Data_Sheet_1_Impact of Hypertension History and Blood Pressure at Presentation on Cardiac Remodeling and Mortality in Aortic Dissection.docx

ObjectiveThis study compared clinical, echocardiographic, and prognostic characteristics among patients with aortic dissection (AD) with (HypHist) and without (No-HypHist) hypertension history and evaluated the association of blood pressure (BP) at presentation with 1-year mortality, left ventricular (LV) remodeling and renal dysfunction.
MethodsWe investigated clinical and echocardiographic characteristics and 1-year mortality among 367 patients with AD (81% HypHist, 66% Type-A) from three Brazilian centers.
ResultsPatients with No-HypHist were more likely to have Marfan syndrome, bicuspid aortic valve, to undergo surgical therapy, were less likely to have LV hypertrophy and concentricity, and had similar mortality compared with HypHist patients. Adjusted restricted cubic spline analysis showed that systolic BP (SBP) and diastolic BP (DBP) at presentation had a J-curve association with mortality among patients with No-HypHist, but did not associate with death among patients with HypHist (p for interaction = 0.001 for SBP and = 0.022 for DBP). Conversely, the association between SBP at presentation and mortality was influenced by previous use of antihypertensive medications in the HypHist group (p for interaction = 0.002). Results of multivariable logistic regression analysis comprising the whole sample showed direct associations of SBP and DBP at presentation with LV hypertrophy (p = 0.009) and LV concentricity (p = 0.015), respectively, and an inverse association between pulse pressure at presentation and estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2 (p = 0.008).
ConclusionCombined information on BP at presentation, previous diagnosis of hypertension, and use of antihypertensive medications might be useful to predict mortality risk and to estimate extra-aortic end-organ damage among patients with AD.

### 研究目的
本研究对比了伴高血压病史（HypHist）与不伴高血压病史（No-HypHist）的主动脉夹层（AD）患者的临床、超声心动图及预后特征，并评估了就诊时血压（BP）与1年死亡率、左心室（LV）重构及肾功能不全的关联。

### 研究方法
本研究纳入来自巴西三家医学中心的367例主动脉夹层患者（其中81%为HypHist组，66%为A型夹层），对其临床及超声心动图特征与1年死亡率情况进行了调查。

### 研究结果
与HypHist组患者相比，No-HypHist组患者更易罹患马方综合征、主动脉瓣二叶畸形，且更倾向于接受外科治疗；其左心室肥厚及向心性构型的发生率更低，但两组患者的死亡率无显著差异。校正后的限制性立方样条分析显示，在No-HypHist组患者中，就诊时收缩压（SBP）与舒张压（DBP）与死亡率呈J型关联，但在HypHist组患者中未观察到此类关联（收缩压交互作用p=0.001，舒张压交互作用p=0.022）。反之，HypHist组患者的就诊时收缩压与死亡率的关联受既往抗高血压药物使用情况的影响（交互作用p=0.002）。针对全样本的多变量logistic回归分析结果显示，就诊时收缩压与舒张压分别与左心室肥厚（p=0.009）及左心室向心性构型（p=0.015）呈正相关；就诊时脉压与估算肾小球滤过率（eGFR）<60 ml/min/1.73 m²呈负相关（p=0.008）。

### 研究结论
结合就诊时血压水平、既往高血压诊断史及抗高血压药物使用情况的综合信息，或可用于预测主动脉夹层患者的死亡风险，并评估其主动脉外终末器官损害程度。