Abstract 16803: Gender Differences in the Impact of Arterial Stiffness on Outcome in Hypertensive Patient With Left Ventricular Hypertrophy (The Life Study)
Background: Increased arterial stiffness is associated with abnormal left ventricular (LV) structure and diastolic function in hypertension, particularly in women. Increased arterial stiffness is also related to adverse outcome, but whether this prognostic impact differs between genders is unknown.
Methods: We used clinic, echocardiographic and outcome data from 360 women and 506 men with hypertension and electrocardiographic (ECG) signs of LV hypertrophy randomized to losartan or atenolol based antihypertensive treatment in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study. Arterial stiffness was estimated from the ratio of pulse pressure/Doppler stroke volume indexed for height to the power of 2.04 (PP/SVi). The association of in-treatment PP/SVi with outcome during 4.8 years follow-up was tested in time varying Cox regression models, adjusting for time-varying LV mass, and reported as hazard ratio (HR) and 95% confidence intervals (CI).
Results: At baseline, higher PP/SVi was associated with higher age, relative wall thickness and serum creatinine, having isolated systolic hypertension or diabetes, and with lower body weight, LV ejection fraction and cardiac output in both genders (all p<0.05). In men, higher PP/SVi was also associated with lower LV mass, and in women with previous myocardial infarction (both p<0.05). In time-varying Cox regression, higher in-treatment PP/SVi predicted a 29% higher rate of combined cardiovascular death, nonfatal stroke and myocardial infarction, the primary study endpoint (95% CI 1.02-1.63, p=0.035). In sex-specific models, higher in-treatment PP/SVi was associated with increased rates of stroke (HR 1.76 [95% CI 1.18-2.63]), hospitalization for heart failure (HR 1.87 [95% CI 1.28-2.73]), cardiovascular mortality (HR 2.15 [95% CI 1.11-4.17]) and total mortality (HR 1.72 [95% CI 1.14-2.59], all p<0.05) in women, and with increased rate of myocardial infarction (HR 1.68 [95% CI 1.14-2.48], p<0.01) in men.
Conclusion: In hypertensive patients with ECG LV hypertrophy, higher in-treatment PP/SVi was associated with increased cardiovascular morbidity and mortality, particularly in women. This relation was independent of LV mass.
- © 2013 by American Heart Association, Inc.