Association of 24-h central hemodynamics and stiffness with cardiovascular events and all-cause mortality. The VASOTENS Registry
Omboni S. Alfie J. Arystan A. Avolio A. Barin E. Bokusheva J. Bulanova N. Butlin M. Cuffaro P. Derevyanchenko M. Grigoricheva E. Gurevich A. Konradi A. Muiesan M.L. Paini A. Pereira T. Statsenko M.E. Tan I.
1 September 2024Lippincott Williams and Wilkins
Journal of Hypertension
2024#42Issue 91590 - 1597 pp.
Objectives: In hemodialysis patients, central hemodynamics, stiffness, and wave reflections assessed through ambulatory blood pressure monitoring (ABPM) showed superior prognostic value for cardiovascular (CV) events than peripheral blood pressures (BPs). No such evidence is available for lower-risk hypertensive patients. Methods: In 591 hypertensive patients (mean age 58 ± 14 years, 49% males), ambulatory brachial and central BP, pulse wave velocity (PWV), and augmentation index (AIx) were obtained with a validated upper arm cuff-based pulse wave analysis technology. Information on treatment for hypertension (73% of patients), dyslipidemia (27%), diabetes (8%), CV disease history (25%), was collected. Patients were censored for CV events or all-cause death over 4.2 years. Results: One hundred and four events (24 fatal) were recorded. Advanced age [hazard ratio and 95% confidence interval: 1.03 (1.01, 1.05), P = 0.0001], female sex [1.57 (1.05, 2.33), P = 0.027], CV disease [2.22 (1.50, 3.29), P = 0.0001], increased 24-h central pulse pressure (PP) [1.56 (1.05, 2.31), P = 0.027], PWV [1.59 (1.07, 2.36), P = 0.022], or AIx [1.59 (1.08, 2.36), P = 0.020] were significantly associated with a worse prognosis (univariate Cox regression analysis). The prognostic power of peripheral and central BPs was lower. However, PWV [1.02 (0.64, 1.63), P = 0.924], AIx [1.06 (0.66, 1.69), P = 0.823], and central PP [1.18 (0.76, 1.82), P = 0.471], were not significant predictors in multivariate analyses. Conclusions: In hypertensive patients, ambulatory central PP, PWV, and AIx are associated with an increased risk of CV morbidity and all-cause mortality. However, this association is not independent of other patient characteristics. Copyright
ambulatory blood pressure , arterial stiffness , augmentation index , blood pressure telemonitoring , central arterial pressure , hypertension , pulse wave velocity , survival , vascular biomarkers
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Clinical Research Unit, Italian Institute of Telemedicine, Varese, Italy
Department of Cardiology, Sechenov First Moscow State Medical University, Moscow, Russian Federation
Servicio de Clınica Medica y Seccion Hipertension Arterial, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
Department of Functional Diagnostics, Medical Center Hospital of President’s Affairs Administration of The Republic of Kazakhstan, Astana, Kazakhstan
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
Macquarie Medical School, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
Pirogov Russian National Research Medical University, Moscow, Russian Federation
Volgograd State Medical University, Volgograd, Russian Federation
South Ural State Medical University, Chelyabinsk, Russian Federation
Almazov National Medical Research Centre, Saint Petersburg, Russian Federation
Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
H&TRC - Health & Technology Research Center, Coimbra Health School, Polytechnic University of Coimbra, Coimbra, Portugal
The George Institute for Global Health, University of New South Wales, Sydney, Australia
Clinical Research Unit
Department of Cardiology
Servicio de Clınica Medica y Seccion Hipertension Arterial
Department of Functional Diagnostics
Department of Cardiovascular Medicine
Macquarie Medical School
Pirogov Russian National Research Medical University
Volgograd State Medical University
South Ural State Medical University
Almazov National Medical Research Centre
Department of Clinical and Experimental Sciences
H&TRC - Health & Technology Research Center
The George Institute for Global Health
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