Coupling study, 4716 were analyzed (51.9% male, mean age 68.5 ± 11.4 years); participants mostly had hypertension treated based on seated office/home BP according to relevant guidelines. During a median follow-up of 5.0 years (interquartile range 3.6–5.2), 231 major cardiovascular events occurred. After adjustment for age, sitting office systolic BP, and other covariates, a 1-unit increase in CAVI (hazard ratio [HR] 1.12, 95% confidence interval [CI] 1.01–1.24) and a 0.1-unit decrease in ABI (HR 1.41, 95% CI 1.18–1.68) were significantly associated with cardiovascular event risk; risk was greatest when CAVI was ≥8.0 and ABI was ≤1.10. Uncontrolled supine hypertension (≥140/90 mmHg) was also significantly associated with adjusted cardiovascular event risk (HR 1.36, 95% CI 1.02–1.81); seated office BP control was not significantly associated with cardiovascular event risk. Increased arterial stiffness, mildly lower ABI, and supine hypertension are risk factors for cardiovascular events during standard clinical practice. Supine evaluation of BP and vascular biomarkers has highlighted a blind spot in current hypertension management (Clinical trial registration: University Hospital Medical Information Network Clinical Trials Registry, UMIN000018474). (Figure presented.)
AB - The prognostic impact of vascular biomarkers and supine blood pressure (BP) is not well understood. The multicenter, prospective Coupling study determined the prognostic impact of vascular biomarkers and supine BP in outpatients aged ≥30 years with ≥1 cardiovascular risk factor. Occurrence of major cardiovascular events during follow-up was recorded. The primary outcome was time to onset of a major cardiovascular event. Office and supine BP, the cardio-ankle vascular index (CAVI), and the ankle-brachial index (ABI) were determined annually. Of the 5109 participants in the Coupling study, 4716 were analyzed (51.9% male, mean age 68.5 ± 11.4 years); participants mostly had hypertension treated based on seated office/home BP according to relevant guidelines. During a median follow-up of 5.0 years (interquartile range 3.6–5.2), 231 major cardiovascular events occurred. After adjustment for age, sitting office systolic BP, and other covariates, a 1-unit increase in CAVI (hazard ratio [HR] 1.12, 95% confidence interval [CI] 1.01–1.24) and a 0.1-unit decrease in ABI (HR 1.41, 95% CI 1.18–1.68) were significantly associated with cardiovascular event risk; risk was greatest when CAVI was ≥8.0 and ABI was ≤1.10. Uncontrolled supine hypertension (≥140/90 mmHg) was also significantly associated with adjusted cardiovascular event risk (HR 1.36, 95% CI 1.02–1.81); seated office BP control was not significantly associated with cardiovascular event risk. Increased arterial stiffness, mildly lower ABI, and supine hypertension are risk factors for cardiovascular events during standard clinical practice. Supine evaluation of BP and vascular biomarkers has highlighted a blind spot in current hypertension management (Clinical trial registration: University Hospital Medical Information Network Clinical Trials Registry, UMIN000018474). (Figure presented.)
KW - Ankle-brachial index
KW - Cardio-ankle vascular index
KW - Cardiovascular disease
KW - Hypertension
KW - Supine hypertension
UR - http://www.scopus.com/inward/record.url?scp=85206665768&partnerID=8YFLogxK
U2 - 10.1038/s41440-024-01922-1
DO - 10.1038/s41440-024-01922-1
M3 - Article
C2 - 39394510
AN - SCOPUS:85206665768
SN - 0916-9636
JO - Hypertension Research
JF - Hypertension Research
ER -