Structural and functional vascular alterations and incident hypertension in normotensive adults: the Multi-Ethnic Study of Atherosclerosis.
Vascular abnormalities may exist before clinical hypertension. Using Poisson regression, the authors studied the association of coronary artery calcium (CAC), common carotid intima-media thickness (CIMT), aortic distensibility, and large and small arterial elasticity with incident hypertension among 2,512 normotensive US adults free of cardiovascular disease. Incidence rate ratios for incident hypertension (blood pressure > or =140/90 mm Hg or new antihypertensive medication) were calculated. Increased CAC was associated with incident hypertension in demographics-adjusted models (incidence rate ratio (IRR) = 1.35, 95% confidence interval (CI): 1.04, 1.75; IRR = 1.35, 95% CI: 1.02, 1.78; and IRR = 1.59, 95% CI: 1.12, 2.25 for CAC scores of 30-99, 100-399, and > or =400, respectively) but was attenuated after further adjustment. Increased common CIMT was associated with incident hypertension (IRR = 1.77, 95% CI: 1.28, 2.46 for quintile 4; IRR = 1.80, 95% CI: 1.28, 2.53 for quintile 5). Participants with the lowest, compared with the highest, aortic distensibility had an increased risk of hypertension (IRR = 1.75, 95% CI: 1.10, 2.79), as did those with the lowest large arterial elasticity (IRR = 1.49, 95% CI: 1.11, 1.99). Lower small arterial elasticity was incrementally associated with incident hypertension starting at quintile 2 (IRR = 2.01, 95% CI: 1.39, 2.91; IRR = 2.47, 95% CI: 1.71, 3.57; IRR = 2.73, 95% CI: 1.88, 3.95; and IRR = 2.85, 95% CI: 1.95, 4.16). Structural and functional vascular abnormalities are independent predictors of incident hypertension. These findings are important for understanding the pathogenesis of hypertension.
Peralta
Carmen A
CA
General Internal Medicine Section 111A1, VA Medical Center, 4150 Clement Street, San Francisco, CA 94124, USA. carmenalicia.peralta@ucsf.edu
Adeney
Kathryn L
KL
Shlipak
Michael G
MG
Jacobs
David
D
Duprez
Daniel
D
Bluemke
David
D
Polak
Joseph
J
Psaty
Bruce
B
Kestenbaum
Bryan R
BR
D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000473:pathology*; D001794:Blood Pressure; D002339:Carotid Arteries / Q000473:pathology*; D015331:Cohort Studies; D016001:Confidence Intervals; D003331:Coronary Vessels / Q000473:pathology*; D005006:Ethnicity; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000473:pathology* / Q000503:physiopathology*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D016012:Poisson Distribution; D012306:Risk; D014481:United States / Q000453:epidemiology