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Arterial stiffness and hypertension in a large population of untreated individuals: the Rotterdam Study

Verwoert, Germaine C.a,b; Franco, Oscar H.a; Hoeks, Arnold P.G.c; Reneman, Robert S.d; Hofman, Alberta; v Duijn, Cornelia M.a; Sijbrands, Eric J.G.b; Witteman, Jacqueline C.M.a; Mattace-Raso, Francesco U.S.a,b

doi: 10.1097/HJH.0000000000000237

Objective: We studied whether arterial stiffness measured as aortic pulse wave velocity (aPWV) and carotid distensibility was associated with different subtypes of hypertension in a large population of untreated middle-aged and elderly men and women.

Methods: The study was conducted within the framework of the population-based Rotterdam Study. We included 4088 individuals with information on aPWV, with 3554 individuals with carotid distensibility measurements without use of antihypertensive medication. Isolated systolic hypertension (ISH) was defined as SBP at least 140 mmHg and DBP less than 90 mmHg. Combined systolic and diastolic hypertension (Sys/Dia hypertension) was defined as SBP at least 140 mmHg and DBP at least 90 mmHg. Analysis of covariance was used to compare means of arterial stiffness for the different subtypes of hypertension. Multinomial logistic regression analysis was performed to investigate the association of arterial stiffness and the subtypes of hypertension in models adjusted for age, sex, mean arterial pressure, heart rate and cardiovascular risk factors.

Results: The mean age of the individuals was 68 years: 45.3% were men, 1597 individuals had ISH and 441 individuals had Sys/Dia hypertension. aPWV was higher (13.2 vs. 12.9 m/s; P = 0.008) in individuals with ISH compared to those with Sys/Dia hypertension. Multivariate odds ratios and corresponding 95% confidence interval of aPWV for ISH were 1.53 (1.38–1.71) and 1.28 (1.09–1.53) for Sys/Dia hypertension. Corresponding odds ratios associated with carotid distensibility were 0.84 (0.75–0.94) and 0.66 (0.54–0.81), respectively. Age significantly modified the association of aPWV with subtypes of hypertension (P < 0.001).

Conclusion: In a large untreated population, we found significant associations of both aPWV and carotid distensibility with ISH and Sys/Dia hypertension. individuals with ISH had higher values of aortic stiffness when compared to individuals with Sys/Dia hypertension, a difference that was most pronounced at older age. The results suggest that aortic stiffness contributes to ISH in older individuals without treatment for hypertension.

aDepartment of Epidemiology

bDepartment of Internal Medicine, Erasmus Medical Center, Rotterdam

cDepartment of Biomedical Engineering

dDepartment of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands

Correspondence to Germaine Verwoert, MD, MSc, Department of Internal Medicine, Erasmus Medical Center, Dr Molewaterplein 50, 3015 GE Rotterdam, The Netherlands. Tel: +31 107035979; fax: +31 107034768; e-mail:

Abbreviations: ΔD, the absolute stroke change in diameter during systole; ΔD/D, the relative stroke change in diameter; aPWV, aortic pulse wave velocity; CHD, coronary heart disease; CI, confidence interval; D, end-diastolic diameter; HDL, high-density lipoprotein; ISH, isolated systolic hypertension; MI, myocardial infarction; MMP, matrix metalloproteinase; OR, odds ratio; RS-I, original Rotterdam Study started in 1990; RS-II, extension of the Rotterdam Study in 1999; Sys/Dia hypertension, combined systolic and diastolic hypertension

Received 18 November, 2013

Revised 1 April, 2014

Accepted 1 April, 2014

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