Association between long-termblood pressure control and ten-year progression in carotid arterial stiffness among hypertensive individuals: themultiethnic study of atherosclerosis

作者：Tedla Yacob G^*; Gepner Adam D; Vaidya Dhananjay; Colangelo Laura; Stein James H; Liu Kiang; Greenland Philip

来源：Journal of Hypertension, 2017, 35(4): 862-869.

DOI：10.1097/HJH.0000000000001199

• arterial stiffness
• blood pressure
• diabetes mellitus
• elderly
• hypertension

Background: Arterial stiffness was shown to be higher among hypertensive patients with diabetes than those without diabetes and among older than younger hypertensive patients. We examined whether the association between long-term blood pressure (BP) control and 10-year progression in carotid arterial stiffness varies by diabetes status and age.
Methods: Participants were 906 individuals with hypertension at baseline and three follow-up visits in the Multi-Ethnic Study of Atherosclerosis (mean age 63.7 years, 44% males). Participants with SBP of less than 140 mmHg and DBP of less than 90 mmHg were considered to have a controlled BP. Arterial stiffness was measured using distensibility coefficient x 10(-4) / mmHg and Young's elastic modulus (YEM x 10(2) mmHg) at baseline and after a mean of 9.5 years (visit 5). Multiple linear regression model was used for the analysis.
Results: Having controlled BP at three visits (distensibility coefficient: beta = 3.6, P = 0.004; YEM: beta = -6.8, P = 0.07) or four visits (distensibility coefficient: beta = 2.4, P = 0.04; YEM: beta = -6.8, P = 0.05), when compared with having uncontrolled BP at all four visit, was associated with lesser progression in arterial stiffness. In a stratified analysis, arterial stiffness progression was slower only among nondiabetics with controlled BP at three visits (distensibility coefficient: beta = 4.3, P = 0.002; YEM: beta = -8.8, P = 0.04) or four visits (beta = 3.7, P = 0.01; YEM: beta = -10.4, P = 0.01) and among those less than 70 years with controlled BP at three visits (distensibility coefficient: beta = 4.9, P = 0.004; YEM: beta = -10.6, P = 0.01) or four visits (distensibility coefficient: beta = 2.9, P = 0.07; YEM: beta = -7.6, P = 0.03).
Conclusion: These findings suggest that controlling BP alone may not be sufficient to slow progression of arterial stiffness among hypertensive patients with concurrent diabetes and elderly hypertensive patients.

• 出版日期2017-4
• 单位西北大学