Determinants of Accelerated Progression of Arterial Stiffness in Normotensive Subjects and in Treated Hypertensive Subjects Over a 6-Year Period

TLDR

Elastic artery stiffness, a consequence of arterial aging, independently predicts cardiovascular risk. This longitudinal study compared 6‑year aortic stiffness progression between treated hypertensives and normotensives and identified its determinants. The study followed 483 participants (187 treated hypertensives and 296 normotensives) over 6 years, measuring aortic stiffness with carotid‑femoral pulse wave velocity at two time points. Older age, higher blood pressure, heart rate, and serum creatinine accelerated aortic stiffness progression, with treated hypertensives showing faster rates unless blood pressure was well controlled; these factors were the main determinants identified in this first longitudinal study.

Abstract

Background — Elastic artery stiffness, a result of arterial aging, is an independent indicator of cardiovascular risk. The aim of the present longitudinal study was to compare the progression of aortic stiffness over a 6-year period in treated hypertensive subjects and normotensive subjects, and to evaluate the determinants of this progression. Methods and Results — Data for the present analysis were gathered from 483 subjects who had 2 health checkups at the Centre d’Investigations Préventives et Cliniques, the first one in 1992–1993 and the second one in 1998–1999. Carotid-femoral pulse wave velocity (PWV) was used to evaluate aortic stiffness in 187 hypertensive subjects who were under treatment at the time of the first visit and throughout the follow-up period, and in 296 subjects who were classified as normotensive during the first visit and who remained treatment-free throughout the follow-up period. In both populations, PWV progression was higher in older subjects. Annual rates of progression in PWV in treated hypertensives were significantly higher than in normotensives. Only treated hypertensives with well-controlled blood pressure levels at the time of both visits had a PWV progression similar to that of normotensives. In treated hypertensives, high heart rate and high creatinine during the first visit were associated with an accelerated progression in PWV. Conclusions — The presence of high blood pressure, high heart rate, and high serum creatinine were the major determinants of accelerated progression of aortic stiffness in treated hypertensives. This is the first longitudinal study to evaluate the determinants of arterial aging over an extended period of time.