Association of Estimated Pulse Wave Velocity With Survival: A Secondary Analysis of SPRINT.

Importance: Aortic stiffness, as assessed by carotid-femoral pulse wave velocity, is an independent predictor of future events in individuals with hypertension. Recent data suggest a predictive role of estimated pulse wave velocity (ePWV) calculated by previously published equations using age and blood pressure in future events in individuals with hypertension. Objective: To investigate whether ePWV and its response to treatment predict survival in the Systolic Blood Pressure Intervention Trial (SPRINT). Design, Setting, and Participants: This exploratory, hypothesis-generating, post hoc secondary analysis conducted from October 1, 2018, to August 31, 2019, examined data from 9361 participants in SPRINT and calculated ePWV at baseline and at 12 months. Adjusted hazard ratios (HRs) with 95% CIs of ePWV per 1 SD were estimated using Cox proportional hazards regression models. A total of 8450 patients were assigned to 4 groups according to their treatment allocation and their response in ePWV after 12 months. Interventions: Participants were assigned a systolic blood pressure target of less than 120 mm Hg (intensive treatment) or less than 140 mm Hg (standard treatment). Main Outcomes and Measures: The primary composite cardiovascular outcome was myocardial infarction, other acute coronary syndromes, stroke, heart failure, or death from cardiovascular causes. Results: In the SPRINT population (3332 women and 6029 men; mean [SD] age, 67.9 [9.4] years), ePWV predicted the primary outcome (HR, 1.30 [95% CI, 1.17-1.43]; P < .001) and all-cause death (HR, 1.65 [95% CI, 1.46-1.86]; P < .001) independent of the Framingham Risk Score. Estimated pulse wave velocity improved the C statistic model for the primary outcome from 0.676 (95% CI, 0.65-0.70) to 0.683 (95% CI, 0.66-0.71; P = .049) and improved the C statistic model for all-cause death from 0.67 (95% CI, 0.64-0.69) to 0.69 (95% CI, 0.66-0.72; P = .03). Net reclassification index indicated improvement in risk discrimination for survival compared with the Framingham Risk Score (categorical net reclassification index = 0.111; P < .001). Regarding response to treatment, intensive treatment was superior to standard treatment only when it was accompanied with a response in ePWV at the first year, while, within the standard treatment group, individuals whose ePWV responded to antihypertensive treatment had improved all-cause mortality, with a 42% lower risk of death compared with nonresponders (HR, 0.58 [95% CI, 0.36-0.94]; P = .03); effects were independent of changes in systolic blood pressure. Conclusions and Relevance: These results suggest that, in the SPRINT trial, ePWV predicted outcomes independent of the Framingham Risk Score, indicating an incremental role of markers of aortic stiffness on cardiovascular risk. Better survival of individuals whose ePWV responded to antihypertensive treatment independently of systolic blood pressure reduction suggests a role of markers of aortic stiffness as effective treatment targets in individuals with hypertension.

Trajectories of arterial stiffness and all-cause mortality among community-dwelling older Japanese.

AIM: Aortic pulse wave velocity (PWV) is a strong predictor of all-cause mortality in later life. The present prospective study used repeated measures analysis to examine sex-specific age trends in brachial-ankle PWV (baPWV), identify baPWV trajectories and determine whether potential baPWV trajectories were associated with all-cause mortality among community-dwelling older Japanese. METHODS: A total of 1744 adults (mean age 71.0 years [SD 5.8 years]; 57.0% women) aged 65-90 years participated in annual geriatric health assessments during the period from April 2003 through July 2015. The average number of follow-up assessments was 4.3, and the total number of observations was 7419. We checked local registries to identify deaths from any cause; 289 (16.6%) participants died during the period through December 2015. RESULTS: baPWV similarly and significantly increased with advancing age in men and women. We identified four distinct trajectory patterns (very high, high, moderate, and low) in adults aged 65-90 years, and these trajectories showed parallel increases. After adjusting for important confounders, participants in the moderate, high and very high baPWV trajectory groups had hazard ratios of 1.12 (95% CI 0.84-1.44), 1.04 (95% CI 0.74-1.45) and 1.98 (95% CI 1.20-3.29), respectively, for all-cause mortality, as compared with those in the low trajectory group. CONCLUSIONS: baPWV increased with age in men and women, and there was no significance between sexes in later life. This prospective study identified four major baPWV trajectory patterns in community-dwelling older adults. Individuals in the very high baPWV trajectory group, especially younger seniors, had a higher mortality risk. Geriatr Gerontol Int 2018; 18: 1108-1113.

Change in radial artery pulse wave in stroke hemiplegic patients: Protocol for a case-control study.

INTRODUCTION: About 55% to 75% of stroke survivors have motor disorders and problems that affect their quality of life. The prevention of secondary neurological damages through relapse prevention and the rehabilitation of stroke patients suffering from morbidities are crucial to improve the prognosis of patients with stroke. Pulse examinations can be used to determine the stroke progression. This study will investigate the differences and changes in radial artery pressure-pulse waves during the treatment of hemiplegia caused by stroke. METHODS/DESIGN: This study protocol is for a prospective matched case-control study. A total of 84 participants will be recruited, 56 patients with hemiplia caused by stroke, and 28 control patients matched by age, gender, and body mass index. The primary outcome of this study will be the differences and changes in the radial augmentation index. DISCUSSION: The results of the study will help to determine the differences and changes in radial artery pressure-pulse waves during the treatment of hemiplegia caused by stroke. The findings will provide information about the physiological and hemodynamic mechanisms. CONCLUSION: This will be the first study to analyze the pulse wave of the radial artery (PWRA) on the affected side and on the normal side in stroke patients with hemiplegia. This study will clarify whether the radial artery pressure pulse wave can be used to evaluate the result of stroke treatment objectively. The results of the study will be available in February 2019. The version of the protocol is v1.6 written in March 7, 2016. ETHICS AND DISSEMINATION: Written informed consent will be obtained from all participants. This study has been approved by the Institutional Review Board (IRB) of Wonkwang University Gwangju Hospital, Gwangju, Republic of Korea (WKIRB-2016/8). The study findings will be published in peer-reviewed journals and presented at national and international conferences. TRIAL REGISTRATION NUMBER: This trial was registered with the Clinical Research Information Service (CRIS) of the Korea National Institute of Health (NIH), Republic of Korea (KCT0002147).

Pulse Wave Velocity: A Valuable Predictor for Cardio-Cerebrovascular Disease and Death in PD Patients.

AIMS: To evaluate the value of pulse wave velocity (PWV) to predict cardio-cerebrovascular (CVD) and death in peritoneal dialysis (PD) patients. METHODS: In all, 59 maintenance PD patients from January 2012 to December 2012 were enrolled. Patients were classified as group A (>9 m/s) and group B (≤9 m/s), based on the results of carotid-femoral PWV (CF-PWV). RESULTS: CF-PWV was positively correlated with age (r = 0.71, p < 0.01), left atrial diameter (r = 0.58, p < 0.01), left ventricular mass index (r = 0.59, p < 0.01) and 24H average systolic blood pressure (SBP) (r = 0.57, p < 0.01). Age (relative risk (RR) 1.086, 95% confidence interval (CI) 1.024-1.153, p < 0.01) and 24H average SBP (RR 1.047, 95% CI 1.013-1.082, p < 0.01) were risk factors of higher CF-PWV. The cumulative and new CVD free survival rates of group A significantly decreased. Elder (RR 1.114, 95% CI 1.013-1.224, p = 0.026) and higher PWV (RR 1.482, 95% CI 1.01-2.176, p = 0.044) were risk factors of CVD in PD patients. CONCLUSION: PWV is a valuable predictor of CVD and death in PD patients.