THE SIGNIFICANCE OF CARDIOVASCULAR-KIDNEY-METABOLIC SYNDROME IN HYPERTENSIVE PATIENTS

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Objective: The aim of our study was to determine the relationship between various stages in cardiovascular-kidney-metabolic syndrome (CKM) and their clinical outcomes in patients followed at the Hypertension Center at the Niska Banja Institute. Design and method: The study was prospective and conducted in one center starting in January 2009 until December 2024. The study included 138 patients with arterial hypertension and high cardiovascular (CV) risk. The average age was 62.5 years with more women (56.5%) included. Based on the staging criteria for CKM, the patients were divided into 3 groups at the beginning of the follow-up: stage 2 had 30 (21.7%) patients; stage 3 had 77 (55.8%) patients; stage 4 had 31 patients (22.5%). Results: Patients with stage 2 were significantly younger among the entire population studied (57.8 vs. 63) (p=0.014), had lower left ventricular mass index (116.7 vs. 145.5 vs. 162.2 g/m2)(p=0.001);fewer plaques in carotid arteries (24.1% vs. 53.9% vs. 79.2%) (p=0.001); higher eGFR at the beginning (79 vs. 68.4 vs. 65.5) (p=0.012) and at the end of follow-up (67 vs. 56 vs. 51.3) (p=0.008) and lower number of patients with DM at the end of the trial (10.7% vs. 37.7% vs. 38.7%) (p.0.023). There was a significant difference in CV mortality between patients respective to their CKM stages (log-rank=10.497, p=0.005). CV death was registered in 10 (13%) patients with stage 3 CKM, and 9 (29%) patients with CKM stage 4, with no CV deaths in CKM stage 2 group. There is no significant difference in all-cause mortality between patients respective to their CKM stages (log-rank=5.807, p=0.055). Individual comparison showed that there is a difference between CKM stage 2 and 3 (HR 4.36, 95%CI 1.02-18.57), as well as between CKM stage 2 and 4 (HR 5.35, 95%CI 1.17-24.55). However, there is no difference in the overall survival between CKM stage 3 and 4 (HR 0.82, 95%CI 0.36-1.73). Conclusions: CKM stage has a significant linear influence on CV mortality but not on overall mortality because our study did not show differences between stage 3 and 4.

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