Mancusi Costantino, Losi Maria Angela, Izzo Raffaele, Gerdts Eva, Canciello Grazia, Arnone Maria Immacolata, Trimarco Bruno, de Simone Giovanni, De Luca Nicola
a Hypertension Research Center, Federico II University , Naples , Italy.
b Department of Advanced biomedical Science , Federico II University Hospital , Naples , Italy.
Blood Press. 2019 Aug;28(4):268-275. doi: 10.1080/08037051.2019.1612705. Epub 2019 May 9.
Increased arterial stiffness is associated with advanced arteriosclerosis, abnormal left ventricular (LV) geometry and function. Whether increased arterial stiffness is associated with incident cardiovascular (CV) event (MACE), independent of other markers of target organ damage needs to be clarified. We selected hypertensive participants of the Campania Salute Network free of prevalent CV disease, with available echocardiogram and carotid ultrasound, ejection fraction ≥50%, and ≤ stage III Chronic Kidney Disease ( = 6907). Median follow-up was 63 months. End-point was incident MACE (fatal and non-fatal stroke and myocardial infarction, sudden cardiac death, carotid stenting and heart failure requiring hospitalization). Arterial stiffness was assessed from ratio of brachial pulse pressure/stroke index (i.e. normalized for body height in meter to 2.04 power) (PP/SVi). High PP/SVi ( = 980) was defined as >95th sex-specific percentile of the normal distribution from a reference normal population (>2.63/>2.82 mmHg/ml in men and women, respectively). Patients with high PP/SVi were more likely to be women, older, diabetic, with higher systolic blood pressure (BP) and heart rate, more LV concentric geometry, left atrial dilatation and more carotid plaque (all < .01). At given increase in SVi, patients with high PP/SVi exhibited two-fold increase in PP compared to normal PP/SVi. In Cox regression, patients with high PP/SVi had 63% increased hazard of MACE [95% CI (1.02-2.59) = .04], independently of significant effect of older age, male sex, carotid plaque and less frequent anti-RAS therapy. In treated hypertensive patients, high PP/SVi predicted increased rate of MACE, independent of common confounders.
动脉僵硬度增加与晚期动脉硬化、左心室（LV）几何形状和功能异常有关。动脉僵硬度增加是否与心血管（CV）事件（主要不良心血管事件）相关，独立于其他靶器官损害标志物，这一点尚需明确。我们从坎帕尼亚健康网络中选取了无CV疾病史的高血压参与者，这些参与者有可用的超声心动图和颈动脉超声检查结果，射血分数≥50%，且慢性肾脏病≤III期（n = 6907）。中位随访时间为63个月。终点是发生主要不良心血管事件（致命和非致命性中风、心肌梗死、心源性猝死、颈动脉支架置入术以及需要住院治疗的心力衰竭）。通过肱动脉脉压/每搏量指数（即根据身高米数归一化至2.04次方）（PP/SVi）比值评估动脉僵硬度。高PP/SVi（n = 980）定义为高于参考正常人群正常分布的第95性别特异性百分位数（男性和女性分别>2.63/>2.82 mmHg/ml）。高PP/SVi患者更可能为女性、年龄较大、患有糖尿病、收缩压（BP）和心率较高、左心室更呈向心性几何形状、左心房扩张且颈动脉斑块更多（均P < 0.01）。在每搏量指数给定增加的情况下，高PP/SVi患者的脉压相比正常PP/SVi患者增加了两倍。在Cox回归分析中，高PP/SVi患者发生主要不良心血管事件的风险增加63% [95%置信区间（1.02 - 2.59），P = 0.04]，独立于年龄较大、男性、颈动脉斑块以及抗肾素 - 血管紧张素系统（RAS）治疗频率较低的显著影响。在接受治疗的高血压患者中，高PP/SVi可预测主要不良心血管事件发生率增加，独立于常见混杂因素。
