Author + information
We hypothesized that arterial stiffness measures would predict increases in systolic (SBP), mean (MAP) and pulse pressure (PP) over time in treated hypertensives.
In 414 non-Hispanic white hypertensives (mean age 60±8 yrs, 55% women, 91% treated), blood pressure (BP) was obtained 8.5±0.9 years apart in the right arm with a sphygmomanometer; the average of 3 was recorded. Carotid-femoral pulse wave velocity [cfPWV], aortic augmentation index [AIx] and central pulse pressure [CPP]) were obtained at baseline using applanation tonometry. Stepwise multivariable linear regression and Cox-proportional hazards analyses were used to assess associations of arterial stiffness measures with changes in BP over time and with hypertension progression (defined as a difference in BP between 2nd and 1st visits > 0), respectively.
Median (IQR) cfPWV, AIx and CPP were 9.4 (8.2,11) m/s, 33 (27,39) % and 45 (37,55) mmHg, respectively. Measures of arterial stiffness were associated with BP increases over time (Table). cfPWV was independently associated with increases in SBP, DBP and PP; AIx was associated with increases in SBP, DBP and MAP, and CPP was associated with increases in SBP, MAP and PP. cfPWV > median (9.4m/s) was associated with higher risk of hypertension progression.
Measures of arterial stiffness are associated with increases in SBP, MAP and PP over time in treated hypertensives, and may help identify those at increased risk of disease progression and adverse outcomes.
|Multivariable linear regression|
|cfPWV (m/s) β±SE||AIx (%) β±SE||CPP (mmHg) β±SE|
|Δ SBP (mmHg)||0.71±0.38 P=0.05||0.23±0.08 P=0.01||0.45±0.07 P<0.0001|
|Δ DBP (mmHg)||−0.37±0.19 P=0.05||0.16±0.04 P=0.0005||0.02±0.04 P=0.57|
|Δ MAP (mmHg)||−0.05±0.26 P=0.85||0.27±0.06 P<0.0001||0.22±0.05 P<0.0001|
|Δ PP (mmHg)||1.10±0.33 P=0.0008||0.06±0.007 P=0.46||0.42±0.06 P<0.0001|
|Multivariable Cox proportional hazards|
|cfPWV> 9.4m/s HR (95% CI)||AIx > 33% HR (95% CI)||CPP > 45 mmHg HR (95% CI)|
|SBP progression||1.91 (1.30, 2.80) P=0.001||1.30 (0.90, 1.88) P=0.17||1.49 (1.00, 2.22) P=0.05|
|DBP progression||1.43 (1.09, 1.87) P=0.009||1.10 (0.85, 1.41) P=0.46||1.17 (0.87, 1.60) P=0.29|
|MAP progression||1.51 (1.03, 2.21) P=0.03||1.39 (0.97, 2.01) P=0.07||1.42 (0.96, 2.12) P=0.08|
|PP progression||2.03 (1.21, 3.42) P=0.008||0.94 (0.57, 1.55) P=0.82||1.29 (0.75, 2.10) P=0.35|
Potential confounding variables entered in the models were: age, sex, time interval, baseline SBP and DBP, total, and HDL cholesterol, history of diabetes, smoking, myocardial infarction and stroke, BMI, glomerular filtration rate, and use of anti-hypertensive medications and statins. We used criteria of P≤0.10 to enter, and P≤0.05 to stay in the models. Age and sex were forced into all models.
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Determinants and Modifiers of Arterial Stiffness
Abstract Category: 25. Prevention: Hypertension
Presentation Number: 1234-22
- 2013 American College of Cardiology Foundation