title: Relative Contributions of Arterial Stiffness and Hypertension to Cardiovascular Disease: The Framingham Heart Study.
abstract: The presence and implications of abnormal arterial stiffness, a potential independent predictor of outcomes, in community-dwelling treated hypertensives is unknown. Furthermore, limited data exist regarding the risk of cardiovascular disease (CVD) associated with arterial stiffness across the entire range of blood pressure.
  
  
  
  We measured carotid-femoral pulse wave velocity (PWV) and classical CVD risk factors in 2127 community-dwelling participants (mean age 60 years, 57% women) of The Framingham Offspring Cohort. The participants were divided into 4 groups according to hypertension (yes/no, defined as blood pressure ≥140/90 mm Hg or use of antihypertensive treatment) and PWV status (high/low based on age- and sex-specific median values) and followed up for CVD events (CVD death, myocardial infarction, unstable angina, heart failure, and stroke). Sixty percent (233 of 390) of controlled and 90% (232 of 258) of uncontrolled treated hypertensives had high PWV. The multivariable-adjusted risk for CVD events (n=248, median follow-up 12.6 years) rose from normotension with low PWV (reference) to normotension with high PWV (hazard ratio 1.29, 95% CI 0.83-2.00) and from hypertension with low PWV (hazard ratio 1.54, 95% CI 1.01-2.36) to hypertension with high PWV (hazard ratio 2.25, 95% CI 1.54-3.29).
  
  
  
  A substantial proportion of treated hypertensives have high arterial stiffness, a finding that may explain some of the notable residual CVD risk associated with even well-controlled hypertension. High PWV is associated with a trend towards increasing CVD risk in both nonhypertensives and hypertensives, a finding that may support the use of arterial stiffness measurements in both populations.
authors.affiliation: National Heart, Blood and Lung Institute's and Boston University's Framingham Heart Study, Framingham, MA teemu.niiranen@thl.fi.
authors.forename: Teemu J
authors.initials: TJ
authors.lastname: Niiranen
authors.affiliation: Center for Clinical Translational Epidemiology and Comparative Effectiveness Research, Boston University School of Medicine, Boston, MA.|Section of Preventive Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA.
authors.forename: Bindu
authors.initials: B
authors.lastname: Kalesan
authors.affiliation: Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA.|Section of Cardiology, Department of Medicine, Boston University School of Medicine, Boston, MA.|Section of Vascular Biology, Department of Medicine, Boston University School of Medicine, Boston, MA.
authors.forename: Naomi M
authors.initials: NM
authors.lastname: Hamburg
authors.affiliation: National Heart, Blood and Lung Institute's and Boston University's Framingham Heart Study, Framingham, MA.|Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA.|Section of Preventive Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA.|Section of Cardiology, Department of Medicine, Boston University School of Medicine, Boston, MA.|Department of Epidemiology, Boston University School of Public Health, Boston, MA.
authors.forename: Emelia J
authors.initials: EJ
authors.lastname: Benjamin
authors.affiliation: Cardiovascular Engineering, Inc., Norwood, MA.
authors.forename: Gary F
authors.initials: GF
authors.lastname: Mitchell
authors.affiliation: National Heart, Blood and Lung Institute's and Boston University's Framingham Heart Study, Framingham, MA.|Center for Clinical Translational Epidemiology and Comparative Effectiveness Research, Boston University School of Medicine, Boston, MA.|Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA.|Section of Preventive Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA.|Section of Cardiology, Department of Medicine, Boston University School of Medicine, Boston, MA.|Department of Epidemiology, Boston University School of Public Health, Boston, MA.
authors.forename: Ramachandran S
authors.initials: RS
authors.lastname: Vasan
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D063177:Pulse Wave Analysis; D012307:Risk Factors; D059289:Vascular Stiffness / Q000502:physiology*
chemical_list: D000959:Antihypertensive Agents
keywords: antihypertensive agent; arterial stiffness; cardiovascular disease; epidemiology; hypertension