Abstract-Aortic stiffness may predict progression to hypertension beyond classic risk factors. In a longitudinal study, we assessed the predictive value of aortic stiffness on future hypertension in nonhypertensive subjects with blood pressure (BP) Ͻ140/90. Aortic stiffness was determined by echocardiography at baseline in 2512 subjects. The follow-up time was 4 years. A stepwise increase in hypertension incidence occurred across the male and older participants: 3.8% of young female individuals, 11.5% of young male, 26.1% of old female, and 58.8% of old male subjects progressed to hypertension over 4 years. In multivariate analysis, aortic stain, distensibility, and stiffness index (␤) remained significantly associated with the progression to future hypertension after adjustment to classic risk factors in men and women and in young and old populations. This study provides the first direct evidence to our knowledge in a longitudinal study that aortic stiffness is an independent predictor of progression to hypertension in nonhypertensive individuals. Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in patients with essential hypertension. 4 -6 Furthermore, aortic stiffness constant is the best single predictor of acute coronary syndromes. 6,7 Aortic stiffness may predict sustained hypertension; in patients with hypertension and hypothyroidism and in patients with repaired coarctation of aorta, sustained hypertension is caused by the increased aortic stiffness. 8,9 The aim of the present study was to increase the reliability of prediction of future BP by using aortic stiffness in nonhypertensive subjects who were followed-up in our outpatient department. Methods Study PopulationA total of 2571 subjects (1460 women and 1111 men), aged 35 to 94 years, entered the study. This population included subjects examined in our outpatient department, and they were free of the following exclusion criteria: hypertension (systolic BP Ն140 mm Hg or a diastolic BP Ն90 mm Hg, or the use of antihypertensive medication); overt cardiovascular disease or symptoms; and history of a myocardial infarction or of congestive heart failure. None of these patients was referred for typical symptoms of coronary heart disease or other cardiovascular disease. All participants gave informed consent.Four years later, all participants were re-examined and aortic stiffness was measured again. The coexistence of metabolic or endocrine conditions affecting aortic stiffness was studied by the routine clinical examination and determination of hormones by specific laboratory tests. Some participants (239; 9.5%) started on BP-altering medication during the follow-up period. Before measurements, any medication was discontinued for at least 5 half-lives before the study. A total of 2512 subjects (1440 women and 1072 men), aged 35 to 94 years, were successfully re-examined after 4-year interval. Fifty-nine (2.3%) subjects were lost from observation. Twenty-one deaths have occurred, 11 of them caused by cardiovascular even...

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In this population of patients evaluated before non-cardiac surgery, BNP is an independent predictor of postoperative cardiac events. BNP > 189 pg/ml identified patients at highest risk.

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