Progression of Carotid Arterial Stiffness With Treatment of Hypertension Over 10 Years

Abstract

Associations with antihypertensive medication classes and progression of arterial stiffness have not been studied in a prospective multi-ethnic cohort. All participants had hypertension at baseline, defined as blood pressure ≥140/90 mmHg or use of antihypertensive medications. Medication use and blood pressure were assessed at 5 time points. Young’s elastic modulus and distensibility coefficient of the right common carotid artery were obtained by ultrasound at baseline and after a mean (standard deviation) follow up period of 9.4 (0.5) years. Associations with changes in Young’s elastic modulus and distensibility coefficient, baseline antihypertensive medication use, number of visits each medication class were reported, and blood pressure control (<140/90 mmHg) were assessed using multiple linear regression models. At baseline, participants (n=1206) were mean age 63.2 (9.0) years (55% female; 35% African-American, 19% Hispanic, 12% Chinese). Mean systolic blood pressure was 136.5 (20.6) mmHg. Greater progression of arterial stiffness was associated with older age, African-American ethnicity, and baseline calcium channel blocker use. There were no other associations between changes in Young’s elastic modulus or distensibility coefficient and use of other medication classes (all p>0.4). Achieving blood pressure control (<140/90 mmHg) at all visits was associated with slower progression of arterial stiffness (Young’s elastic modulus β=−790.1 mmHg, p=0.01, distensibility coefficient: β=7.34×10−4 mmHg−1, p=0.001). Blood pressure control, rather than use of any particular antihypertensive medication class, was associated most strongly with slowing arterial stiffness progression. Over nearly a decade of follow-up, no consistent associations between any specific antihypertensive medication class and progressive carotid arterial stiffening were identified.

Atrial Fibrillation and Hypertension

“…32 LV hypertrophy contributes to diastolic dysfunction, another independent risk factor for incident AF. Diastolic dysfunction leads to heart failure with preserved ejection fraction commonly observed in AF.…”

Protocol of Aerobic Exercise and Cognitive Health (REACH): A Pilot Study

“…The peak systolic velocity, end-diastolic velocity, resistive index, pulsatility index and systolic to diastolic ratio were recorded from the pulsed wave Doppler waveform for each arterial segment. The distal one centimeter of the right common carotid artery was imaged to perform carotid distensibil-ity and intima-media thickness (IMT) measurements [55][56][57]. Carotid IMT was measured on the far wall of the right common carotid artery from an anterior, lateral and posterior angle using the Meijer Arc [58,59].…”

Vascular age concept: role in assessing risk and choosing therapy

“…Следует отметить, что эффективное снижение АД, а не выбор определенного антигипертензивного препарата, по-видимому, играет ключевую роль и в профилактике прогрессирования жесткости сонных артерий. Так, в ходе выполнения известного проспективного обсервационного исследования MESA (Multi-Ethnic Study of Atherosclerosis) [41] были получены данные о связи между устойчивым снижением АД менее 140/90 мм рт. ст.…”