Clinical characteristics, imaging phenotypes and events free survival in hypertensive Takayasu arteritis population

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 hypertensive TAK population. Methods This current research was based on a prospectively on-going observational cohort-the East China Takayasu Arteritis (ECTA) cohort, centered in Zhongshan Hospital, Fudan University. Totally, 204 hypertensive TAK patients 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, and 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 three imaging clusters. In all, 187 patients were followed-up for a median of 46 (9-102) months; 127 (67.9%) cases did not experience any events, while 72 events were observed in 60 patients. 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, patients had controlled blood pressure and Cluster 1 phenotype was set as reference, better EFS was observed in patients with controlled blood pressure and Cluster 2 phenotype (HR = 2.21, 95%CI 1.47–4.32), while those had uncontrolled blood pressure and Cluster 1 phenotype (HR = 0.64, 95%CI: 0.52–0.89) and those had uncontrolled blood pressure and Cluster 3 phenotype (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 hypertensive TAK.