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. 2016 Oct 26;5(11):e004271.
doi: 10.1161/JAHA.116.004271.

Relative Contributions of Arterial Stiffness and Hypertension to Cardiovascular Disease: The Framingham Heart Study

Teemu J Niiranen  1 , Bindu Kalesan  2   3 , Naomi M Hamburg  4   5   6 , Emelia J Benjamin  7   4   3   5   8 , Gary F Mitchell  9 , Ramachandran S Vasan  7   2   4   3   5   8
Affiliations

Relative Contributions of Arterial Stiffness and Hypertension to Cardiovascular Disease: The Framingham Heart Study

Teemu J Niiranen et al. J Am Heart Assoc. .

Abstract

Background: The presence and implications of abnormal arterial stiffness, a potential independent predictor of outcomes, in community-dwelling treated hypertensives is unknown. Furthermore, limited data exist regarding the risk of cardiovascular disease (CVD) associated with arterial stiffness across the entire range of blood pressure.

Methods and results: We measured carotid-femoral pulse wave velocity (PWV) and classical CVD risk factors in 2127 community-dwelling participants (mean age 60 years, 57% women) of The Framingham Offspring Cohort. The participants were divided into 4 groups according to hypertension (yes/no, defined as blood pressure ≥140/90 mm Hg or use of antihypertensive treatment) and PWV status (high/low based on age- and sex-specific median values) and followed up for CVD events (CVD death, myocardial infarction, unstable angina, heart failure, and stroke). Sixty percent (233 of 390) of controlled and 90% (232 of 258) of uncontrolled treated hypertensives had high PWV. The multivariable-adjusted risk for CVD events (n=248, median follow-up 12.6 years) rose from normotension with low PWV (reference) to normotension with high PWV (hazard ratio 1.29, 95% CI 0.83-2.00) and from hypertension with low PWV (hazard ratio 1.54, 95% CI 1.01-2.36) to hypertension with high PWV (hazard ratio 2.25, 95% CI 1.54-3.29).

Conclusions: A substantial proportion of treated hypertensives have high arterial stiffness, a finding that may explain some of the notable residual CVD risk associated with even well-controlled hypertension. High PWV is associated with a trend towards increasing CVD risk in both nonhypertensives and hypertensives, a finding that may support the use of arterial stiffness measurements in both populations.

Keywords: antihypertensive agent; arterial stiffness; cardiovascular disease; epidemiology; hypertension.

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Figures

Figure 1
Figure 1
Cumulative incidence of cardiovascular events in groups by hypertension and pulse wave velocity status (truncated at 13 years after baseline). HT indicates hypertension; NT, normotension; PWV, pulse wave velocity.
Figure 2
Figure 2
Risk of left ventricular hypertrophy and cardiovascular events in groups by hypertension and pulse wave velocity status. Odds/hazard ratios (95% CIs) are adjusted for age, sex, body mass index, smoking status, diabetes mellitus, total cholesterol, and HDL cholesterol. Trend in odds and hazard ratios was tested by entering the exposure categories as a linear term in the model. HDL indicates high‐density lipoprotein; PWV, pulse wave velocity.
Figure 3
Figure 3
Proportion of participants with increased pulse wave velocity (over age‐ and sex‐specific median) in groups by hypertension subtype. P≤0.001 for all between‐group differences. BP indicates blood pressure; HTN, hypertension; PWV, pulse wave velocity.
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