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Aortic pulse wave velocity as a marker of cardiovascular risk in hypertensive patients
1Department of Internal Medicine and Inserm U 337, Broussais Hospital, Paris, France.
Insights
Pulse wave velocity (PWV) is a strong predictor of cardiovascular risk in hypertensive patients. Higher PWV indicates more atherosclerosis and a greater risk of cardiovascular mortality.
Area of Science:
- Cardiovascular Medicine
- Hypertension Research
- Vascular Biology
Background:
- Large artery damage significantly contributes to cardiovascular morbidity and mortality in hypertension.
- Pulse wave velocity (PWV) assesses arterial distensibility but its role as a cardiovascular risk marker is underexplored.
Purpose of the Study:
- To investigate factors influencing aortic PWV in hypertensive patients.
- To evaluate PWV as a predictor of atherosclerosis and cardiovascular risk.
Main Methods:
- A cohort of 710 essential hypertension patients was studied.
- Atherosclerosis alterations (AA) were identified via clinical events.
- Cardiovascular risk was calculated using Framingham equations; PWV was measured.
Main Results:
- PWV was significantly higher in patients with AA (14.9 vs. 12.4 m/s).
- PWV was the primary determinant of atherosclerosis extent.
- In patients without AA, cardiovascular risks increased with PWV.
- Aortic PWV was the best predictor of cardiovascular mortality, with an odds ratio of 7.1 for the highest quartile.
Conclusions:
- Aortic PWV is strongly associated with atherosclerosis presence and extent.
- PWV is a potent marker and predictor of cardiovascular risk in hypertensive individuals.
- A PWV >13 m/s is a strong, independent predictor of cardiovascular mortality.
Abstract:
Large artery damage is a major contributory factor to cardiovascular morbidity and mortality of patients with hypertension. Pulse wave velocity (PWV), a classic evaluation of arterial distensibility, has never been ascertained as a cardiovascular risk marker. To determine the factors influencing aortic PWV and the potential predictor role of this measurement, we studied a cohort of 710 patients with essential hypertension. Atherosclerosis alterations (AA) were defined on the basis of clinical events. Calculation of cardiovascular risks, by use of Framingham equations, was performed in subjects without AA. PWV was higher in the presence of AA (14.9+/-4.0 versus 12.4+/-2.6 m/s, P<0.0001), even after adjustments on confounding factors and was the first determinant (P<0.0001) of the extent of atherosclerosis assessed as the sum of the atherosclerotic sites. In patients without AA, all cardiovascular risks increased constantly with PWV. Furthermore, at a given age, aortic PWV was the best predictor of cardiovascular mortality. The odds ratio of being in a high cardiovascular mortality risk group (>5% for 10 years) for patients in the upper quartile of PWV was 7.1 (95% confidence intervals 4.5 to 11.3). The presence of a PWV >13 m/s, taken alone, appeared as a strong predictor of cardiovascular mortality with high performance values. This study shows that aortic PWV is strongly associated with the presence and extent of atherosclerosis and constitutes a forceful marker and predictor of cardiovascular risk in hypertensive patients.