Characterization of participants with a disproportionate degree of hypertension-mediated organ damage: the Maastricht study

Dellaneira Setjiadi; Christian Delles; Abraham A Kroon; Koen Ressink; Otto Bekers; Steven J R Meex; Sebastian Köhler; Jeroen P Kooman; Jacobus F A Jansen; Hans-Peter Brunner-La Rocca; Anke Wesselius; Alfons J H M Houben; Marleen M J van Greevenbroek

doi:10.1097/HJH.0000000000004265

Characterization of participants with a disproportionate degree of hypertension-mediated organ damage: the Maastricht study

J Hypertens. 2026 Feb 16. doi: 10.1097/HJH.0000000000004265. Online ahead of print.

Affiliations

¹ School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK.
² Department of Internal Medicine, Maastricht University, Maastricht, The Netherlands, CARIM, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands.

PMID: 41818313
DOI: 10.1097/HJH.0000000000004265

Abstract

Background: Although there is a well established link between blood pressure (BP) levels and the severity of hypertension-mediated organ damage (HMOD), some patients with hypertension exhibit a disproportionate degree of HMOD relative to their BP.

Objective: This study aims to define disproportionate degrees, relative to blood pressure, of left ventricular hypertrophy (LVH) measured by Sokolow-Lyon (SL) index and of arterial stiffness measured by carotid-femoral pulse wave velocity (PWV), and to assess the sex differences and characteristics of individuals with such disproportional SL index and PWV.

Methods: SL index was analysed in 6487 participants of The Maastricht Study [50.9% men; 23.7% type 2 diabetes mellitus (T2DM)]. PWV was analysed in 6239 participants (51.3% men; 23.5% T2DM). The residuals of linear regression models for the relationship between SL index or PWV and 24 h mean arterial pressure (MAP) was used to define participants with disproportional SL index and PWV, respectively. Individuals with higher-than-expected (>90th percentile of the residuals) and lower-than-expected (<10th percentile) of SL index or PWV were defined as subclinical HMOD. A multinomial regression analysis was conducted to identify the clinical characteristics associated with subclinical HMOD.

Results: Males and females with higher SL index than expected based on their 24 h MAP, were older, had a higher BMI and were more often living with type 2 diabetes in comparison to those in the as-expected and lower-than-expected groups. In line, men who are living with diabetes are 34% less likely to be in the group with lower-than-expected SL index while women living with prediabetes and type 2 diabetes are 40% more likely to be in the group with higher-than-expected SL index. Likewise, males and females with higher-than-expected PWV were older and more often living with type 2 diabetes than those in the as-expected and lower-than-expected groups.

Conclusions: Persons who are older, or living with obesity and/or T2D are more likely to have subclinical HMOD, than would be expected based on their prevailing level of BP. Therefore, these clinical determinants would result in higher-than-expected HMOD. Treating those with overweight and obesity with prediabetes and diabetes more aggressively will likely reduce subclinical HMOD.

Keywords: BP; CV; DBP; ECG; HMOD; Hypertension mediated organ damage; MAP; PP; PWV; SBP; SL index; Sokolow–Lyon index; arterial stiffness; blood pressure; cardiovascular; diastolic blood pressure; electrocardiogram; hypertension-mediated organ damage; left ventricular hypertrophy; mV; mean arterial pressure; millivolts; pulse pressure; pulse wave velocity; systolic blood pressure.