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Association between long-term blood pressure control and ten-year progression in carotid arterial stiffness among hypertensive individuals: the multiethnic study of atherosclerosis

Tedla, Yacob G.; Gepner, Adam D.; Vaidya, Dhananjay; Colangelo, Laura; Stein, James H.; Liu, Kiang; Greenland, Philip

doi: 10.1097/HJH.0000000000001199
ORIGINAL PAPERS: Therapeutic aspects

Background: Arterial stiffness was shown to be higher among hypertensive patients with diabetes than those without diabetes and among older than younger hypertensive patients. We examined whether the association between long-term blood pressure (BP) control and 10-year progression in carotid arterial stiffness varies by diabetes status and age.

Methods: Participants were 906 individuals with hypertension at baseline and three follow-up visits in the Multi-Ethnic Study of Atherosclerosis (mean age 63.7 years, 44% males). Participants with SBP of less than 140 mmHg and DBP of less than 90 mmHg were considered to have a controlled BP. Arterial stiffness was measured using distensibility coefficient × 10−4/mmHg and Young's elastic modulus (YEM × 102 mmHg) at baseline and after a mean of 9.5 years (visit 5). Multiple linear regression model was used for the analysis.

Results: Having controlled BP at three visits (distensibility coefficient: β = 3.6, P = 0.004; YEM: β = –6.8, P = 0.07) or four visits (distensibility coefficient: β = 2.4, P = 0.04; YEM: β = −6.8, P = 0.05), when compared with having uncontrolled BP at all four visit, was associated with lesser progression in arterial stiffness. In a stratified analysis, arterial stiffness progression was slower only among nondiabetics with controlled BP at three visits (distensibility coefficient: β = 4.3, P = 0.002; YEM: β = −8.8, P = 0.04) or four visits (β = 3.7, P = 0.01; YEM: β = −10.4, P = 0.01) and among those less than 70 years with controlled BP at three visits (distensibility coefficient: β = 4.9, P = 0.004; YEM: β = −10.6, P = 0.01) or four visits (distensibility coefficient: β = 2.9, P = 0.07; YEM: β = -7.6, P = 0.03).

Conclusion: These findings suggest that controlling BP alone may not be sufficient to slow progression of arterial stiffness among hypertensive patients with concurrent diabetes and elderly hypertensive patients.

aDepartment of Preventive Medicine, Northwestern University, Chicago, Illinois

bDivision of Cardiovascular Medicine, University of Wisconsin Madison, Madison, Wisconsin

cJohn Hopkins University School of Medicine, Baltimore, Maryland, USA

Correspondence to Yacob G. Tedla, PhD, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 N Lake Shore Drive Suit 1400, Chicago, IL 60611, USA. Tel: +1 312 503 0626; e-mail:

Abbreviations: BP, blood pressure; YEM, Young's elastic modulus

Received 3 June, 2016

Revised 22 September, 2016

Accepted 5 November, 2016

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