Abstract

Research Article

Design and validation of an Index to predict the development of Hypertensive Cardiopathy

Alexis Álvarez-Aliaga*, Andrés José Quesada-Vázquez, Alexis Suárez-Quesada and David de Llano Sosa

Published: 16 February, 2018 | Volume 3 - Issue 1 | Pages: 008-022

Introduction: The high morbidity and mortality by hypertensive cardiopathy demand the construction and validation of tools to stratify the risk of developing this condition.

Objective: To design and validate an index, based on risk factors, that permits to predict the development of hypertensive cardiopathy in patients with a diagnosis of essential arterial hypertension.

Methods: A prospective cohort study was done 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 1st, 2010 to December 31, 2016. Internal and external validity and the internal consistency of the index were determined.

Results: The index sensitivity was of 97, 20 (IC: 93, 93-94.09) and specificity of 65, 38 (IC: 76, 25-76, 20). Both the index discriminative capacity (area under the ROC curve= 0,944; interval of confidence: 0.932-0.956; p<0.0005) and calibration (p=0.751) were adequate.

Conclusions: The present study proposes an index to predict the risk of developing hypertensive cardiopathy, with adequate discriminative capacity and calibration (external validity). The index can be used as a tool of clinical and epidemiological surveillance since it permits to identify subjects with greater probability of developing the condition and to stratify the risk.

Read Full Article HTML DOI: 10.29328/journal.jccm.1001022 Cite this Article Read Full Article PDF

References

  1. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. The JNC 7 report. 2003; 289: 2560-2572. Ref.: https://goo.gl/s9MtBw
  2. República de Cuba. Anuario Estadístico de Salud; 2016. [citado 10 abril 2017]. Disponible en.
  3. Tientcheu D, Ayers C, Das SR, McGuire DK, de Lemos JA, et al. Target organ complications and cardiovascular events associated with masked hypertension and white-coat hypertension. Analysis from the Dallas heart study. Am Coll Cardiol. 2015; 66: 2159-2169. Ref.: https://goo.gl/B4sMN3
  4. Díez J, Frohlich E D. A translational approach to hypertensive heart disease. Hypertension. 2010; 55: 1-8. Ref.: https://goo.gl/xNGLyg
  5. 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. Rev Esp Cardiol. 2013; 66: 880.
  6. Mancia G, Laurent S, Agabiti-Rosei E, Ambrosioni E, Burniere M, et al. Reappraisal of European guidelines on hypertension management: A European Society of Hypertension Task Force document. J Hypertens. 2009; 27: 2121-2158. Ref.: https://goo.gl/HBrVk9
  7. Maione A, Annemans L, Strippoli G. Proteinuria and clinical outcomes in hypertensive patients. Am J Hypertens. 2009; 22: 1137-1147. Ref.: https://goo.gl/w2pMxY
  8. Angeli F, Ambrosio G. Mecanismos de la hipertrofia ventricular izquierda en la hipertensión: más que solo la presión arterial. Rev Argent Cardiol. 2015; 83: 6-7. Ref.: https://goo.gl/1BKVsC
  9. Harbaoui B, Courand PY, Defforges A, Khettab F, Milon H, et al. Cumulative effects of several target organ damages in risk assessment in hypertension. Am J Hypertens. 2016; 29: 234-244. Ref.: https://goo.gl/MFLhNw
  10. Wang SX, Xue H, Zou YB, Sun K, Fu CY, et al. Prevalence and risk factors for left ventricular hypertrophy and left ventricular geometric abnormality in the patients with hypertension among Han Chinese. Chin Med J. 2012; 125: 21-26. Ref.: https://goo.gl/SesKhT
  11. Sharman J E. New insights into cardiovascular risk from the exercise central waveform. Artery Res. 2009; 2: 132-137. Ref.: https://goo.gl/Zd9a6A
  12. García Iglesias A, Lozano Alonso J E, Álamo Sanz R, Vega Alonso T. Factores asociado al control de la presión arterial en la cohorte del estudio del riesgo de enfermedad cardiovascular en Castilla y León (RECCyL). Hipertens Riesgo Vasc. 2015; 32: 48-55. Ref.: https://goo.gl/AAKq4U
  13. 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/VwxWXY
  14. Khouri MG, Peshock RM, Ayers CR, de Lemos JA, Drazner MH. A 4-tiered classification of left ventricular hypertrophy based on left ventricular geometry: The Dallas Heart Study. Circ Cardiovasc Imaging. 2010; 3: 164-171. Ref.: https://goo.gl/8Fnptm
  15. Fuster V, Rydén L E, Cannom D S, Crijns H J, Curtis A B, et al. 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation. J Am Coll Cardiol. 2011; 123: 104-123. Ref.: https://goo.gl/uYTEgW
  16. 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. Ref.: https://goo.gl/d9zaUu
  17. 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/FsyiuG
  18. 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. Rev Esp Cardiol. 2007; 60: 244-250. Ref.: https://goo.gl/9V1PG6
  19. 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/Romh5u
  20. Egan BM, Zhao Y, Axon RN. US trends in prevalence, awareness, treatment, and control of hypertension, 1988-2008. JAMA. 2010; 303: 2043-2050. Ref.: https://goo.gl/JHFMTu
  21. Álvarez Aliaga A, González Aguilera JC, Maceo Gómez LR. Factores asociados al desarrollo de la cardiopatía hipertensiva: un estudio de cohorte, en Bayamo, Cuba. Medwave. 2016; 16. Ref.: https://goo.gl/csGC8P
  22. Moriyama IM. Problems in the measurement of health status. En: Sheldon EB, Moore W. eds. Indicators of social change: concepts and measurements. New York: Rusell Sage fundation. 1968: 573-599.
  23. D'Agostino RB, Grundy S, Sullivan LM, Wilson P, for the CHD Risk Prediction Group. Validation of the Framingham Coronary Heart Disease Prediction Scores. Results of a multiple ethnic groups investigation. JAMA. 2001; 286:180-187. Ref.: https://goo.gl/UBzXFm
  24. Álvarez Aliaga A, González Aguilera JC, Quesada Vázquez AJ, Frómeta Guerra A, Cisneros Sánchez L, Maceo Gómez LR. Índice predictivo para la cardiopatía hipertensiva. Rev Cubana de Med. 2010; 49: 311-329. Ref.: https://goo.gl/2pBkEe
  25. Drazner M H. The Progression of Hypertensive Heart Disease. Circulation. 2011; 123: 327-334. Ref.: https://goo.gl/chYmgm
  26. 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 height(2.7). J Hypertens. 2009; 27: 2465-2471. Ref.: https://goo.gl/Jvobsg
  27. Gu Q, Dillon CF, Burt VL, Gillum RF. Association of hypertension treatment and control with all-cause and cardiovascular disease mortality among US adults with hypertension. Am J Hypertens. 2010; 23: 38-45. Ref.: https://goo.gl/k3x92g
  28. Peralta CA, Katz R, Newman AB, Psaty BM, Odden MC. Systolic and diastolic blood pressure, incident cardiovascular events, and death in elderly persons: the role of functional limitation in the Cardiovascular Health Study. Hypertension.2014; 64: 472-480. https://goo.gl/d2GVgz
  29. 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/vSJHBL
  30. De la Noval García R, Armas Rojas NB, de la Noval González I, Fernández González Y, Pupo Rodríguez HB, et al. Estimación del riesgo cardiovascular global en una población del área de salud Mártires del Corynthia. Ciudad Habana, Cuba. Rev Cubana Cardiol Cir Cardiovasc. 2011; 17: 62-68. Ref.: https://goo.gl/77vWvG
  31. Armas Rojas NB, De la Noval García R, Dueñas Herrera A, Castillo Núñez JC, Suárez Medina R, et al. Estimación del riesgo cardiovascular mediante tablas de la Organización Mundial de la Salud. Área de salud “Héroes del Moncada”. 2011. Rev Cubana Cardiol Cir Cardiovasc. 2014; 20. Ref.: https://goo.gl/x1U0K2
  32. D’Agostino RB, Vasan RS, Pencina MJ, Wolf PA, Cobain M, et al. General cardiovascular risk profile for use in primary care the Framingham heart study. Circulation. 2008; 117: 743-753. Ref.: https://goo.gl/XgFgAh
  33. Ang DSC, Fahey TP, Wright GA, Struthers AD. Development and validation of a clinical score to identify echocardiographic left ventricular hypertrophy in patients with cardiovascular disease. Am J Hypertens.2008; 21: 1011-1017. Ref.: https://goo.gl/8VWSLa
  34. Creemers EE, Pinto YM. Molecular mechanisms that control interstitial fibrosis in the pressure-overloaded heart. Cardiovasc Res. 2011; 89: 265-272. Ref.: https://goo.gl/fJ85zY
  35. Drazner MH. The Progression of Hypertensive Heart Disease. Circulation. 2011; 123: 327-334. Ref.: https://goo.gl/chYmgm
  36. Feinstein AR, Cicchetti DV. High agreement but low kappa: I. The problem of two paradoxes. J Clin Epidemiol. 1990; 43: 543-549. Ref.: https://goo.gl/8NisKG
  37. Streiner DL, Norman GR. Health measurement scales. A practical guide to their development and use. Oxford: Oxford University Press; 1989: 144-161.
  38. García Cadena CH. La medición en las ciencias sociales y la psicología, en estadística con SPSS y metodología de la investigación de René Landeros Hernández y Mónica T González Ramírez. México, Trillas (comp). 2006. Ref.: https://goo.gl/RY1Qad

Figures:

Figure 1

Figure 1

Similar Articles

Recently Viewed

Read More

Most Viewed

Read More