Aortic Pulse Wave Velocity as a Marker of Cardiovascular Risk in Hypertensive Patients

Abstract

Abstract-Large artery damage is a major contributory factor to cardiovascular morbidity and mortality of patients with hypertension. Pulse wave velocity (PWV), a classic evaluation of arterial distensibility, has never been ascertained as a cardiovascular risk marker. To determine the factors influencing aortic PWV and the potential predictor role of this measurement, we studied a cohort of 710 patients with essential hypertension. Atherosclerosis alterations (AA) were defined on the basis of clinical events. Calculation of cardiovascular risks, by use of Framingham equations, was performed in subjects without AA. PWV was higher in the presence of AA (14.9Ϯ4.0 versus 12.4Ϯ2.6 m/s, PϽ0.0001), even after adjustments on confounding factors and was the first determinant (PϽ0.0001) of the extent of atherosclerosis assessed as the sum of the atherosclerotic sites. In patients without AA, all cardiovascular risks increased constantly with PWV. Furthermore, at a given age, aortic PWV was the best predictor of cardiovascular mortality. The odds ratio of being in a high cardiovascular mortality risk group (Ͼ5% for 10 years) for patients in the upper quartile of PWV was 7.1 (95% confidence intervals 4.5 to 11.3). Nevertheless, in these studies, the number of patients needed to be treated in order to avoid 1 cardiovascular event remains high, particularly in the younger population. Clearly, the consideration of the other cardiovascular risk factors associated with hypertension would enable a more accurate evaluation of individual risk, risk stratification, and cost-effective preventive therapy. 3 From the Framingham population, evaluations have been proposed, taking into account simultaneously the contribution of blood pressure (BP), tobacco consumption, gender, lipid profile, diabetes mellitus, and ECG left ventricular hypertrophy. 4 However, an appropriate and simple evaluation of individual risk, based on a single measurement, is still lacking.Arterial stiffness increases with age 5 and hypertension 6 and is also enhanced in subjects with diabetes mellitus, 7 atherosclerosis, 8 and end-stage renal disease. 9 The most obvious consequences of arterial stiffening are increased pulsatile BP caused by higher systolic BP (SBP) and lower diastolic BP (DBP), thereby causing increased left ventricular afterload and altering coronary perfusion. 6,9 High SBP and pulse pressure, low DBP, and left ventricular hypertrophy have been identified as independent factors of cardiovascular morbidity and mortality in the general population. 1,10 -12 Arterial stiffness can be assessed noninvasively with the use of pulse wave velocity (PWV) measurement, that is, the velocity of the pulse wave to travel a given distance between 2 sites of the arterial system. Nevertheless, whether aortic stiffening is predictive of clinical outcome and/or mortality needs to be established.The goal of the present study was (1) to test the ability for aortic PWV to act as a marker of individual cardiovascular risk, integrating the atherosclerotic vascular damages ...

Diastolic blood pressure is an important determinant of augmentation index and pulse wave velocity in young, healthy males

“…25,39 Both stiffness indices, augmentation index and PWV, were strongly correlated to DBP suggesting that DBP may be an important determinant of arterial stiffness. This is consistent with the report by Giannattasio et al describing a positive relation between pressure and arterial stiffness in humans.…”

“…Some studies showed that PWV was only correlated to SBP. 22,25 Others found that PWV was correlated to both SBP and DBP 18 or was correlated to SBP in both men and women, but was correlated to DBP only in women. 26 The controversial results reported in the literature may be attributed to the large variability in the population studied, such as the broad age range, gender distribution and the presence of different diseases or drug regimens.…”

Relationship between blood pressure parameters and pulse wave velocity in normotensive and hypertensive subjects: invasive study

“…Those findings are consistent with our results. In some studies, PWV was only correlated with SBP, 20,21 but in others with both SBP and DBP. 22 Sa Cunha et al 23 suggested gender difference; SBP showed correlation with PWV in both genders, whereas DBP was correlated with PWV only in women.…”

“…Although BP is one of the strongest factors influencing PWV, varying correlation coefficients have been reported between the various PWV (aorta-leg-arm) and BP (systolic, diastolic, mean, pulse) using non-invasive methods. 5,[18][19][20][21][22][23][24] This variation may be attributable, at least in part, to the inherent variability of both PWV and BP within and across individual subjects and also to the method of BP 25 and PWV measurements.…”

Daily dialysis reduces pulse wave velocity in chronic hemodialysis patients

“…Aortic stiffness, which is assessed through aortic pulse wave velocity (PWV), is a predictor of morbidity and mortality in the general population [1][2][3][4] and in ESRD patients. 5,6 We previously demonstrated that hemodialysis (HD) patients have weekly cyclic variations in PWV that correlate with their dialysis rhythms, hydration status and blood pressure (BP). 7 In addition, we observed for the first time that different PWV behaviors during dialysis were associated with different mortality risks.…”