Aortic Stiffness, Blood Pressure Progression, and Incident Hypertension

Study Questions:

What is the temporal relationship between hypertension and arterial stiffening?


This longitudinal cohort study examined 1,759 individuals from the Framingham Offspring study, and compared the temporal relationship between blood pressure and arterial stiffness and pulsatility between two study cycles 7 years apart (cycles 7 and 8). Studied measures of arterial stiffness and pressure pulsatility included carotid-femoral pulse-wave velocity (CFPWV), forward wave amplitude (FWA), and augmentation index. Primary outcomes of the study were blood pressure and incident hypertension on cycle 8; secondary outcomes were CFPWV, FWA, and augmentation index during cycle 8.


Mean age was 60 years, 55% were female, and 40% had baseline hypertension. Higher CFPWV (β 1.5, p = 0.006) and FWA (β 1.3, p = 0.002) during cycle 7 were independently associated with a higher systolic blood pressure during cycle 8; while lower CFPWV (β -1.1, p < 0.001) during cycle 7 was independently associated with a higher diastolic blood pressure during cycle 8. Amongst 1,048 individuals without hypertension during cycle 7, variables independently associated with incident hypertension during cycle 8 included CFPWV (odds ratio [OR], 1.3; p = 0.04), FWA (OR, 1.6; p < 0.001), and augmentation index (OR, 1.7; p < 0.001). Measures of blood pressure during cycle 7 were not independently associated with CFPWV during cycle 8.


Higher arterial stiffness and pulsatility at baseline were independently associated with increased systolic blood pressure and incident hypertension on follow-up. However, baseline blood pressure was not independently associated with follow-up arterial stiffness.


Hypertension may induce vascular damage and increase arterial stiffening, while arterial stiffening impacts pulsatility, which may affect systolic blood pressure. Whether hypertension or arterial stiffening comes first has been unclear, and this study was designed to examine this temporal relationship. This important study finds that baseline markers of increased arterial stiffness and pulsatility were predictive of higher blood pressure and incident hypertension on follow-up, while blood pressure at baseline was not predictive of arterial stiffness on follow-up. These findings suggest that higher arterial stiffness contributes to the development of hypertension, rather than resulting from hypertension. These markers may therefore be helpful to identify patients at risk of development or progression of hypertension, and may serve as potential therapeutic targets.

Clinical Topics: Prevention, Hypertension

Keywords: Odds Ratio, Follow-Up Studies, Pulse Wave Analysis, Cardiovascular Diseases, Blood Pressure Determination, Hypertension, Vascular Stiffness, Disease Progression

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