NEW YORK (Reuters Health) – Systolic blood pressure, left ventricular (LV) mass, and diabetes status independently predict the likelihood that prehypertensive patients with cardiac risk factors will develop overt hypertension, according to a report in the November issue of Hypertension.

Based on their findings, Dr. Marina De Marco, from Federico II University Hospital in Napoli, Italy, and associates advise that “prehypertensive diabetic patients and/or those with increased LV mass…be referred to more extensive clinical evaluation…and possibly treated to prevent (hypertension)” and overweight prehypertensive patients should be directed to weight-loss programs.

All participants in the authors’ study were American Indians, “a population with a high prevalence of diabetes mellitus and obesity.”

At baseline, the 625 men and women in the study were a mean age of 59. All had untreated prehypertension but none had cardiovascular disease. Sixty-three percent were women, and 22% had diabetes.

The 4-year incidence of hypertension in this cohort was 38%, the authors report. Progression to hypertension was predicted by higher baseline systolic blood pressure (odds ratio 1.6 per 10 mmHg), the presence of diabetes (OR 2.73), and larger waist circumference (ORR 1.1 per 10 cm).

When they added echocardiographic parameters to their model, “LV mass index provided an additional, independent prediction,” the authors said. Specifically, baseline LV hypertrophy was associated with an OR of 1.78 for progression to overt hypertension. In an alternative model, LV stroke volume index was also an independent risk factor for hypertension.

On the other hand, regression from pre-HTN to normal BP was associated with lower baseline body size and significant reduction of waist girth, “extending the established indications of lifestyle modifications for arterial hypertension to the management of pre-hypertension.”

The researchers note that their findings in their American Indian cohort are “not necessarily generalizable and need to be verified in other populations with different genetic and environmental backgrounds.”

Reference:
Hypertension 2009;54:974-980.