Skip to main content
SpringerLink
Log in

Multiple Cardiovascular Risk Factors Indicate Cardiovascular Disease in Stage 1 Hypertension

  • Short Communication
  • Published:
High Blood Pressure & Cardiovascular Prevention Aims and scope Submit manuscript

Abstract

In November 2017, the American College of Cardiology and American Heart Association released new guidelines on hypertension that lowered the blood pressure (BP) definition of stage 1. Impedance cardiography (ICG) has shown that ventricular, vascular, and hemodynamic abnormalities are prevalent in adults over 40 years of age with at least 2 cardiovascular (CV) risk factors. This suggests that all stage 1 hypertension patients with multiple CV risk factors, over 40 years of age, have earlystage CV disease and should be treated. For many of these patients, ICG testing has shown low cardiac index with high systemic vascular resistance or vice versa. If only BP is measured, these significant extremes in hemodynamics would be unknown. With ICG data, drug selection and titration can be customized based on the abnormal underlying mechanisms to rapidly control BP while reducing adverse side effects and preventing progression of CV disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

References

  1. Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC Jr, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA Sr, Williamson JD, Wright JT Jr. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71(6):e13–115. https://doi.org/10.1161/hyp.0000000000000065 (Epub 2017 Nov 13. Erratum in: Hypertension. 2018 Jun;71(6):e140–e144).

    Article  CAS  Google Scholar 

  2. The SPRINT Research Group. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med. 2015;373:2103–16.

    Article  CAS  PubMed Central  Google Scholar 

  3. Sheppard JP, Stevens S, Stevens R, Martin U, Mant J, Hobbs FDR, McManus RJ. Benefits and harms of antihypertensive treatment in low-risk patients with mild hypertension. JAMA Intern Med. Published online October 29, 2018. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2708195, https://doi.org/10.1001/jamainternmed.2018.4684.

  4. Mancia G, Laurent S, Agabiti-Rosei E, Ambrosioni E, Burnier M, Caulfield MJ, Cifkova R, Clément D, Coca A, Dominiczak A, Erdine S, Fagard R, Farsang C, Grassi G, Haller H, Heagerty A, Kjeldsen SE, Kiowski W, Mallion JM, Manolis A, Narkiewicz K, Nilsson P, Olsen MH, Rahn KH, Redon J, Rodicio J, Ruilope L, Schmieder RE, Struijker-Boudier HA, van Zwieten PA, Viigimaa M, Zanchetti A. Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document. J Hypertens. 2009;27:2121–58.

    Article  CAS  PubMed  Google Scholar 

  5. Goff DC Jr, Lloyd-Jones DM, Bennett G, Coady S, D’Agostino RB, Gibbons R, Greenland P, Lackland DT, Levy D, O’Donnell CJ, Robinson JG, Schwartz JS, Shero ST, Smith SC Jr, Sorlie P, Stone NJ, Wilson PW, Jordan HS, Nevo L, Wnek J, Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH, DeMets D, Hochman JS, Kovacs RJ, Ohman EM, Pressler SJ, Sellke FW, Shen WK, Smith SC Jr, Tomaselli GF. American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129(25 Suppl 2):S49–73. https://doi.org/10.1161/01.cir.0000437741.48606.98 (Epub 2013 Nov 12. Erratum in: Circulation. 2014 Jun 24;129(25 Suppl 2):S74–5).

    Article  PubMed  Google Scholar 

  6. Vasan RS, Larson MG, Leip EP, Kannel WB, Levy D. Assessment of frequency of progression to hypertension in non-hypertensive participants in the Framingham Heart Study: a cohort study. Lancet. 2001;358:1682–6.

    Article  CAS  PubMed  Google Scholar 

  7. Berry JD, Dyer A, Cai X, Garside DB, Ning H, Thomas A, Greenland P, Van Horn L, Tracy RP, Lloyd-Jones DM. Lifetime risks of cardiovascular disease. N Engl J Med. 2012;366:321–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. DeMarzo AP. Using impedance cardiography to detect subclinical cardiovascular disease in women with multiple risk factors: a pilot study. Prev Cardiol. 2009;12(2):102–8. https://doi.org/10.1111/j.1751-7141.2008.00012.x.

    Article  PubMed  Google Scholar 

  9. DeMarzo AP. Using impedance cardiography with postural change to stratify patients with hypertension. Ther Adv Cardiovasc Dis. 2011;5(3):139–48. https://doi.org/10.1177/1753944711406770.

    Article  PubMed  Google Scholar 

  10. Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, Fruchart JC, James WP, Loria CM, Smith SC Jr, International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; International Association for the Study of Obesity. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009;120(16):1640–5. https://doi.org/10.1161/circulationaha.109.192644.

    Article  CAS  PubMed  Google Scholar 

  11. Lauer MS, Anderson KM, Kannel WB, Levy D. The impact of obesity on left ventricular mass and geometry. The Framingham Heart Study. JAMA. 1991;266(2):231–6.

    Article  CAS  PubMed  Google Scholar 

  12. DeMarzo AP. Using impedance cardiograph to detect asymptomatic cardiovascular disease in prehypertensive adults with risk factors. High Blood Press Cardiovasc Prev. 2013;20:61–7. https://doi.org/10.1007/s40292-013-0009-0.

    Article  CAS  PubMed  Google Scholar 

  13. DeMarzo AP, Calvin JE, Kelly RF, Stamos TD. Using impedance cardiography to assess left ventricular systolic function via postural change in patients with heart failure. Prog Cardiovasc Nurs. 2005;20(4):163–7.

    Article  PubMed  Google Scholar 

  14. Levy D, Larson MG, Vasan RS, Kannel WB, Ho KK. The progression from hypertension to congestive heart failure. JAMA. 1996;275:1557–62.

    Article  CAS  PubMed  Google Scholar 

  15. Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, et al. ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation. 2005;112:e154–235.

    Article  PubMed  Google Scholar 

  16. DeMarzo AP, Calvin JE. A new approach for low-cost noninvasive detection of asymptomatic heart disease at rest. Prev Cardiol. 2007;10:9–14.

    Article  PubMed  Google Scholar 

  17. Matthews RE, Magenheim D. Improvement in blood pressure control using a quality improvement process with impedance cardiography to guide antihypertensive therapy. J Clin Hypertens (Greenwich). 2008;10(issue 5, suppl A, P-170):A76.

    Google Scholar 

  18. Webster R, Salam A, de Silva HA, Selak V, Stepien S, Rajapakse S, Amarasekara S, Amarasena N, Billot L, de Silva AP, Fernando M, Guggilla R, Jan S, Jayawardena J, Maulik PK, Mendis S, Mendis S, Munasinghe J, Naik N, Prabhakaran D, Ranasinghe G, Thom S, Tisserra N, Senaratne V, Wijekoon S, Wijeyasingam S, Rodgers A, Patel A, TRIUMPH Study Group. Fixed low-dose triple combination antihypertensive medication vs usual care for blood pressure control in patients with mild to moderate hypertension in Sri Lanka: a randomized clinical trial. JAMA. 2018;320(6):566–79. https://doi.org/10.1001/jama.2018.10359.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, Clement DL, Coca A, de Simone G, Dominiczak A, Kahan T, Mahfoud F, Redon J, Ruilope L, Zanchetti A, Kerins M, Kjeldsen SE, Kreutz R, Laurent S, Lip GYH, McManus R, Narkiewicz K, Ruschitzka F, Schmieder RE, Shlyakhto E, Tsioufis C, Aboyans V, Desormais I, Authors/Task Force Members. 2018 ESC/ESH Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. J Hypertens. 2018;36(10):1953–2041. https://doi.org/10.1097/HJH.0000000000001940.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Dermed Diagnostics Inc, 2S 558 White Birch Lane, Wheaton, IL, 60189, USA

    Arthur P. DeMarzo

Authors
  1. Arthur P. DeMarzo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Arthur P. DeMarzo.

Ethics declarations

Conflict of interest

The author reports that there is no specific funding in relation to this communication. A potential conflict of interest is that the author is an employee of a company which manufactured an impedance cardiograph.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

DeMarzo, A.P. Multiple Cardiovascular Risk Factors Indicate Cardiovascular Disease in Stage 1 Hypertension. High Blood Press Cardiovasc Prev 26, 135–137 (2019). https://doi.org/10.1007/s40292-019-00304-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40292-019-00304-w

Keywords

Search

Navigation