Munich, Germany—New prognostic markers of hypertension were presented at the 2012 European Society of Cardiology Congress. Roland E. Schmieder, MD, Head of the Clinical Unit of Hypertension and Vascular Medicine, Erlangen University Hospital in Nürnberg, Germany, discussed the results of 3 studies that “identified prognostic markers in hypertensive patients.” These markers include blood pressure (BP) variability, low testosterone levels, and treatment-resistant hypertension.
An analysis by a team from the University of California that involved 20,952 patients in the lipid-lowering TNT, IDEAL, and CARDS trials showed that visit-to-visit BP variability (ie, control of BP over months and years) was a significant risk factor for stroke and coronary events. The statin treatment effect in each trial was not affected or mediated by the adjustment for systolic BP or diastolic BP variability or other BP parameters.
“These trials more accurately reflect daily real-life practice” of BP control, said Dr Schmieder, because the protocols did not dictate BP management.
“Epidemiologic studies show that total testosterone is a cardiovascular [CV] risk predictor,” said Dr Schmieder.
Low Testosterone Levels
In a prospective study by a team of researchers from the Medical School of Athens University, Greece, a low level of testosterone was associated with a higher risk of major CV events. A 2.5-times higher risk of CV events was found in the men with hypertension who were in the lowest tertile of testosterone (<4.0 ng/mL) compared with the highest tertile (>4.9 ng/mL).
“This was an independent determinant of risk,” said Dr Schmieder, independent of age, BP values, metabolic profile, antihypertensive therapy, and statins. A total of 29 events occurred in the 275 hypertensive men (mean age, 52 years) during the 43-month study.
Treatment-resistant hypertension was an independent predictor of risk in a single-center study of 2345 patients with uncomplicated hypertension (mean age, 58 years) that was conducted by another group of researchers from the Medical School of Athens University, Greece.
The 18.4% of patients who had treatment-resistant hypertension had a much higher rate of CV complications, such as coronary artery disease (4.7% vs 2.1%, respectively), stroke (1.9% vs 0.7%, respectively), and atrial fibrillation (6.1% vs 2.7%, respectively), and the composite of these (11.9% vs 5.5%, respectively) compared with patients with hypertension that was not treatment resistant. On average, the treatment-resistant hypertension group was older by 5 years, had larger waist circumference and greater body mass index, and more patients had diabetes.