The hypertension-based chronic disease model in a primary care setting

Eduardo Thadeu de Oliveira Correia; Jeffrey I Mechanick; Antonio José Lagoeiro Jorge; Leticia Mara Dos Santos Barbetta; Maria Luiza Garcia Rosa; Adson Renato Leite; Dayse Mary da Silva Correia; Evandro Tinoco Mesquita

doi:10.1016/j.ijcrp.2023.200204

The hypertension-based chronic disease model in a primary care setting

Int J Cardiol Cardiovasc Risk Prev. 2023 Aug 14:18:200204. doi: 10.1016/j.ijcrp.2023.200204. eCollection 2023 Sep.

Authors

Eduardo Thadeu de Oliveira Correia^{1

2}, Jeffrey I Mechanick³, Antonio José Lagoeiro Jorge², Leticia Mara Dos Santos Barbetta², Maria Luiza Garcia Rosa², Adson Renato Leite², Dayse Mary da Silva Correia², Evandro Tinoco Mesquita²

Affiliations

¹ Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
² Universidade Federal Fluminense, Niteroi, Rio de Janeiro, Brazil.
³ Marie-Josée and Henry R. Kravis Center for Clinical Cardiovascular Health at Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

Abstract

Background: Driver-based chronic disease models address the public health challenge of cardiometabolic risk. However, there is no data available about the novel Hypertension-Based Chronic Disease (HBCD) model. This study investigates the prevalence, characteristics, and prognostic significance of HBCD Stages in a primary care cohort.

Methods: This study included participants aged ≥45 years, randomly selected from the primary care program of a Brazilian medium-sized city. Participants underwent electrocardiogram, tissue Doppler echocardiogram and were followed for a median of 6 years. Participants were classified into HBCD Stages as follows: Stage 1: hypertension risk factors; Stage 2: pre-hypertension; Stage 3: hypertension; and Stage 4: hypertension complications.

Results: Overall, 633 participants were included in the cross-sectional analysis and 560 that had follow-up data were included in the prognostic analysis. From 633 participants, 1.3% had no identifiable risk factors for HBCD, 10.0% were Stage 1, 14.7% Stage 2, 51.5% Stage 3, and 22.5% Stage 4. Increasing HBCD stages had worse glomerular filtration rates, echocardiographic markers, and higher body mass index, waist circumference, blood glucose levels, and prevalence of type 2 diabetes. Rates of all-cause mortality or cardiovascular hospitalization increased across HBCD Stages: Stage 1: 3.6%; Stage 2: 4.8%, Stage 3: 7.6%; and Stage 4: 39.5%. Kaplan-Meier curves showed composite outcome worsened across HBCD Stages 1-4 (p < 0.001).

Conclusions: HBCD is a conceptually and prognostically valid model. Remarkably, HBCD stages were associated with progressively worsening markers of heart disease, declining kidney function and higher rates of all-cause mortality or cardiovascular hospitalization.

Keywords: Blood pressure; Cardiometabolic disease; Hypertension; Prehypertension.