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CLINICAL RESEARCH: HYPERTENSION

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

Samer S. Najjar, MD^_*,_*, Angelo Scuteri, MD, PhD^_*,, Veena Shetty, MPH^_*, Jeanette G. Wright, BA, Denis C. Muller, MS, Jerome L. Fleg, MD, FACC, Harold P. Spurgeon, PhD^_*, Luigi Ferrucci, MD, PhD and Edward G. Lakatta, MD^_*

^_* Laboratory of Cardiovascular Science, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
U.O. Geriatria, Instituto Nazionale Ricovero e Cura per Anziani (INRCA), Rome, Italy
Clinical Research Branch, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland.

Manuscript received August 7, 2007; revised manuscript received October 10, 2007, accepted October 15, 2007.

^_* Reprint requests and correspondence: Dr. Samer S. Najjar, NIA/ASTRA unit, 5th Floor, Harbor Hospital, 3001 South Hanover Street, Baltimore, Maryland 21225. (Email: NajjarSa{at}mail.nih.gov).

Objectives: This study sought to evaluate whether pulse wave velocity (PWV), a noninvasive index of arterial stiffness, is a predictor of the longitudinal changes in systolic blood pressure (SBP) and of incident hypertension.

Background: Although arterial stiffness is believed to underlie, in part, the age-associated changes in SBP, particularly at older ages, few longitudinal studies in humans have examined the relationship between arterial stiffness and blood pressure.

Methods: Pulse wave velocity was measured at baseline in 449 normotensive or untreated hypertensive volunteers (age 53 ± 17 years). Repeated measurements of blood pressure were performed during an average follow-up of 4.9 ± 2.5 years.

Results: After adjusting for covariates including age, body mass index, and mean arterial pressure, linear mixed effects regression models showed that PWV was an independent determinant of the longitudinal increase in SBP (p = 0.003 for the interaction term with time). In a subset of 306 subjects who were normotensive at baseline, hypertension developed in 105 (34%) during a median follow-up of 4.3 years (range 2 to 12 years). By stepwise Cox proportional hazards models, PWV was an independent predictor of incident hypertension (hazard ratio 1.10 per 1 m/s increase in PWV, 95% confidence interval 1.00 to 1.30, p = 0.03) in individuals with a follow-up duration greater than the median.

Conclusions: Pulse wave velocity is an independent predictor of the longitudinal increase in SBP and of incident hypertension. This suggests that PWV could help identify normotensive individuals who should be targeted for the implementation of interventions aimed at preventing or delaying the progression of subclinical arterial stiffening and the onset of hypertension.

Abbreviations and Acronyms   BMI = body mass index   BP = blood pressure   CI = confidence interval   DBP = diastolic blood pressure   HDL = high-density lipoprotein   HTN = hypertension   HR = hazard ratio   MAP = mean arterial pressure   PP = pulse pressure   PWV = pulse wave velocity   SBP = systolic blood pressure