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Hypertension Global Newsletter #2 Hype
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HYPERTENSION-MEDIATED ORGAN DAMAGE/ARTERIAL STIFFNESS
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Hypertension-mediated organ damage: Prevalence, correlates, and prognosis in
the community.

Vasan RS, et al. Hypertension. 2022;79(3):505-515.

While international guidelines emphasize the importance of
screening people with elevated BP for the presence of end-
organ damage, the prevalence of hypertension-mediated
organ damage (HMOD) varies based on different thresholds
for defining hypertension and according to the age of
individuals and the choice of the screening test. In this study,
the authors characterized HMOD prevalence, correlates,
and prognosis in the community-based Framingham Study
(n=7898, mean age 51.6 years, 54% women) according to BP
categories defined by four international guidelines.

The prevalence of HMOD varied positively with systolic BP
and pulse pressure, but negatively with diastolic BP. This
direct association of HMOD and pulse pressure underscores
the need to target pulsatile load to mitigate vascular
consequences. High prevalence of HMOD (40%–60%) was
seen in those with elevated carotid-femoral pulse wave
velocity (CFPWV). Intermediate prevalence of HMOD (20%–
40%) was seen in patients with left ventricular hypertrophy,
reduced kidney function, microalbuminuria, increased carotid
intima-media thickness, and abnormal brain imaging findings.
Low prevalence of HMOD (<5%) was seen with low ankle-
brachial index.

On follow up (median, 14.1 years) the presence of HMOD
confers clinically important prognostic information regarding
CVD risk at any given BP elevation (a finding consistent
across BP guidelines) and may be used to guide treatment
decisions in patients with elevated BP.

CLINICAL PEARLS FROM THE FACULTY

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