Arterial Stiffness, Central Blood Pressure, and the Risk of Incident Stroke in Hypertensive Adults.

BACKGROUND AND AIMS

Whether hypertensive patients with elevated arterial stiffness and central systolic blood pressure (cSBP) are exposed to higher stroke risk is unclear.

METHODS

A total of 6663 participants without a history of cardiovascular disease were enrolled in this study. cSBP was measured noninvasively using the A-Pulse CASPro device; carotid-femoral pulse wave velocity (cfPWV) was collected using a Pulse Pen device. The primary outcome was incident stroke.

RESULTS

Over 4.4 years (median), 454 incident strokes occurred (15.92 per 1000 person-years). Compared to the reference group (cSBP < 137 mmHg and cfPWV < 10 m/s), patients with elevated cSBP and cfPWV had a significantly increased risk of incident stroke (HR 1.78 [95% CI 1.39, 2.27]), and were the only group showing statistical significance versus those with solely increased cSBP (HR 1.13 [95% CI 0.87, 1.48]) or cfPWV (HR 1.15 [95% CI 0.87, 1.52]) after adjusting for covariates; p for trend < 0.001. Consistent findings were identified in multiple sensitivity and exploratory analyses. The additive interaction between elevated cSBP and cfPWV was significant, with a relative excess risk due to interaction of 0.55 [95% CI 0.05-1.03]. The association between elevated cSBP and cfPWV with incident stroke risk was more robust among patients who were taking non-guideline recommended antihypertensive medication at baseline (HR 3.03) than among those who took recommended regimens (HR 1.58).

CONCLUSIONS

Hypertensive patients with elevated cSBP and cfPWV have a significantly higher risk of incident stroke than those with lower or solely increased cSBP and cfPWV. Greater clinical attention and tailored treatment strategies are needed.