Although arterial stiffening is related to atherosclerosis progression, its prognostic role in cerebrovascular events in hypertension is not fully elucidated. The aim of the present study was to assess the predictive role of arterial stiffness for the incidence of stroke in a cohort of essential hypertensive patients.
We followed up 1079 essential hypertensives (mean age 55.8 years, 572 males, office blood pressure (BP) = 144/91 mmHg) for a mean period of 8 years. All subjects had at least one annual visit and at baseline underwent blood sampling for assessment of metabolic profile and arterial stiffness was evaluated on the basis of carotid to femoral pulse wave velocity (PWV), by means of a computerized method. The distribution of PWV was split by the median (8.1 m/sec) and accordingly subjects were classified into those with high (n = 546) and low values (n = 533). Stroke was defined as rapid onset of a new neurological deficit persisting at least 24 hours unless death supervened confirmed by computed tomography and magnetic resonance angiography and/or cerebrovascular angiography findings.
The incidence of stroke over the follow-up period was 2.03%. Hypertensives who had stroke (n = 25) compared to those without stroke at follow-up (n = 1054) were older at baseline (63 ± 8 vs 55 ± 10 years, p = 0.012), had higher office BP levels (155 ± 13 vs 144 ± 16 mmHg, p = 0.022) and prevalence of high PWV levels (68% vs 42%, p = 0.019). No difference was observed between hypertensives with stroke and those without stroke with respect to baseline renal function and lipid levels (p = NS for all). By univariate Cox regression analysis it was revealed that high baseline PWV levels predicted stroke (hazard ratio = 1.314, p = 0.0034). Moreover, in multivariate Cox regression model, baseline age (hazard ratio = 1.098, p = 0.04) and PWV (hazard ratio = 1.105, p = 0.015) but not baseline office BP levels turned out to be independent predictors of stroke.
In essential hypertensive patients, PWV predicts future development of stroke, independently of established confounders, including BP. These findings support that PWV constitutes a potent prognosticator of cerebrovascular events and its estimation is essential in order to improve risk stratification in hypertension.
First Cardiology Clinic, University of Athens, Hippokration Hospital, Athens, Greece