Hypertension is an important risk factor for cardiovascular disease (CVD). Although overall reduction of absolute risk factors for CVD is the goal, blood pressure (BP) management remains a key factor. Concepts of the 1999 World Health Organization (WHO)/ International Society of Hypertension (ISH) guidelines, stating that comprehensive risk stratification is the essential strategy for the management of hypertension. They were calculated from data on the average 10 year risk of the cardiovascular death, nonfatal stroke or nonfatal myocardial infarction among participants in the Framingham Study. Four categories of absolute cardiovascular disease risk are defined. Each categories represent a range of absolute disease risks (low risk with the risk of a major cardiovascular event in the next 10 years is typically less than 15%, medium risk with 15–20%, high risk with 20–30%, and very high risk with 30% or more). Among these patients with mild hypertension if diabetes presence as additional other risk factor, the risk of a major cardiovascular event in the following 10 years is typically about 20–30%.
Based on risk stratification in the hypertensive patients, we would like to observe the presence of other risk factor such as diabetes mellitus, will play role as a strong predictor of future cardiovascular event.
There were 184 hypertensive patients that were referred to nuclear cardiology laboratory after enrolled within 14 months for evaluation of myocardial perfusion status because of chest pain or suspected coronary artery disease without previous infarction or revascularization. Then the patients where observed within three years after indexing the patients, for the occurrence of MACE such as cardiac death or myocardial infarction. All the clinical variables, laboratory, nuclear perfusion result, were evaluated and analyzed with SPSS version 24.
From 184 patients with hypertension enrolled, there were 116 (63 %) male, typical angina 88 (48 %), diabetes mellitus 67 (36 %), dyslipidemia 144 (78 %), smoker 31 (17 %), family history 37 (20%), obesity 89 (48 %), systolic blood pressure 174.1 ± 26,2 and diastolic blood pressure 93,1 ± 13,8 mmHg. There were 62 (34 %) patients with abnormal perfusion scan result. Cardiac event in the hypertensive patients with diabetes mellitus 9 (13 %) had cardiac death, and 3 (4 %) had myocardial infarction; and without diabetes mellitus 5 (4 %) had cardiac death, and 1 (0,8 %) had myocardial infarction. From multivariate analysis, three independent variables were significant as a predictor such as type 2 diabetes with p 0.01, RR 3,2 (CI: 1.2–8,8); abnormal scan with p 0.05, RR 5,4 (CI: 1.6–17,6); and Post Stress EF with p 0,01, RR 3,5 (CI: 1,2–9,7).
The presence of diabetes mellitus in hypertensive patients, particularly with abnormal myocardial perfusion, will give the incremental prognostic power for the occurrence of cardiovascular event (MACE) such as cardiac death and myocardial infarction
Department of Cardiology, Faculty of Medicine, University of Indonesia, National Cardiovascular Centre Harapan Kita Hospital