Arterial hypertension as an independent predictor of adverse outcomes in heart failure
S Paljoskovska Jordanova, S Kjaeva Anastasova, D Petkoska Spirova, I Kuzmanoski, I Bojovski, M BosevskiAbstract
Background
Hypertension remains one of the most prevalent and modifiable risk factors for the development of congestive heart failure (CHF). Through sustained pressure overload, neurohormonal activation, and adverse ventricular remodeling, hypertension contributes to both systolic and diastolic dysfunction and may influence long-term prognosis in patients with established cardiovascular disease.
Purpose
The aim of this study was to evaluate the impact of arterial hypertension on prognosis in patients with heart failure (HF) within a cohort of patients with documented coronary artery disease (CAD).
Methods
We conducted a prospective cohort study including 1,031 patients with angiographically or clinically proven CAD. All patients underwent carotid artery screening. Demographic characteristics, cardiovascular risk factors (including hypertension, dyslipidemia, and obesity), laboratory parameters, and associated comorbidities were systematically collected. Multivariate analysis was performed to identify independent predictors of clinical outcomes and mortality.
Results
Of the 1,031 patients included, 686 (66.6%) were men and 345 (33.5%) were women, with a mean age of 64.4 years. Heart failure was present in 118 patients (11.4%), prior myocardial infarction in 363 (35.2%), obesity in 138 (13.4%), and arterial hypertension in 835 patients (81.0%). During 12 months of follow-up, 12 patients (1.2%) died, of whom 9 (75%) had a history of arterial hypertension. Only 3 patients with heart failure required hospitalization, and just 1 patient with HF died. These data highlight the high prevalence of hypertension among patients experiencing mortality, while HF-related deaths and hospitalizations were relatively low in this cohort. Multivariate analysis suggested a trend toward hypertension as an independent risk factor for adverse outcomes, alongside established predictors such as age and prior myocardial infarction.
Conclusion
Hypertension was the most prevalent cardiovascular risk factor in this cohort and was observed in the majority of patients who died during follow-up. Even in patients without overt heart failure, chronic hypertension may predispose to adverse outcomes. Optimal blood pressure management may help prevent the development of HF and reduce cardiovascular risk, highlighting the importance of early recognition and control of hypertension in patients with coronary artery disease.