Change in pulse pressure/stroke index in response to sustained blood pressure reduction and its impact on left ventricular mass and geometry changes: the life study.
BACKGROUND
In cross-sectional data in hypertensive subjects, brachial pulse pressure (PP)/Doppler stroke index (SVi), (PP/SVi) correlates weakly but significantly with left ventricular (LV) mass and relative wall thickness (RWT).


METHODS
In the Losartan Intervention For End-point reduction in hypertension (LIFE) study, we evaluated the impact of antihypertensive treatment on change of PP/SVi as raw indicator of systemic arterial stiffness, and further explored the impact of the change in PP/SVi on the change in LV mass and RWT.


RESULTS
Compared to baseline, mean PP/SVi reduction was -13% at year 1, -15% at year 2, and -16% at year 3 follow-up, and was sustained through year 4 and year 5 follow-ups; change in PP/SVi was related to increased SVi and decreased PP during the annual follow-ups, but not to LV mass change. Restricting analyses to the first two follow-ups to ensure highest statistical power, age >65 and diabetes were associated with higher PP/SVi at baseline and throughout follow-ups; black participants and women had baseline PP/SVi mean values comparable with those of their counterparts, showed blunted PP/SVi reduction after 1 year, but differences became smaller and not statistically significant at year 2 follow-up. Losartan- or atenolol-based treatments were associated with comparable reduction of PP/SVi. At year 2 follow-up, reduced PP/SVi was associated with greater reductions in mean blood pressure (BP) and heart rate and greater increase in SVi, but not with lower LV mass; RWT was lower with lower PP/SVi at year 2 follow-up.


CONCLUSIONS
Reduction in PP/SVi by long-term antihypertensive treatment did not have significant impact on change in LV mass index, but correlated with LV remodeling toward eccentric geometry.
Palmieri
Vittorio
V
Division of Cardiology, Department of Medicine, Weill Medical College of Cornell University, New York, NY, USA. vpalmier@med.cornell.edu
Bella
Jonathan N
JN
Gerdts
Eva
E
Wachtell
Kristian
K
Papademetriou
Vasilios
V
Nieminen
Markku S
MS
Dahlöf
Björn
B
Devereux
Richard B
RB
D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001158:Arteries / Q000503:physiopathology; D001262:Atenolol / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects*; D001916:Brachial Artery / Q000503:physiopathology; D002306:Cardiac Volume; D003430:Cross-Sectional Studies; D004452:Echocardiography; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D019808:Losartan / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011674:Pulse; D016276:Ventricular Function
D000959:Antihypertensive Agents; D001262:Atenolol; D019808:Losartan