Hypertension, Arterial Stiffness, and Clinical Outcomes: A Cohort Study of Chinese Community-Based Population

Abstract

Whether the combination of different blood pressure and arterial stiffness (AS) status is independently associated with clinical outcomes in community dwellers has not been fully investigated so far. We measured AS by brachial-ankle pulse wave velocity and other cardiovascular risk factors in a community-based population. A total of 5797 participants were enrolled. The end point was a composite of stroke, unfatal myocardial infraction, and all-cause death. Using Cox proportional hazard model to calculate hazard ratios with 95% CIs, we compared the end point between individuals with ideal vascular function (defined as normotension with normal AS), normotension with elevated AS, hypertension with normal AS, and hypertension with elevated AS. After a median follow-up of 6.34 years, the end point was confirmed in 346 participants. Compared with ideal vascular function group, the individuals of normotension with elevated AS and hypertension with elevated AS exerted a higher risk independently (normotension with elevated AS: hazard ratio, 1.74 [95% CI, 1.09–2.79]; hypertension with elevated AS: hazard ratio, 2.10 [95% CI, 1.30–3.39]; P for trend, <0.001), but the association between ideal vascular function and hypertension with normal AS did not reach statistical significance (hazard ratio, 1.13 [95% CI, 0.58–2.17]). In subgroup analysis, our data showed similar results in individuals with isolated systolic, isolated diastolic, high systolic and diastolic hypertension, and uncontrolled hypertension, while for the individuals with controlled hypertension, although crude model showed a similar result, after adjusting for risk factors, the risk of hypertension with elevated AS was not significantly increased. In conclusion, the individuals with hypertension and elevated AS had a much higher risk than the other groups. Combined control of hypertension and AS may help reduce the risk of clinical events.