Association between D-Dimer and Long-Term Major Adverse Cardiovascular Outcomes in Patients with Masked Hypertension.

Abstract

Objective: We investigated the relationship between D-dimer levels and long-term major adverse cardiovascular events in masked hypertension patients admitted to the cardiology outpatient clinic.

Methods: A total of 512 masked hypertension patients with a median 6 years of follow-up data who underwent serum D-dimer measurement in the hypertension outpatient clinic between April 2014 and June 2016 were retrospectively enrolled. The patients were stratified according to their D-dimer levels and were then divided into tertiles. Clinical outcomes were assessed for major adverse cardiovascular events (MACE) which were defined as all-cause mortality, cardiovascular mortality, non-fatal myocardial infarction (MI), and non-fatal stroke.

Results: The long-term incidence of MACE in masked hypertension patients was higher in the highest tertile of D-dimer. In multivariable analysis, D-dimer was an independent predictor of long-term MACE in masked hypertensive patients (OR: 1.006 (1.004-1.007); p < 0.001). Compared to the lowest tertile, MACE was approximately 3 times higher in tertile 2 and approximately 10.5 times higher in the highest tertile. In addition, MACE was approximately 3.5 times more common in Tertile 3 than in Tertile 2. D-dimer was able to predict MACE in patients with masked hypertension (AUC for MACE 0.778 (95% CI 0.724-0.832; p < 0.001) based on receiver operating characteristic curve analysis. In the Kaplan-Meier curve showing follow-up without MACE (MACE-free) according to the D-dimer cut-off value, the long-term incidence of MACE was significantly higher in the high D-dimer group (p < 0.001).

Conclusions: D-dimer levels in patients with masked hypertension showed a significant association with increased long-term risk of MACE in this study.