Silent brain infarcts, peripheral vascular disease predict CV events in hypertensive patients

Silent brain infarcts (SBI) and ankle-to-brachial index (ABI) <0.9 are independently associated with a higher risk of cardiovascular (CV) events in hypertensive individuals, suggests a study.

“Assessment of SBI and ABI less than 0.9 may refine the cardiovascular risk stratification in patients with hypertension,” the investigators said.

Data from the Investigating Silent Strokes in Hypertensives Study, a longitudinal and observational study conducted in patients with hypertension aged 50‒70 years and stroke free at baseline, were analysed. Participants underwent a clinical interview, a brain magnetic resonance imaging, urine and blood sampling collection, and vascular testing studies at the baseline visit.

Subsequently, the investigators obtained markers of target organ damage from the brain (ie, white matter hyperintensities, SBI, cerebral microbleeds, and enlarged perivascular spaces), from the kidney (ie, microalbuminuria and glomerular filtration), and regarding large vessels (ie, ABI and carotid‒femoral pulse wave velocity).

Finally, the association between the above predictors and the incidence of CV events were evaluated using survival analyses.

Nine hundred sixty-four individuals were followed within a median time of 5 years, corresponding to 4,377.1 person-years. Of the participants, 73 presented with incident CV events, which corresponded to a rate of 8.2 percent.

ABI <0.9 (hazard ratio [HR], 2.2, 95 percent confidence interval [CI], 1.17‒4.13; p=0.014) and SBI (HR, 2.9, 95 percent CI, 1.47‒5.58; p=0.002) independently contributed to an increased risk of incident CVE.

“The inclusion of both variables in a clinical model resulted in an increased discrimination of individuals with new CV events of 4.72 percent, according to the integrated discrimination index,” the investigators said.