Longitudinal blood pressure control, long-term mortality and predictive utility of serum liver enzymes and bilirubin in hypertensive patients

Mccallum, L. et al. (2015) Longitudinal blood pressure control, long-term mortality and predictive utility of serum liver enzymes and bilirubin in hypertensive patients. Hypertension, 66(1), pp. 37-43. 25941342. (doi:10.1161/HYPERTENSIONAHA.114.04915) (PMID:PMC4461392)

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Abstract

There is accruing evidence from general population studies that serum bilirubin and liver enzymes affect blood pressure and cardiovascular risk, but it is unclear whether these have an impact on hypertensive patients in terms of long-term survival or blood pressure control. We analysed 12,000 treated hypertensive individuals attending a tertiary care clinic followed up for 35 years for association between baseline liver function tests and cause-specific mortality after adjustment for conventional cardiovascular covariates. Generalized estimating equations were used to study the association of liver tests and follow-up blood pressure. The total time at risk was 173,806 person years with median survival 32.3 years. Follow-up Systolic BP over 5 years changed by -0.4 (alanine transaminase and bilirubin), +2.1(alkaline phosphatase ), +0.9(gamma-glutamyl transpeptidase) mmHg for each standard deviation increase. Serum total bilirubin and alanine transaminase showed a significant negative association with all-cause and cardiovascular mortality while alkaline phosphatase and gamma-glutamyl transpeptidase showed a positive association, and aspartate transaminase, a “U-shaped”association. Serum bilirubin showed an incremental improvement of continuous net reclassification improvement (cNRI) by 8-26% for 25 year and 35 year cardiovascular mortality while all liver markers together improved cNRI by 19-47% compared to reference model. In hypertensive patients, serum liver enzymes and bilirubin within 4 standard deviations of the mean show independent effects on mortality and BP control. Our findings would support further studies to elucidate the mechanisms by which liver enzymes and bilirubin may exert an effect on BP and CV risk but there is little support for using them in risk stratification.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Hastie, Dr Claire and Padmanabhan, Professor Sandosh and Patel, Dr Rajan and Dominiczak, Professor Anna and Mccallum, Dr Linsay and Sattar, Professor Naveed and Muir, Dr Scott and Walters, Professor Matthew
Authors: Mccallum, L., Panniyammakal, J., Hastie, C. E., Hewitt, J., Patel, R., Jones, G. C., Muir, S., Walters, M., Sattar, N., Dominiczak, A., and Padmanabhan, S.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:Hypertension
Publisher:American Heart Association
ISSN:0194-911X
ISSN (Online):1524-4563
Copyright Holders:Copyright © 2015 The Authors
First Published:First published in Hypertension 66(1):37-43
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
664101Serum Chloride - epidemiology and genetic dissection of a novel marker of cardiovascular riskSandosh PadmanabhanBritish Heart Foundation (BHF)FS/14/52/30901RI CARDIOVASCULAR & MEDICAL SCIENCES