title: Comparison of arterial functional evaluations as a predictor of cardiovascular events in hypertensive patients: the Non-Invasive Atherosclerotic Evaluation in Hypertension (NOAH) study.
abstract: Increased arterial stiffness and impaired vasodilator response have been associated with cardiovascular events in high-risk patients. However, whether arterial changes predict the occurrence of hypertensive complications is still unclear. Therefore, we designed a hospital-based cohort study to examine the prognostic impact of arterial functional changes on stroke and cardiovascular diseases in hypertensive patients. The study employed 676 patients with essential hypertension. At baseline, we evaluated second-derived photoplethysmography, carotid-femoral pulse wave velocity (PWV), and forearm reactive hyperemia. We classified subjects into quartile groups according to the baseline measurements of these evaluations and assessed the ability of each measure to predict stroke and cardiovascular diseases (CVD). During a mean follow-up period of 57 months, 52 strokes, 40 CVD, and 22 deaths were recorded. Kaplan-Meier analysis revealed that patients in the highest quartile of PWV showed a higher frequency of stroke and CVD (p<0.0001) and total mortality (p=0.0016), and those in the highest quartile of reactive hyperemia showed a lower frequency of stroke and CVD (p=0.0415). A Cox hazard model identified that classification in the highest quartile of PWV (relative risk=2.717) and reactive hyperemia (0.416) were predictive of stroke and CVD after adjustment for other risk factors. In subjects who did not experience stroke or CVD before the study period (n=558), only PWV was related with the occurrence of stroke and CVD based on the Cox hazard model. In conclusion, increased aortic stiffness evaluated by PWV is more prognostic of cardiovascular events in hypertensive patients than several non-invasive atherosclerotic evaluations.
authors: Department of Geriatric Medicine, Osaka University Graduate School of Medicine, Suita, Japan.
authors: Minako
authors: M
authors: Terai
authors: Mitsuru
authors: M
authors: Ohishi
authors: Norihisa
authors: N
authors: Ito
authors: Takashi
authors: T
authors: Takagi
authors: Yuji
authors: Y
authors: Tatara
authors: Masaharu
authors: M
authors: Kaibe
authors: Norio
authors: N
authors: Komai
authors: Hiromi
authors: H
authors: Rakugi
authors: Toshio
authors: T
authors: Ogihara
mesh_terms: D000328:Adult; D000368:Aged; D001158:Arteries / Q000503:physiopathology*; D050197:Atherosclerosis / Q000209:etiology*; D001783:Blood Flow Velocity; D002318:Cardiovascular Diseases / Q000209:etiology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications*; D008297:Male; D008875:Middle Aged; D017156:Photoplethysmography; D016016:Proportional Hazards Models; D011673:Pulsatile Flow; D020521:Stroke / Q000209:etiology