Risk for hypertension heightened by aortic stiffness

Certain measures of aortic stiffness may serve as predictors of hypertension, according to new data.

Researchers examined the association between vascular stiffening and BP by evaluating 1,759 participants (mean age, 60 years) from cycles 7 (1998 to 2011) to 8 (2005 to 2008) of the Framingham Offspring study. During a 7-year period, they evaluated temporal relationships among BP and three measures of vascular stiffness and pressure pulsatility derived from arterial tonometry, including carotid-femoral pulse wave velocity, forward wave amplitude and augmentation index.

Results from a multivariable-adjusted regression model revealed a joint association between higher forward wave amplitude (P=.002) and higher carotid-femoral pulse wave velocity (P=.006) during cycle 7 and systolic BP during cycle 8. Moreover, in a model that included systolic and diastolic BP and additional risk factors during cycle 7, higher forward wave amplitude (OR=1.6; 95% CI, 1.3-2), augmentation index (OR=1.7; 95% CI, 1.4-2) and carotid-femoral pulse wave velocity (OR=1.3; 95% CI, 1-1.6) were associated with incident hypertension during cycle 8. However, the researchers found no relationship between BP during cycle 7 and aortic stiffness assessed by carotid-femoral pulse wave velocity during cycle 8.

After accounting for BP and tonometry variables, higher resting brachial artery flow (OR=1.23; 95% CI, 1.04-1.46) and lower flow-mediated dilation (OR=0.8; 95% CI, 0.67-0.96) during cycle 7 were associated with incident hypertension during cycle 8.

“Our data suggest that aortic stiffness, central pressure pulsatility, peripheral wave reflection, large artery endothelial function and microvascular function jointly antedate and potentially contribute to the development of clinical hypertension,” the researchers wrote. “Arterial stiffness and function may therefore be important potential targets for interventions aimed at preventing incident hypertension.”

In an accompanying editorial, Debabrata Mukherjee, MD, MS, of Texas Tech University Health Sciences Center, said these study findings may have significant clinical implications, especially in terms of prevention.

“By concentrating on the underlying drivers of chronic diseases like hypertension and atherosclerosis, clinicians may be able to move from today’s sick care system to a true health care system that encourages health and well-being,” Mukherjee wrote. “If prospective studies validate both prevention of hypertension and improved cardiovascular outcomes using lifestyle modifications as well as a combination therapy approach in individuals with vascular stiffness, endothelial dysfunction, or both, before hypertension develops, such a strategy could become a cornerstone of a national preventive strategy.

For more information:

Kaess BM. JAMA. 2012;308:875-881.

Mukherjee D. JAMA. 2012;308:919-920.

Disclosure: Gary F. Mitchell, MD, reports being the owner of Cardiovascular Engineering Inc. and serving as a consultant to Novartis and Merck. All other researchers report no relevant financial disclosures. Mukherjee reports receiving royalties from Lippincott Williams & Wilkins for editing 1001 Questions: An Interventional Cardiology Board Review and from Informa Healthcare books for editing Cardiovascular Catheterization and Intervention.