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Do treatment-induced changes in arterial stiffness affect left ventricular structure? A meta-analysis

van der Waaij, Koen M.a,b,*; Heusinkveld, Maarten H.G.a,*; Delhaas, Tammoa; Kroon, Abraham A.b; Reesink, Koen D.a

doi: 10.1097/HJH.0000000000001918
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Background: Vascular research demonstrated that pulse wave velocity (PWV), a measure of arterial stiffness, is inherently blood pressure dependent. Considering the hypothesized pathophysiological chain of increased arterial stiffness leading to increased blood pressure load with consequent left ventricular hypertrophy (LVH) development, we conducted a systematic review of antihypertensive and lifestyle intervention studies to determine the association between, on the one hand, changes in arterial stiffness and blood pressure, and, on the other hand, changes in left ventricular mass (LVM).

Methods: Using PubMed, EMBASE, Cochrane and Web of Science, we identified 23 studies, containing 2573 patients. Studies reported changes in arterial stiffness (assessed by means of PWV), SBP, DBP and LVM index (LVMI), respectively.

Results: Statistically significant reductions in SBP, PWV and LVMI were reported in 16, 14 and 20 studies, respectively. Pooled analysis of studies showed that the proportion in SBP reduction did not correlate significantly to the proportion in reductions of the other two variables. On the contrary, we found a significant positive correlation (r = 0.61, P = 0.003) between arterial stiffness and reduction of LVM, expressed as a relevant reduction in LVMI of 6.9 g/m2 per 1.0 m/s reduction in PWV.

Conclusion: Our findings provide evidence that a decrease in arterial stiffness is associated with reduction of LVM. To investigate whether there exists a causal relation between LVH due to arterial stiffness increases and in turn blood pressure load increases, future studies should strive for a multiple follow-up design and use of blood pressure independent or corrected stiffness indices.

aDepartment of Biomedical Engineering

bDepartment of Internal Medicine, CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre, Maastricht, the Netherlands

Correspondence to Maarten H.G. Heusinkveld, MSc, Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre, P.O. Box 616, Maastricht 6200 MD, the Netherlands Tel: +31 43 3881659; e-mail: m.heusinkveld@maastrichtuniversity.nl

Abbreviations: A0, diastolic cross-sectional lumen area; CC, compliance; CI, confidence interval; LVM, left ventricular mass; LVMI, left ventricular mass index; PWV, pulse wave velocity; ρ, blood density

Received 17 May, 2018

Accepted 30 July, 2018

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