Research Article

Non-hemodynamic factors associated to the risk of developing hypertensive cardiopathy

Alexis Álvarez-Aliaga*, Julio César González-Aguilera, Liliana del Rosario Maceo-Gómez, Lic David del Llano Sosa, Raúl Leyva-Castro and Rosa Ojeda-Vázquez

Published: 20 September, 2017 | Volume 2 - Issue 1 | Pages: 068-084

Introduction: Hypertensive cardiopathy is the target organ lesion caused by arterial hypertension (HTN) that exhibits the highest morbidity and mortality rates. Although the importance of hemodynamic overload exerted by HTN on the onset of cardiopathy is well established, several non-hemodynamic factors may contribute significantly to its development.

Objective: To evaluate the influence of different non-hemodynamic risk factors in the development of hypertensive cardiopathy.

Methods: A prospective cohort study was carried out in hypertensive patients assisted at the specialized arterial hypertension physicians’ office of the “Carlos Manuel de Céspedes” Specialty Policlinic attached to the General University Hospital, Bayamo Municipality, Granma Province, Cuba from January 5, 2006 to December 31, 2015. The study included 18-to-55-year-old hypertensive patients with a stage 1 arterial hypertension diagnosis for less than a year1.

Results: The multivariate analysis showed a significant and independent relation among the majority of the factors studied and the risk of developing cardiopathy. The major factor was C-reactive protein (HR: 5.020; IC 95%: 3.383-7,448; p<0.005) followed by microalbuminuria (HR: 2.649; IC 95%: 1.932-3.631; p<0.005). The area under the model ROC curve was 0.887 (p<0,005).

Conclusions: The results showed that it is possible to estimate the risk of developing hypertensive cardiopathy with the application of the regression model to major risk factors.

Read Full Article HTML DOI: 10.29328/journal.jccm.1001017 Cite this Article Read Full Article PDF


Arterial hypertension; Hypertensive cardiopathy; Non-hemodynamic cardiovascular risk factors Abstract


  1. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, et al. Guía de práctica clínica de la ESH/ESC 2013 para el manejo de la hipertensión arterial. RevEspCardiol. 2013; 23: 3-16. Ref: https://goo.gl/pdLH5T
  2. Victor RG. Arterial hypertension. En: Lee Goldman L, Schafer AI, editors. Goldman-Cecil Medicine. 25th ed.Philadelphia, PA: ElsevierSaunders. 2016; 67: 381-397.
  3. República de Cuba. Ministerio de Salud Pública. Anuario Estadístico de Salud. 2016.
  4. Díez J, Frohlich ED. A translational approach to hypertensive heart disease. Hypertension. 2010; 55: 1-8. Ref: https://goo.gl/NyEqK8
  5. Tzoulaki I, Murray GD, Lee AJ, Rumley A, Lowe GDO, et al. Relative value of inflammatory, hemostatic, and rheological factors for incident myocardial infarction and stroke: the Edinburgh Artery Study. Circulation. 2007; 115: 2119-2127. Ref: https://goo.gl/hzbp9m
  6. Sharman JE. New insights into cardiovascular risk from the exercise central waveform. Artery Res. 2009; 2: 132-137. Ref: https://goo.gl/BpS9FK
  7. Tomiyama H, Matsumoto C, Yamada J, Yoshida M, Odaira M, et al. Predictors of progression from prehypertension to hypertension in Japanese men. Am J Hypertens. 2009; 22: 630-636. Ref: https://goo.gl/QXDu2D
  8. Álvarez Aliaga A, González Aguilera JC, Maceo Gómez LR. Factores asociados al desarrollo de la cardiopatía hipertensiva: un estudio de cohorte, en Bayamo, Cuba. Medwave2016; 16: 6492. Ref: https://goo.gl/KjbCaF
  9. Álvarez Aliaga A, González Aguilera JC. Algunos factores de riesgo de la cardiopatía hipertensiva. Rev Cubana de Med. 2009; 48: 139-151. Ref: https://goo.gl/LZnLPD
  10. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, et al. National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003; 289: 2560-2572. Ref: https://goo.gl/21maJJ
  11. Dévereux RB, Reichek N. Echocardiographic determination of left ventricular mass in man. Anatomic validation of the method. Circulation. 1977; 55: 613-618. Ref: https://goo.gl/N3sdsr
  12. Pérez Caballero MD, Dueñas Herrera A, Alfonso Guerra JP, Vázquez Vigoa A, Navarro Despaigne D, et al. Hipertensión arterial. Guía para la prevención, diagnóstico y tratamiento. Comisión Nacional Técnica Asesora del Programa de Hipertensión Arterial. La Habana: Editorial Ciencias Médicas. 2008.
  13. Whelton S, Chin A, Xin X, He J. Effect of aerobic exercise on blood pressure: a meta-analysis of randomized, controlled trials. Ann Intern Med. 2002; 136: 493-503. Ref: https://goo.gl/8jtdSP
  14. Cabrera de León A, Rodríguez-Pérez C, Rodríguez-Benjumeda M, Anía-Lafuente B, Brito-Díaz B, et al. Sedentarismo: tiempo de ocio activo frente a porcentaje del gasto energético. RevEspCardiol. 2007; 60: 244-50. Ref: https://goo.gl/EpUDwi
  15. Zhao W, Hasegawa K, Chen J. Part A. Recent advances in dietary assessment tools. The use of food-frequency questionnaires for various purposes in China. Public Health Nutrition. 2002; 5: 829-833. Ref: https://goo.gl/M3zAAt
  16. Mazumdar M, Glassman JR. Categorizing a prognostic variable: review of methods, code for easy implementation and applications to decision-making about cancer treatments. Stat Med. 2000; 19: 113-132. Ref: https://goo.gl/A7MNWm
  17. Graf K, Schaefer-Graf UM. Is Smad3 the key to inflammation and fibrosis in hypertensive heart disease? Hypertension. 2010; 55: 1088-1089. Ref: https://goo.gl/KnonvS
  18. Drazner MH. The progression of hypertensive heart disease. Circulation. 2011; 123: 327- 334. Ref: https://goo.gl/AVmvg5
  19. Sehestedt T, Jeppesen J, Hansen TW, Rasmussen S, Wachtell K, et al. Which markers of subclinical organ damage to measure in individuals with high normal blood pressure? J Hypertens. 2009; 27: 1165-1171. Ref: https://goo.gl/jXron1
  20. Perkovic V, Verdon C, Ninomiya T, Barzi F, Cass A, et al. The Relationship between proteinuria and coronary risk: A systematic review and meta-analysis. PLoSMed. 2008; 5: 1486-1495. Ref: https://goo.gl/J8fLJC
  21. Maione A, Annemans L, Strippoli G. Proteinuria and clinical outcomes in hypertensive patients. Am J Hypertens. 2009; 22: 1137-1147. Ref: https://goo.gl/LxKXLg
  22. Zhang Z, Dzau VJ. Angiotensin II type 1 receptor–associated protein is an endogenous inhibitor of angiotensin II type 1 receptor action in cardiac hypertrophy. Role in check and balance. Hypertens. 2010; 55:1086-1087. Ref: https://goo.gl/RMHN9T
  23. Tocci G, Paneni F, Ponziani B, Volpe M. Use of predictive markers to improve cardiovascular protection. FutureCardiol. 2007; 3: 447-456. Ref: https://goo.gl/Axptnn
  24. Martínez-Castelao A, Górriz JL, Bover J, Segura-de la Morena J, Cebollada J, et al. Documento de consenso para la detección y manejo de la enfermedad renal crónica. Hipertens Riesgo Vasc. 2014; 46: 501-519. Ref: https://goo.gl/ki1f1w
  25. Halperin RO, Michael Gaziano JM, Howard D, Sesso HD. Smoking and the risk of incident hypertension in middle-aged and older men. Am J Hypertens. 2008; 21: 148-152. Ref: https://goo.gl/6DK9ug
  26. Johnson HM, Gossett LK, Piper ME, Aeschlimann SE, Korcarz CE, et al. Effects of smoking and smoking cessation on endothelial function 1-year outcomes from a randomized clinical trial. J Am CollCardiol. 2010; 55: 1988-1995. Ref: https://goo.gl/jW5LjH
  27. Schmidt AC, Flick B, Jahn E, Bramlage P. Effects of the vasodilating beta-blocker nebivolol on smoking-induced endothelial dysfunction in young healthy volunteers. Vasc Health Risk Manag. 2008; 4: 909-915. Ref: https://goo.gl/Mg88bR
  28. Appel LJ. The case for population-wide salt reduction gets stronger. BMJ. 2009; 339:b4980. Ref: https://goo.gl/rcBr9T
  29. Strazzullo P, D’Elia L, Kandala NB, Cappuccio FP. Salt intake, stroke, and cardiovascular disease: meta-analysis of prospective studies. BMJ. 2009; 339: 4567. Ref: https://goo.gl/6863jC
  30. He J, Ogden LG, Bazzano LA, Vupputuri S, Loria C, et al. Dietary sodium intake and incidence of congestive heart failure in overweight US men and women: first National Health and Nutrition Examination Survey epidemiologic follow-up study. Arch Intern Med. 2002; 162: 1619-1624. Ref: https://goo.gl/C3UzFE
  31. Haddy FJ. Role of dietary salt in hypertension. LifeSci. 2006; 79: 1585-1592. Ref: https://goo.gl/WFoaYs
  32. Frohlich ED. The salt conundrum: a hypothesis. Hypertension. 2007; 50: 161-166. Ref: https://goo.gl/p6RdEQ
  33. Cuspidi C, Valerio C, Sala C, Negri F, Esposito A, et al. Metabolic syndrome and biventricular hypertrophy in essential hypertension. J Hum Hypertens. 2009; 23: 168-175. Ref: https://goo.gl/xpZyxA
  34. Ärnlöv J, Ingelsson E, Sundström J, Lind L. Impact of body mass index and the metabolic syndrome on the risk of cardiovascular disease and death in middle-aged men. Circulation. 2010; 121: 230-236. Ref: https://goo.gl/gpZ9vq
  35. Alegría Ezquerra E, Castellano Vázquez JM, Alegría Barrero A. Obesidad, síndrome metabólico y diabetes: implicaciones cardiovasculares y actuación terapéutica. RevEspCardiol. 2008; 61: 752-764. Ref: https://goo.gl/QoQnss
  36. Son NH, Yu S, Tuinei J, Arai K, Hamai H, et al. PPARgamma-induced cardiolipotoxicity in mice is ameliorated by PPARalpha deficiency despite increases in fatty acid oxidation. J Clin Invest. 2010; 120: 3443-3454. Ref: https://goo.gl/fEM9c6
  37. Hernández del Rey R. ¿Es importante el ejercicio físico en el control del hipertenso? En: Coca A, de la Sierra A, editores. Decisiones clínicas y terapéuticas en el paciente hipertenso. 3a ed. Barcelona: JIMS SL. 2002; 313-320.
  38. Agarwal D, Haque M, Sriramula S, Mariappan N, Pariaut R, et al. Role of proinflammatory cytokines and redox homeostasis in exercise induced delayed progression of hypertension in spontaneously hypertensive rats. Hypertension. 2009; 54: 1393-1400. Ref: https://goo.gl/CRx6g5
  39. Wildman RP, Gu D, Muntner P, Huang G, Chen J, et al. Alcohol intake and hypertension subtypes in Chinese men. J Hypertens. 2005; 23: 737-743. Ref: https://goo.gl/Q6MHyS
  40. Núñez-Córdoba JM, Martínez-González MA, Bes-Rastrollo M, Toledo E, Beunza JJ, et al. Consumo de alcohol e incidencia de hipertensión en una cohorte mediterránea: el estudio SUN. RevEspCardiol. 2009; 62: 633-641. Ref: https://goo.gl/6bNdSb
  41. Fernández-Solá J, Fatjó F, Sacanella E, Estruch R, Bosch X, et al. Evidence of apoptosis in alcoholic cardiomyopathy. Hum Pathol. 2006; 37: 1100-1105. Ref: https://goo.gl/pN7Bxh
  42. Nagai T, Anzai T, Kaneko H, Mano Y, Anzai A, et al. C-reactive protein overexpression exacerbates pressure overload–induced cardiac remodeling through enhanced inflammatory response. Hypertension. 2011; 57: 208-215. Ref: https://goo.gl/vbi3iP
  43. Anand IS, Latini R, Florea VG, Kuskowski MA, Rector T, et al. C-reactive protein in heart failure: prognostic value and the effect of valsartan. Circulation. 2005; 112: 1428-1434. Ref: https://goo.gl/GQr6pD
  44. Kardys I, Knetsch AM, Bleumink GS, Deckers JW, Hofman A, et al. C-reactive protein and risk of heart failure. The Rotterdam study. Am Heart J. 2006; 152: 514-520. Ref: https://goo.gl/yB1JDM
  45. Araujo JP, Lourenco P, Azevedo A, Frioes F, Rocha-Goncalves F, et al. Prognostic value of high-sensitivity C-reactive protein in heart failure: a systematic review. J Cardiol Fail. 2009; 15: 256-266. Ref: https://goo.gl/JqbyBW
  46. Wang CH, Li SH, Weisel RD, Fedak PW, Dumont AS, et al. C-reactive protein upregulates angiotensin type 1 receptors in vascular smooth muscle. Circulation. 2003; 107: 1783-1790. Ref: https://goo.gl/58YVLT
  47. Verma S, Wang CH, Li SH, Dumont AS, Fedak PW, et al. A self-fulfilling prophecy: C-reactive protein attenuates nitric oxide production and inhibits angiogenesis. Circulation. 2002; 106: 913-919. Ref: https://goo.gl/e8TDqs
  48. Zhang R, Zhang YY, Huang XR, Wu Y, Chung AC, et al. C-reactive protein promotes cardiac fibrosis and inflammation in angiotensin II-induced hypertensive cardiac disease. Hypertension. 2010; 55: 953-960. Ref: https://goo.gl/dH6z2b
  49. Duda MK, O’Shea KM, Tintinu A, Xu W, Khairallah RJ, et al. Fish oil, but not flaxseed oil, decreases inflammation and prevents pressure overload-induced cardiac dysfunction. Cardiovasc Res. 2009; 81: 319-327. Ref: https://goo.gl/4DbFwi
  50. Cheng S, Fernandes VR, Bluemke DA, McClelland RL, Kronmal RA, et al. Age-related left ventricular remodeling and associated risk for cardiovascular outcomes: the Multi-Ethnic Study of Atherosclerosis. CircCardiovascImaging. 2009; 2: 191-198. Ref: https://goo.gl/Wmxaxf
  51. Piskorz D, Quaglino M, Pigozzi F, Vitelleschi M. Importancia de las variables no hemodinámicas en el desarrollo de hipertrofia ventricular izquierda en hipertensión. RevFedArgCardiol. 2010; 39: 288-293. Ref: https://goo.gl/eEtSJo
  52. Barter P, Gotto AM, LaRosa JC, Maroni J, Szarek M, et al. HDL cholesterol, very low levels of LDL cholesterol, and cardiovascular events. N Engl J Med. 2007; 27: 1301-1310. Ref: https://goo.gl/21LQVF
  53. Ashen MD, Blumenthal RS. Clinical practice. Low HDL cholesterol levels. N Engl J Med. 2005; 353: 1252-1260.
  54. O’Donnell CH, Elosua R. Factores de riesgo cardiovascular. Perspectivas derivadas del FraminghamHeartStudy. RevEspCardiol. 2008; 61: 299-310. Ref: https://goo.gl/9cVUxP
  55. Cuspidi C, Giudici V, Negri F, Meani S, Sala C, et al. Improving cardiovascular risk stratification in essential hypertensive patients by indexing left ventricular mass to height2.7. J Hypertens. 2009; 27: 2465-2471. Ref: https://goo.gl/dAW2xq
  56. Felício JS, T Pacheco JT, Ferreira SR, Plavnik F, Moisés VA, et al. Hyperglycemia and nocturnal systolic blood pressure are associated with left ventricular hypertrophy and diastolic dysfunction in hypertensive diabetic patients. CardiovasDiabetol. 2006; 5: 19. Ref: https://goo.gl/KbSxEy
  57. Franjic B, Marwick TH. The diabetic, hypertensive heart: epidemiology and mechanisms of a very high-risk situation. J HumHypertens. 2009; 23: 709-717. Ref: https://goo.gl/QhoJfF
  58. Oliveras A, Armario P, Hernández-del Rey R, Arroyo JA, Poch E, et al. Urinary albumin excretion is associated with true resistant hypertension. J HumHypertens [Internet]. 2010; 24: 27-33. Ref: https://goo.gl/GQCpFf
  59. Xu JZ, Zhang Y, Wu SN, Niu WQ, Zhu DL, et al. Impaired endothelial function in hypertensive patients with target organ damage. J HumHypertens. 2009; 23: 751-757. Ref: https://goo.gl/q51Vu6
  60. De Leeuw PW, Ruilope LM, Palmer CR, Brown MJ, Castaigne A, et al. Clinical significance of renal function in hypertensive patients at high risk: results from the INSIGHT trial. Arch Intern Med. 2004; 164: 2459-2464. Rerf: https://goo.gl/5B4nux
  61. Miguel-Carrasco JL, Mate A, Monserrat MT, Arias JL, Aramburu O, et al. The Role of Inflammatory Markers in the Cardioprotective Effect of l-Carnitine in l-NAME-Induced Hypertension. Am J Hypertens. 2008; 21: 1231-1237. Ref: https://goo.gl/Q6pT3Z
  62. James PA, Oparil S, Carter BL, Cushman WC, Dennison- Himmelfarb C, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014; 311: 507-520. Ref: https://goo.gl/pGxtdB
  63. Yeboah J, Crouse JR, Bluemke DA, Lima JAC, Polak JF, et al. Endothelial dysfunction is associated with left ventricular mass (assessed using MRI) in an adult population (MESA). J Hum Hypertens. 2011; 25: 25-31. Ref: https://goo.gl/HBjT9z
  64. Badimón JJ, Ibáñez B. Incremento de las HDL como arma terapéutica en la aterotrombosis. RevEspCardiol. 2010; 63: 323-333. Ref: https://goo.gl/2sbhco
  65. Feig DI, Kang DH, Johnson RJ.Uric Acid and Cardiovascular Risk. N Engl J Med. 2008; 359: 1811-1821. Ref: https://goo.gl/8ZNnZL
  66. Vlachopoulos C, Xaplanteris P, Vyssoulis G, Bratsas A, Baou K, et al. Association of serum uric acid level with aortic stiffness and arterial wave reflections in newly diagnosed, never-treated hypertension. Am J Hypertens. 2011; 24: 33-39. Ref: https://goo.gl/ZoZpJk
  67. Brunzell JD. Hypertriglyceridemia. N Engl J Med. 2007; 357: 1009-1017. Ref: https://goo.gl/kPvZw5
  68. Miller M, Stone NJ, Ballantyne C, Bittner V, Criqui MH, et al. Triglycerides and cardiovascular disease a scientific statement from the American Heart Association. Circulation. 2011; 123: 2292-2333. Ref: https://goo.gl/sDr9tG


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