Clinical characteristics, imaging phenotypes and events free survival in Takayasu arteritis patients with hypertension

Abstract

Background: Hypertension occurred in 30-80% of Takayasu arteritis (TAK) patients around the world and the occurrence of hypertension might worsen the disease prognosis. This study aimed to investigate the clinical characteristics and imaging phenotypes, as well as their associations with events free survival (EFS) in Chinese TAK patients with hypertension.

Methods: This current research was based on a prospectively ongoing observational cohort-the East China Takayasu Arteritis (ECTA) cohort, centered in Zhongshan Hospital, Fudan University. Totally, 204 TAK patients with hypertension were enrolled between January 2013 and December 2019. Clinical characteristics and imaging phenotypes of each case were evaluated and their associations with the EFS by the end of August 30, 2020, were analyzed.

Results: Severe hypertension accounted for 46.1% of the entire population. Three specific imaging phenotypes were identified: Cluster 1: involvement of the abdominal aorta and/or renal artery (27.5%); Cluster 2: involvement of the ascending aorta, thoracic aorta, the aortic arch, and/or its branches (18.6%); and Cluster 3: combined involvement of Cluster 1 and 2 (53.9%). Clinical characteristics, especially hypertensive severity, differed greatly among the three imaging clusters. In all, 187 patients were followed up for a median of 46 (9-102) months; 72 events were observed in 60 patients (1-3 per person). The overall blood pressure control rate was 50.8%, and the EFS was 67.9% by the end of the follow-up. Multivariate Cox regression indicated that controlled blood pressure (HR = 2.13, 95% CI 1.32-3.74), Cluster 1 (HR = 0.69, 95% CI 0.48-0.92) and Cluster 3 (HR = 0.72, 95% CI 0.43-0.94) imaging phenotype was associated with the EFS. Kaplan-Meier curves showed that patients with controlled blood pressure showed better EFS (p = 0.043). Furthermore, using cases with Cluster 1 imaging phenotype and controlled blood pressure as reference, better EFS was observed in patients with Cluster 2 phenotype and controlled blood pressure (HR = 2.21, 95%CI 1.47-4.32), while the case with Cluster 1 phenotype plus uncontrolled blood pressure (HR = 0.64, 95%CI 0.52-0.89) and those with Cluster 3 phenotype and uncontrolled blood pressure (HR = 0.83, 95%CI 0.76-0.92) suffered worse EFS.

Conclusion: Blood pressure control status and imaging phenotypes showed significant effects on the EFS for TAK patients with hypertension.

Keywords: Blood pressure control status; Events free survival; Hypertension; Hypertensive severity; Imaging phenotype; Takayasu arteritis.

Fig. 1

Study flow chart. In all, 204 hypertensive Takayasu arteritis patients were enrolled in to the present study from the East China Takayasu arteritis cohort between January 2013 and December 2019. Clinical characteristics and imaging features of each case were evaluated. The main outcome of the investigation was the events free survival by the end of August 30, 2020. Subgroup analysis, according to hypertensive severity and imaging phenotype, was also performed. Cluster 1: involvement of abdominal aorta and/or renal artery; Cluster 2: involvement of ascending aorta, thoracic aorta, and/or the aortic arch and its branches; and Cluster 3: combined involvement of Cluster 1 and Cluster 2.

Fig. 2

Clinical characteristics and follow-up events of patients with different imaging phenotypes. Clinical characteristics at the baseline in the radar map (left) included age, sex, clinical manifestations, and baseline complications. Blood pressure control status as well as events, including prevalence of total events, persistent refractory/malignant hypertension, renal insufficiency, congestive heart failure, and cerebrovascular events were shown in the right radar map. AR: aortic regurgitation.

Fig. 3

Characteristics of patients with different blood pressure control status. Characteristics showed in the radar map included imaging phenotype (cluster), hypertensive degree, severe AR, and treatment (the usage of hypertensive drugs and Revascularization operation). AR: aortic regurgitation; CCB: calcium channel blocker; ACEI/ARB: angiotensin-converting enzyme inhibitor/angiotensin receptor blocker; Cluster 1: involvement of abdominal aorta and/or renal artery; Cluster 2: involvement of ascending aorta, thoracic aorta, aortic arch, and its branches; Cluster 3: combined involvement of Cluster 1 and Cluster 2

Fig. 4

Events free survival in patients with different imaging phenotypes and with different blood control status. A Events free survival in patients with different imaging phenotypes. B Events free survival in patients with different blood pressure control status. Cluster 1: involvement of abdominal aorta and/or renal artery; Cluster 2: involvement of ascending aorta, thoracic aorta, and/or the aortic arch and its branches; and Cluster 3: combined involvement of Cluster 1 and Cluster 2.

Fig. 5

Decision tree for predicting the prognosis of Takayasu arteritis patients with hypertension. Using three variables including imaging phenotype, blood pressure control status, and co-existence of severe AR, a decision tree diagram was established to predict the disease prognosis. Through the diagram, 69.2% of patients could be classified into the right prognosis group. AR: aortic regurgitation