Arterial Stiffness From Monitoring of Timing of Korotkoff Sounds Predicts the Occurrence of Cardiovascular Events Independently of Left Ventricular Mass in Hypertensive Patients

Abstract

Markers of subclinical target organ damage increase cardiovascular risk prediction beyond traditional risk factors. Arterial stiffness (AS) is one of these markers. 1 The predictive value for future cardiovascular events (CVEs) has been demonstrated for the carotido-femoral pulse wave velocity (PWV) in patients with renal failure, 2 in hypertensives, 3 and in the general population, 4 as well as from ambulatory measurement of the timing of Korotkoff sounds (QKD) in hypertensives. 5 The predictive value of AS is independent of traditional risk factors: sex, age, diabetes mellitus, smoking, cholesterol, and blood pressure (BP), even when monitored during 24 hours with the QKD method. However, very few studies 6 have compared the respective predictive values of different markers of target organ damage. This is a major issue because the question whether all parameters should be measured, or only some of them, in routine condition is opened. To date there are no studies that have evaluated the prognostic value of AS in comparison with another powerful risk factor, left ventricular mass (LVM) as measured by echocardiography in hypertensive patients We evaluated the prognostic value of these 2 parameters in the same population of patients with essential hypertension using the QKD method, which offers the advantages to combine 24-hour BP monitoring and an estimation of AS independent of BP. Methods PopulationThe patients included in this study belong to the Bordeaux cohort of hypertensive. This registry was started in 1984 and includes all patients consecutively referred to our center before administration of antihypertensive treatment and fulfilling the following criteria:Office BP>140/90 on ≥2 occasions; Essential hypertension. Absence of cardiovascular complications or pathology likely to affect the prognosis, absence of type 1 diabetes mellitus.For the validity of the ambulatory measurement of AS, 2 other selection criteria were used.Absence of bundle-branch block on ECG (QRS duration <120 ms). Absence of known thyroid pathology.All the patients gave their consent to participation in this registry, which was approved by our local committee of ethics and protection See Editorial Commentary, pp 10-12Abstract-Several studies have established that the increase in arterial stiffness (AS) is a cardiovascular risk factor but to date no studies have evaluated in hypertensive patients its prognostic value in comparison with another powerful risk factor, left ventricular mass (LVM) as measured by echocardiography. We prospectively evaluated the prognostic value of AS and LVM in patients with essential hypertension. The population studied comprised 793 patients (56% men) aged 54±14 years. For 519 patients, baseline measurements were made before any antihypertensive treatment, for 274 patients, the measurement were obtained during the follow-up period under antihypertensive treatment. AS was assessed from ambulatory monitoring of blood pressure and timing of Korottkoff sounds. Left ventricular mass was measured in 523 patients....

Arterial Stiffness as an Imaging Biomarker

“…9 Because most of the pioneering epidemiological studies used the cfPWV method, novel devices using a different method for determining arterial stiffness should also demonstrate that the stiffness parameter which they measure has an independent predictive value for CV events. This is what has been adequately done by Gosse et al 7 in the article published in the present issue of Hypertension. Indeed, novel devices measuring a novel stiffness parameter cannot claim a predictive value for CV events simply from data showing a significant correlation between the novel parameter and cfPWV obtained during a cross-sectional validation study.…”

“…The article by Gosse et al 7 published in the present issue of Hypertension provides an important contribution with regard to the predictive value of arterial stiffness for CV events for ≥4 reasons. First, the authors reported that arterial stiffness, measured in a population of 793 patients with hypertension with a mean follow-up of 97 months, was independently related to all CV events, major CV events, and total mortality.…”

“…The independent predictive value of arterial stiffness was significant whether measured before or after the administration of antihypertensive treatment. Finally, Gosse et al 7 showed, in a subgroup of 523 patients who had a measurement of left ventricular mass index, that the predictive value of arterial stiffness for major CV events was independent of left ventricular mass index. The authors thus confirmed the very few epidemiological studies which analyzed the predictive value of biomarkers of target organ damages (ie, left ventricular mass index, urinary albumin excretion rate, carotid intimamedia thickness, and arterial stiffness) and found that arterial stiffness retained a significant predictive value when adjusted either to left ventricular mass index 6 or carotid intima-media thickness.…”

“…The authors thus confirmed the very few epidemiological studies which analyzed the predictive value of biomarkers of target organ damages (ie, left ventricular mass index, urinary albumin excretion rate, carotid intimamedia thickness, and arterial stiffness) and found that arterial stiffness retained a significant predictive value when adjusted either to left ventricular mass index 6 or carotid intima-media thickness. 5 The findings of Gosse et al 7 are stimulating from another point of view: the method which has been used to determine arterial stiffness. Indeed, Gosse et al 8 proposed, 2 decades ago, to take advantage of an ambulatory measurement of BP and continuous monitoring of ECG >24 hours, to calculate the QKD interval.…”

Evaluation of arterial stiffness by finger-toe pulse wave velocity measured by pOpmetre® in black africans patients with systemic scleroderma

“…Elle constitue également la première étude a utilisé le Popmètre comme outil de mesure de la RA chez des malades sclérodermiques. Les études antérieures étaient plutôt basées sur la mesure de l'intervalle QKd (temps qui sépare le complexe QRS de l'ECG de l'apparition du dernier bruit de Korotkoff perçu au niveau de l'artère humérale lors de la mesure de la tension artérielle [7]. Le Popmètre est une nouvelle méthode ambulatoire de mesure de la RA qui est objective, rapide, non invasive et surtout reproductible [8].…”