Carotid-femoral pulse wave velocity progression in hypertensive patients is associated with subsequent cardiovascular outcomes.

Abstract

Objective: Pulse wave velocity (PWV) is associated with cardiovascular events and mortality. However, little is known on the relationship of its progression (ΔPWV) over time with cardiovascular outcomes. The aim of our study was to evaluate the relationship between ΔPWV and all-cause mortality and cardiovascular events in hypertensive patients.

Methods: We enrolled 402 consecutive hypertensive outpatients. At baseline, anamnestic, clinical, blood pressure (BP), laboratory data and PWV were assessed. PWV examination was repeated after 3.8 (I-III quartiles 3.5-4.2) years. Patients were subsequently followed for a median time of 10.1 (I-III quartiles 9.5-10.5) years recording all-cause mortality and cardiovascular events.

Results: At baseline, mean age was 53.2 ± 13.0 years, SBP and DBP were 141.8 ± 17.5 and 86.8 ± 10.5 mmHg and PWV was 8.5 ± 1.9 m/s. Despite an improvement in BP control (-9.2 ± 19.5 and -8.0 ± 12.3 for SBP and DBP, respectively), at follow-up, the population showed a PWV increase (ΔPWV +0.6 ± 1.9 m/s). Progressors (ΔPWV ≥0.5 m/s, 204 patients, 50.7%) had a significantly lower survival probability and higher cumulative incidence of composite events, while no differences were seen for cardiovascular events (unadjusted analysis). At Cox multivariable analysis, neither ΔPWV at least 0.5 m/s (progressors) nor ΔPWV (as a spline function) were associated with cardiovascular events and with all-cause mortality. However, the association with survival probability and cumulative incidence of cardiovascular events, as a composite outcome, was significant (hazard ratio = 2.33, 95% CI 1.34-4.05, P  = 0.003).

Conclusion: Our study shows that PWV progression at least 0.5 m/s is frequent in hypertensive patients and is associated with a significantly higher risk of developing cardiovascular events or dying (composite outcome).