P6576Hypertensive patients with multiple determination of very high cardiovascular risk: estimation of outcomes in outpatient RECVASA registry

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Purpose: To evaluate outcomes in hypertensives with different number of criteria of very high cardiovascular risk (CVR) enrolled in outpatient registry of cardiovascular diseases (CVD) in the Ryazan Region. Methods: The total of 3648 patients with hypertension (age 66.1±12.9; 72% women) applied for general practitioners or cardiologists of 3 outpatient clinics were enrolled in the RECVASA registry. CVR was assessed accordingly to ESC guidelines. End points were evaluated at 4-year follow-up period. Cox model was used to estimate the hazard ratio (HR), 95% confidential interval (CI) for prediction of all cause mortality (MTot), cardiovascular mortality (CVM), nonfatal stroke and myocardial infarction (MI). Results: The most of the hypertensives - 2922 (80.1%) had very high CVR. The following criteria of very high CVR were revealed: history of MI in 417 cases (11.4%), angina – 2465 (67.6%), history of coronary revascularization – 39 (1.1%), chronic heart failure – 2691 (73.8%), history of stroke – 307 (8.4%) or transient ischaemic attack – 51 (1.4%), chronic kidney disease with eGFR <30 mL/min/1.73m2 – 27 (0.7%). Hypertensives with very high CVR were subdivided in groups with risk 4A (1–2 criteria of high CVR) and risk 4B (3 or more criteria). There were 1971 (67.5%) patients in group of risk 4A (age 68.3±12.0; 77.0% women) and 951 (32.5%) patients in group of risk 4B (age 71.2±10.6; 62.0% women). So, patients in group with risk 4B were older and percent of men was bigger than in group with risk 4A (p<0.001). Incidence of target blood pressure (BP) level in hypertensives of groups with CVR 4A and 4B was 25.7% and 25.9%, respectively (p=0.93). Average level of systolic BP was 146.1±18.6 and 144.4±20.1 mmHg (p=0.027), diastolic BP – 87.6±11.0 and 85.5±11.5 mmHg (p<0.001). Mean follow-up was 3.7±0.9 years; lost to follow-up - 4.6%. During 48 months follow-up we identified: 379 cases of death (250 due to CVD), 100 cases of stroke, 59 – of MI. The next values adjusted to age, sex and BP level were significantly bigger in group of CVR 4B compared with group of risk 4A: MTot - 17.7% and 10.7% (HR=1.50; CI 1.22–1.84; p<0.0001), CVM - 12.1% and 6.9% (HR=1.60; CI 1.24–2.06; p<0.0001), incidence of nonfatal stroke - 5.1% and 2.6% (HR=1.82; CI 1.21–2.75; p=0.001) and incidence of nonfatal MI - 3.8% and 1.2% (HR=3.30; CI 1.94–5.62; p<0.0001).

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