Level and predictors of global cardiovascular risk among untreated newly diagnosed and treated black patients with arterial hypertension. A cross sectional study

Objective: to evaluate the level and determinants of global cardiovascular (CV) risk in untreated newly diagnosed and treated black patients with arterial hypertension. Design: cross sectional study Setting: Hypertension Outpatient Clinic, University of Kinshasa Hospital. Methods: We obtained anthropometric, clinical, biological and electrocardiographic (ECG) measurements in 100 consecutive patients with arterial hypertension (47 females, 47%) aged 20 years or more. Risk stratification tables from WHO/ISH guidelines (2003) were used to stratify global CV risk. Multivariate logistic regression analysis was used to assess the independent predictors of hypertrophy of left ventricular based on ECG (ECG-LVH) as a marker of global CV risk.

Results: fifty patients (50%) were receiving antihypertensive therapy; they were older (52 ± 8 vs 45 ± 9 years; p ≤ 0.001) and had hypertension for long time (100 ± 77 vs 32 ± 48 months, p ≤ 0.001), a higher pulse pressure, PP (57 ± 15 vs 51 ± 14 mmHg; p ≤ 0.05), waist circumference (95 ± 12 vs 90 ± 11 cm; p ≤ 0.0001) and proportion of LVH (68 vs 28%; p ≤ 0.05) in comparison to untreated patients for hypertension. In the group of untreated newly diagnosed patients, high CV risk was observed in 8 (16%), 30 (60%) and 12 (100%) patients in hypertension grade 1, 2 and 3, respectively. High CV risk was observed in 10 (83%), 17 (94%) and 12 (71%) treated patients in hypertension grade 1, 2 and 3, respectively.

In multivariate adjusted analysis, the main determinants of CV risk were duration of hypertension (DHT), HDL-c, fasting plasma glucose and  hypertension treatment. Patients with DHT > 2 years had a 7 times risk (adjusted OR 7.23; 95% CI 1.57-42.88) than those with DHT < 2 years. The risk was lower in patients with HDL-c > 1.03 mmol/l (adjusted OR 0.19 95% CI 0.05-0.65; p = 0.008) and those on hypertension treatment (adjusted OR 0.23 95% CI 0.08-0.64; p = 0.005).

Conclusion: Whatever the stage and the therapeutic status in these case series, hypertension is associated with high global CV risk highlighting the need for more aggressive strategy treatment. Key words: global CV risk, predictors, hypertension, Blacks