Carotid-femoral pulse wave velocity (PWV), an index of arterial stiffness and a proxy of arterial aging, has been reported to be an independent determinant of cardiovascular health. Whether the effects of antihypertensive treatment vary in the presence of accelerated arterial aging (stiffer artery, ie, PWV >10 m/s) has not been established. We tested this hypothesis in a longitudinal study in a large community-dwelling population.
Longitudinal population study with repeated measures.
Setting and Participants
Study population consisted of a cohort of 6011 volunteers (2546 men and 3465 women, age range 14-101 years; 15,011 observations over a median follow-up of 6.8 years) participating in the SardiNIA Study.
Repeated measures of PWV, blood pressure (BP), and metabolic risk factors and the antihypertensive medication trajectories of BP and PWV over time were assessed via mixed effects models.
Antihypertensive treatment significantly affected the trajectory of BP in both participants with (−0.47 ± 0.20 mmHg/y, P = .02) and participants without stiffer arteries (−0.47 ± 0.07 mmHg/y, P = .001). They also affected the trajectory of PWV in participants with stiffer artery, independent of the BP values.
Conclusions and Implications
Antihypertensive treatment is effective in reducing both BP and PWV in older individuals with stiffer arteries.
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- 2018 ESC/ESH Guidelines for the management of arterial hypertension.Eur Heart J. 2018; 39: 3021-3104
- A call to action and a lifecourse strategy to address the global burden of raised blood pressure on current and future generations: The Lancet Commission on Hypertension.Lancet. 2016; 388: 2665-2712
- Epidemiology of multimorbidity and implications for health care, research, and medical education: A cross-sectional study.Lancet. 2012; 380: 37-43
- Frailty and multimorbidity: Different ways of thinking about geriatrics.J Am Med Dir Assoc. 2017; 18: 361-366
- High prevalence of poor quality drug prescribing in older individuals: A nationwide report from the Italian Medicines Agency (AIFA).J Gerontol A Biol Sci Med Sci. 2014; 69: 430-437
- Circadian blood pressure patterns and blood pressure control in patients with chronic kidney disease.Atherosclerosis. 2017; 267: 139-145
- A U-shaped association between blood pressure and cognitive impairment in Chinese elderly.J Am Med Dir Assoc. 2017; 18: 193.e7-193.e13
- Excessive lowering of blood pressure is not beneficial for progression of brain white matter hyperintensive and cognitive impairment in elderly hypertensive patients: 4-year follow-up study.J Am Med Dir Assoc. 2014; 15: 904-910
- Characteristics of healthy vascular ageing in pooled population-based cohort studies: The global Metabolic syndrome and Artery REsearch (MARE) Consortium.J Hypertens. 2018; 36: 2340-2349
- Expert consensus document on arterial stiffness: Methodological issues and clinical applications.Eur Heart J. 2006; 27: 2588-2605
- Pulse wave velocity is an independent predictor of the longitudinal increase in systolic blood pressure and of incident hypertension in the Baltimore Longitudinal Study of Aging.J Am Coll Cardiol. 2008; 51: 1377-1383
- Longitudinal perspective on the conundrum of central arterial stiffness, blood pressure, and aging.Hypertension. 2014; 64: 1219-1227
- Extent of cardiovascular risk reduction associated with treatment of isolated systolic hypertension.Arch Intern Med. 2003; 163: 2728-2731
- An operational definition of SHATS (Systemic Hemodynamic Atherosclerotic Syndrome): Role of arterial stiffness and blood pressure variability in elderly hypertensive subjects.Int J Cardiol. 2018; 263: 132-137
- Pulse wave velocity as a marker of cognitive impairment in the elderly.J Alzheimers Dis. 2014; 42: S401-S410
- Visit-to-visit blood pressure variability and progression of white matter hyperintensities among older people with hypertension.J Am Med Dir Assoc. 2019; 20: 1175-1177.e1
- Aortic stiffness and hypotension episodes are associated with impaired cognitive function in older subjects with subjective complaints of memory loss.Int J Cardiol. 2013; 169: 371-377
- Left ventricular mass increase is associated with cognitive decline and dementia in the elderly independently of blood pressure.Eur Heart J. 2009; 30: 1525-1529
- Age- and gender-specific awareness, treatment, and control of cardiovascular risk factors and subclinical vascular lesions in a founder population: The SardiNIA Study.NutrMetab Cardiovasc Dis. 2009; 19: 532-541
- Noninvasive measurements of arterial stiffness: Repeatability and interrelationships with endothelial function and arterial morphology measures.Vasc Health Risk Manag. 2007; 3: 343-349
- Independent and additive effects of cytokine patterns and the metabolic syndrome on arterial aging in the SardiNIA Study.Atherosclerosis. 2011; 215: 459-464
- Determinants of pulse wave velocity in healthy people and in the presence of cardiovascular risk factors: “Establishing normal and reference values”.Eur Heart J. 2010; 31: 2338-2350
- R: A Language and Environment for Statistical Computing.R Foundation for Statistical Computing, Vienna, Austria2015 (Available at:)Accessed March 6, 2019)
- Model choice can obscure results in longitudinal studies.J Gerontol A Biol Sci Med Sci. 2009; 64: 215-222
- Determinants of accelerated progression of arterial stiffness in normotensive subjects and in treated hypertensive subjects over a 6-year period.Circulation. 2002; 105: 1202-1207
- Determinants of the aortic pulse wave velocity index in hypertensive and diabetic patients: Predictive and therapeutic implications.J Hypertens. 2018; 36: 2324-2332
- Pulse pressure is inversely related to aortic root diameter implications for the pathogenesis of systolic hypertension.Hypertension. 2008; 51: 196-202
- Functional correlates of central arterial geometric phenotypes.Hypertension. 2001; 38: 1471-1475
- Dose-dependent arterial destiffening and inward remodeling after olmesartan in hypertensives with metabolic syndrome.Hypertension. 2014; 64: 709-716
- Ramipril reduces large-artery stiffness in peripheral arterial disease and promotes elastogenic remodeling in cell culture.Hypertension. 2005; 45: 1194-1199
- Effects of perindopril on elastic and structural properties of large arteries in essential hypertension.Can J Cardiol. 2004; 20: 795-799
- Impact of antihypertensive agents on arterial stiffness in hypertensive patients.Int J Cardiol. 2018; 273: 207-212
- Arterial stiffness, cognitive dysfunction, and adherence to antihypertensive agents. Is there a link to hypertensive patients?.Curr Vasc Pharmacol. 2019 Apr 15; ([Epub ahead of print])
- Predictive capacity of frailty phenotype toward patterns of disability identified using latent class analysis.J Am Med Dir Assoc. 2019; 20: 1026-1031
Published online: December 26, 2019
This research was supported in part by the Intramural Research Program of the US National Institutes of Health, National Institute on Aging (No. HHSN271201600005C).
The authors declare no conflicts of interest.
© 2019 AMDA - The Society for Post-Acute and Long-Term Care Medicine.