Prognostic significance of gender and sexual risk factors in the development of arterial hypertension in an organized population

Abstract

Relevance. Persistent high levels of morbidity and mortality of the working-age population from cardiovascular diseases (CVD) in Russia require the search for new targets for screening programs and subsequent development of evidence-based prevention models in organized populations showing their clinical and economic effectiveness in long-term prospective follow-up.Objective. To carry out a comprehensive assessment of the prognostic factors of arterial hypertension (AH) according to the data of 8-year prospective study of an organized sample taking into account gender and sex characteristics.Design and methods. We conducted a two-stage study: a one-stage integral study of an organized population (400 people) followed by a prospective 8-year follow-up of a group of relatively healthy subjects without clinical manifestations of CVD (193 people aged 21 to 64 years, mean age 49,0 [42,0; 58,0], of whom men 48,2%). Stage I indicators under study: sociodemographic characteristics; clinical and physical findings; behavioral factors; family history of early CVD; occupational interview and degree of work stress; psychological characteristics; biochemical indices of stress response; cardiovascular remodeling indices. Stage II indicators under study: newly diagnosed cases of AH.Results. The pattern of prognostic factors for AH depended on gender. Among women, prognostic factors for 8-year incidence of AH were: marital status (widow) (Hazard ratio (HR) 10,1), diastolic blood pressure level (HR1,1), and physical activity outside work (HR0,3). In men, in addition to behavioral (smoking history, HR1,1) and clinical (high normal blood pressure, HR4,1) factors, there was also an independent contribution of a psychological factor (personality anxiety, HR6,5).Conclusions. Our findings substantiate the need for a poly-professional approach (physician-internistpsychiatrist-medical psychologist) to the prevention of CVD in the studied organized population, taking into account gender-specific features.