Influence of baseline arterial stiffness on effects of intensive compared with standard blood pressure control: a post hoc analysis of the STEP trial

Abstract

Background The benefits and risks of intensive versus standard systolic blood pressure (SBP) treatment in older patients with arterial stiffness (AS) remains unclear. This study aims to investigate the interaction between the baseline AS and SBP treatments on cardiovascular outcomes. Methods In this post hoc analysis of the Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients (STEP) trial, we involved 6865 participants with complete data regarding baseline brachial-ankle pulse wave velocity (baPWV). Patients were categorized by baseline AS status (AS, baPWV ≥ 1800 cm/s; non-AS, baPWV < 1800 cm/s). The primary outcome was a composite of cardiovascular events. The secondary outcomes were stroke, acute coronary syndrome (ACS), major cardiovascular events (MACE), and all-cause death. Cox regression was used to calculate hazard ratios for the outcomes. Results During a mean follow-up of 2.69 years, a total of 248 primary outcome events and 81 all-cause deaths occurred. The hazard ratios for the primary outcome were 0.76 (95% confidence interval (CI), 0.54–1.09) and 0.63 (95% CI, 0.43–0.92) in the AS and non-AS groups, respectively (P for interaction = 0.43), and that for stroke was 0.58 (95% CI, 0.33–1.02) and 0.48 (95% CI, 0.23–0.99) in the AS and non-AS groups, respectively (P for interaction = 0.68). Effects of intensive SBP treatment on safety outcomes and all-cause death were also similar in the two groups (P for interaction > 0.05 for all). Conclusions In the STEP trial, the beneficial effects of intensive SBP treatment were similar among those in the AS group and the non-AS group at baseline. Trial registration STEP ClinicalTrials.gov number, NCT03015311. Registered 2 January 2017.

Visceral fat area is more strongly associated with arterial stiffness than abdominal subcutaneous fat area in Chinese patients with type 2 diabetes

“…It is controlled by elements coming from various levels of the vessel wall as well as chemicals like insulin and aldosterone in plasma [24]. Studies have shown that CIMT is mainly used as a measure of localized vascular lesions, whereas baPWV is currently used as a measure of AS [25][26][27]. A study by Amparo et al that included 415 European Americans with an average age of 55 years old confirmed that VFA was independently associated with increased AS and was an independent predictor of CVD, while SFA and BMI did not predict CVD [5].…”

The predictive value of arterial stiffness combined with hypertension in the index of atherosclerotic cardiovascular disease

“…Recently, a multicenter observational study had proved that elevated baPWV mediates a positive correlation between aging and blood pressure, indicating AS might precede increased blood pressure 7 . Another clinical trial had discovered that patients with AS (baPWV≥1800cm/s) at baseline were significantly less likely to achieve their target SBP than those without AS, verifying AS consistently preceded SBP 20, 21 . Additionally, a large-scale cohort based on general Chinese population demonstrated that baPWV had a higher predictive value of ASCVD and all-cause mortality versus blood pressure 22 .…”