Arterial Stiffness, Central Blood Pressure, and the Risk of Incident Stroke in Hypertensive Adults

Abstract

Background and aims: Whether hypertensive patients with elevated arterial stiffness and central systolic blood pressure (cSBP) are exposed to higher stroke risk is unclear.

Methods: A total of 6663 participants without a history of cardiovascular disease were enrolled in this study. cSBP was measured noninvasively using the A-Pulse CASPro device; carotid-femoral pulse wave velocity (cfPWV) was collected using a Pulse Pen device. The primary outcome was incident stroke.

Results: Over 4.4 years (median), 454 incident strokes occurred (15.92 per 1000 person-years). Compared to the reference group (cSBP < 137 mmHg and cfPWV < 10 m/s), patients with elevated cSBP and cfPWV had a significantly increased risk of incident stroke (HR 1.78 [95% CI 1.39, 2.27]), and were the only group showing statistical significance versus those with solely increased cSBP (HR 1.13 [95% CI 0.87, 1.48]) or cfPWV (HR 1.15 [95% CI 0.87, 1.52]) after adjusting for covariates; p for trend < 0.001. Consistent findings were identified in multiple sensitivity and exploratory analyses. The additive interaction between elevated cSBP and cfPWV was significant, with a relative excess risk due to interaction of 0.55 [95% CI 0.05-1.03]. The association between elevated cSBP and cfPWV with incident stroke risk was more robust among patients who were taking non-guideline recommended antihypertensive medication at baseline (HR 3.03) than among those who took recommended regimens (HR 1.58).

Conclusions: Hypertensive patients with elevated cSBP and cfPWV have a significantly higher risk of incident stroke than those with lower or solely increased cSBP and cfPWV. Greater clinical attention and tailored treatment strategies are needed.

Keywords: arterial stiffness; central systolic blood pressure; hypertension; stroke.

FIGURE 1

Kaplan–Meier curves of cumulative hazards of first stroke in groups, by arterial stiffness and cSBP status. Low cfPWV was defined as cfPWV < 10 m/s; high cfPWV was defined as cfPWV ≥ 10 m/s. Low cSBP was determined by a combination of cSBP T1 (< 127 mmHg) and T2 (127 to < 137 mmHg); high cSBP was defined as cSBP T3 (≥ 137 mmHg). Low + Low indicates low cfPWV and low cSBP; Low + High indicates low cfPWV and high cSBP; High + Low indicates high cfPWV and low cSBP; and High + High indicates high cfPWV and high cSBP.

FIGURE 2

Hazard ratios for first stroke in subgroups. Low cfPWV was defined as cfPWV < 10 m/s; high cfPWV was defined as cfPWV ≥ 10 m/s. Low cSBP was determined by a combination of cSBP T1 (< 127 mmHg) and T2 (127 to < 137 mmHg); high cSBP was defined as cSBP T3 (≥ 137 mmHg). The low‐risk group indicates the combination of low cfPWV and low cSBP, low cfPWV and high cSBP, and high cfPWV and low cSBP. The high‐risk group indicates high cfPWV and high cSBP.

FIGURE 3

Hazard ratios for first stroke in anti‐hypertensive drug groups. cSBP tertiles in guideline recommended drug group T1: < 127 mmHg, T2: 127 to < 138 mmHg, T3: ≥ 138. cSBP tertiles in non‐guideline recommended group T1: < 126 mmHg, T2: 126 to < 137 mmHg, T3: ≥ 137 mmHg. Guideline recommended drug included participants who were on single usage of ACE inhibitors (ACEI), angiotensin receptor blockers (ARB), calcium channel blockers (CCB), beta blockers, and diuretics for at least 6 months. Non‐Guideline recommended drug indicates those who were taking single usage of all other hypotensive agents for at least 6 months.