Abstract 13799: Persistent Impairment of Arterial Stiffness is Associated with Future Cardiovascular Events in Patients with Hypertension; Cardio-Ankle Vascular Index Study

Abstract

Background: Arterial stiffness (AS) is a strong predictor of cardiovascular disease (CVD) in patients with hypertension (HT), which is modified by the medications for HT and other atherosclerotic risk factors. Cardio-ankle vascular index (CAVI) provides noninvasive, objective information of the overall AS from the origin of the aorta to the ankle, independent of blood pressure. This study aimed to investigate changes of CAVI after comprehensive management for atherosclerotic risk factors and its impact on future CVD outcome in patients with HT.

Methods: This study consisted of 162 patients with HT (68±9 years, 117 men) those CAVI were impaired. CAVI test was repeated 6 months later. In addition, 100 healthy subjects (66±8 years, 79 men) were served as controls in order to estimate normal value of CAVI. All patients were followed for more than 1 year or until the occurrence of CVD event defined as cardiac death, non-fatal myocardial infarction, unstable angina, ischemia-driven revascularization and stroke.

Results: Based on the results of control subjects, impaired CAVI was defined as >8.7 (mean plus 1 SD of controls). Of the 162 patients, CAVI improved 6 months later in 82 (51%), whereas impaired CAVI was sustained in remaining 80 (49%). During the follow-up (2.4±1.2 years) after second CAVI test, CVD events occurred in 19 (12%) patients. Framingham risk score (p=0.027), multi-vessel coronary disease (p=0.03) and persistently impaired CAVI (p=0.033) were independent predictors for future CVD events, independent of baseline CAVI. Patients with persistently impaired CAVI had worse CVD outcomes as compared to those with improved CAVI (p<0.001) (Figure).

Conclusions: This study demonstrated for the first time that impaired AS, as estimated by CAVI, did not improved even after comprehensive management of HT and other risk factors in approximately half of patients with HT. Serial measurement of CAVI, not a single-time, provides prognostic information in patients with HT.