Abstract 15300: Pulse Wave Velocity as a Predictor of Stroke but not Coronary Artery Disease in Essential Hypertension: Data from a Greek 6-Year Follow-Up Study
Objectives: The aim of the present study was to assess the predictive role of arterial stiffness for the incidence of coronary artery disease (CAD) and stroke in a cohort of essential hypertensive patients.
Methods: We followed up 1128 essential hypertensives (mean age 56.1 years, 587 males, office blood pressure (BP)=144/91 mmHg) free of cardiovascular disease for a mean period of 6 years. All subjects had at least one annual visit and at baseline underwent echocardiographic study for estimation of left ventricular mass index (LVMI). The distribution of carotid to femoral pulse wave velocity (PWV) was split by the median (8.1 m/sec) and subjects were classified into those with high (n=566) and low values (n=562). CAD was defined as the history of myocardial infarction or significant coronary artery stenosis revealed by angiography or coronary revascularization procedure. 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.
Results: The incidence of CAD and stroke over the follow-up period was 2.83% and 2.03%, respectively. Hypertensives who developed CAD (n=32) compared to those without CAD (n=1096) had at baseline higher waist circumference (101.8±11.1 vs 97.2±11.9 cm, p=0.033), LVMI (123.7±22.9 vs 107±24.2 g/m², p=0.014), and prevalence of high PWV levels (69% vs 48%, p=0.019). Hypertensives who developed stroke (n=23) compared to those without (n=1105) had higher office BP (155±13 vs 143±17 mmHg, p=0.018) and prevalence of high PWV levels (67% vs 43%, p=0.021). In multivariate Cox regression models, waist circumference (hazard ratio=1.016, p=0.04) and LVMI (hazard ratio=1.023, p=0.018) but not high PWV turned out to be independent predictors of CAD, whereas age (hazard ratio=1.098, p=0.03) and PWV (hazard ratio=1.125, p=0.017) were independent predictors of stroke.
Conclusions: In hypertensive patients, PWV predicts future development of stroke, whereas exhibits no independent prognostic value regarding CAD. These findings suggest differential effects of the PWV-related atherosclerotic mechanisms on the cerebrovascular system and coronary tree in hypertension.
- © 2012 by American Heart Association, Inc.