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Aortic root dimension and arterial stiffness in arterial hypertension: the Campania Salute Network
Mai Tone Lønnebakken1, Raffaele Izzo, Costantino Mancusi
1aHypertension Research Center bDepartment of Translational Medical Science, Federico II University Hospital, Naples, Italy cDepartment of Clinical Science, University of Bergen, Bergen, Norway dDepartment of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy.
Insights
In hypertensive patients, smaller aortic root dimensions (ARD) are linked to increased arterial stiffness. This association persists even when considering other risk factors like age and diabetes.
Area of Science:
- Cardiovascular Medicine
- Hypertension Research
- Vascular Biology
Background:
- The relationship between aortic root dimension (ARD) and arterial stiffness in hypertension is not well-established.
- Understanding this link is crucial for cardiovascular risk assessment in hypertensive individuals.
Purpose of the Study:
- To investigate the association between aortic root dimension (ARD) and arterial stiffness in a large cohort of hypertensive patients.
- To determine if this relationship is independent of other cardiovascular risk factors.
Main Methods:
- Echocardiographic ARD was measured and normalized using z-scores based on age, sex, and height.
- Arterial stiffness was estimated using pulse pressure/stroke index, with the highest tertile defined as 'high arterial stiffness'.
- Multivariable logistic regression analysis was employed to assess independent associations.
Main Results:
- High arterial stiffness was more prevalent in women and associated with older age, diabetes, and longer hypertension duration.
- Patients with high arterial stiffness exhibited smaller ARD z-scores and increased carotid intima-media thickness.
- Lower ARD z-score and higher carotid intima-media thickness were independently associated with high arterial stiffness.
Conclusions:
- Smaller aortic root dimension (ARD) is significantly associated with increased arterial stiffness in hypertensive patients.
- This association is independent of major confounders, including age, sex, body size, and diabetes.
- Aortic root dimension may serve as a potential indicator of arterial stiffness and atherosclerotic changes in conduit arteries.
Objectives:
The relation between aortic root dimension (ARD) and measures of arterial stiffness is uncertain. Accordingly, we studied the relation between ARD and an estimate of arterial stiffness in 12 392 hypertensive patients (age 53 ± 12 years, 43% women) free of prevalent cardiovascular disease and with ejection fraction at least 50%, from the Campania Salute Network Registry.
Methods:
Echocardiographic ARD was measured and compared with the value predicted by age, sex and height by using a z-score. Arterial stiffness was assessed by the pulse pressure/stroke index. The highest population tertile of pulse pressure/stroke index was considered 'high arterial stiffness'.
Results:
High arterial stiffness was more common in women than in men (P < 0.001) and associated with older age, diabetes, longer duration of hypertension and less frequent smoking habit (all P less than 0.01). Patients with high arterial stiffness had smaller ARD, higher carotid intima-media thickness and plasma cholesterol, and lower BMI and glomerular filtration rate (all P less than 0.01). In multivariable logistic analysis, high arterial stiffness was associated with both lower ARD z-score [OR 0.83 (95% confidence interval 0.79-0.88)] and higher carotid intima-media thickness [OR 1.36 (95% confidence interval 1.26-1.47); both P less than 0.0001], independent of significant associations with age, female sex, body size, DBP, heart rate, duration of hypertension, diabetes and smoking habit.
Conclusion:
Small ARD, together with atherosclerotic modifications of conduit arteries, is associated with increased 2-element Windkessel model of arterial stiffness in hypertension, independently of the significant effect of confounders.