The natural course of hypertensive phenotypes over time – the helius study

Objective: Hypertension can be classified into different phenotypes according to systolic and diastolic blood pressure (BP). We assessed the natural course of BP phenotypes over time in younger adults and identified risk factors predisposing to the development of sustained hypertension in a diverse population. Design and method: We used baseline and follow-up data from all participants aged below 40 years without antihypertensive medication at baseline from the ongoing multi-ethnic HEalthy LIFe in an Urban Setting (HELIUS) study. Participants were stratified according to baseline office BP: normotensive (NT; < 140/< 90 mmHg), isolated systolic hypertension (ISH; > = 140/< 90 mmHg), isolated diastolic hypertension (IDH; < 140/> = 90 mmHg) and combined systolic and diastolic hypertension (SDH; > = 140/> = 90 mmHg). Sankey diagrams were created stratified by sex to visualise change in phenotypes over time and risk of sustained hypertension (defined as BP > = 140/90 mmHg or use of antihypertensive medication) was assessed using logistic regression models adjusted for age, sex, ethnicity and follow-up time. In further adjusted models we added BMI, smoking, baseline eGFR, glucose, and total cholesterol levels to assess risk factors. Results: We included 2,818 participants aged 30.1 years (SD 6.0), 44% male, who attended the follow-up visit with a median follow-up time of 6.2 years (SD 1.1). Of all participants, 91.5% was normotensive at baseline, whereas 2.8%, 2.8% and 2.9% had ISH, IDH and SDH, respectively. In males the prevalence of ISH decreased over time, while in females the prevalence increased (figure). Compared to normotensive individuals, the adjusted odds ratios for developing sustained hypertension were 4.5 (95% CI 2.5 – 7.9) for ISH, 17.4 (95% CI 10.7 - 28.4) for IDH and 33.5, (95% CI 19.7 – 58.9) for SDH. Higher BMI was the most important predictor for development of sustained hypertension. Conclusions: Participants with SDH had the highest risk for developing sustained hypertension, followed by participants with IDH. The risk for sustained hypertension in individuals with ISH was much lower and differed between males and females, suggesting differences in pathophysiology and management.