Components of Hemodynamic Load and Cardiovascular Events: The Framingham Heart Study | Journal Scan

Dec 31, 2014
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Authors:
Cooper LL, Rong J, Benjamin EJ, et al.
Citation:
Circulation 2014;Nov 21:[Epub ahead of print].
Summary By:
Reema Hasan, MD, FACC

Study Questions:

What is the relationship between the incidence of cardiovascular death (CVD) and the comprehensive panel of individual mean and pulsatile components of blood pressure derived from an analysis of measured central aortic pressure and flow?

Methods:

Proportional hazard models were used to examine the association of incident CVD with forward pressure wave amplitude, mean arterial pressure, and global reflection coefficient derived from wave separation analysis and echocardiography in 2,492 participants (mean age 66 ± 9 years, 56% women) in the Framingham Heart Study.

Results:

The sample size consisted of 2,492 participants, 56% of whom were women. In multivariable models adjusting for age, sex, antihypertensive therapy, body mass index, heart rate, total and high-density lipoprotein cholesterol concentrations, smoking, and presence of diabetes, forward pressure wave amplitude (hazard ratio [HR], 1.40; 95% confidence interval [CI], 1.16, 1.67; p = 0.0003) was associated with incident CVD, whereas mean arterial pressure (HR, 1.10; 95% CI, 0.94-1.29; p = 0.25) and global wave reflection (HR, 0.93; 95% CI, 0.78-1.12; p = 0.58) were not. After adding systolic blood pressure and carotid-femoral pulse wave velocity to the model, forward pressure wave amplitude persisted as a correlate of events (HR, 1.33; 95% CI, 1.05-1.68; p = 0.02).

Conclusions:

These results indicate that the forward pressure wave (a measure of proximal aortic geometry and stiffness) component of blood pressure and pulsatile load, rather than mean arterial pressure, is the individual component of blood pressure that is most closely associated with first-onset major CVD events in this cohort.

Perspective:

This study supports the need to better define the effects of existing therapeutic agents on aortic function and forward pressure wave amplitude and its overall clinical value at reducing CVD.

Keywords: Antihypertensive Agents, Blood Pressure, Blood Pressure Determination, Body Mass Index, Cholesterol, HDL, Diabetes Mellitus, Echocardiography, Heart Rate, Hemodynamics, Pulse Wave Analysis, Smoking


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