Abstract
The usefulness of brachial–ankle pulse wave velocity (baPWV), an index of arterial stiffness, is not fully known for the management of treated hypertensive patients with a history of coronary artery disease (CAD) who have blood pressure less than 130/80 mmHg, a recommended blood pressure target in the updated major hypertension guidelines. We analyzed data for 447 treated hypertensive patients with CAD enrolled in FMD-J Study A for assessment of the predictive value of baPWV for future cardiovascular events. The primary outcome was a composite of coronary events, stroke, heart failure, and sudden death. During a median follow-up period of 47.6 months, the primary outcome occurred in 64 patients. Blood pressure less than 130/80 mmHg was significantly associated with a lower risk of the composite outcome independent of other cardiovascular risk factors in treated hypertensive patients with CAD (hazard ratio, 0.59; 95% confidence interval (CI), 0.35–0.99; P = 0.04). In treated hypertensive patients with CAD who had blood pressure less than 130/80 mmHg, baPWV above the cutoff value of 1731 cm/s, derived from receiver–operator characteristic curve analysis for the composite outcome was significantly associated with a higher risk of the composite outcome independent of conventional risk factors (hazard ratio, 2.83; 95% CI, 1.02–7.91; P = 0.04). baPWV was an independent predictor of cardiovascular events in treated hypertensive patients with CAD who had blood pressure less than 130/80 mmHg, for whom measurement of baPWV is recommended for cardiovascular risk assessment.
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References
Xie X, Atkins E, Lv J, Bennett A, Neal B, Ninomiya T, et al. Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: updated systematic review and meta-analysis. Lancet. 2016;387:435–43.
Ettehad D, Emdin CA, Kiran A, Anderson SG, Callender T, Emberson J, et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet. 2016;387:957–67.
Thomopoulos C, Parati G, Zanchetti A. Effects of blood pressure lowering on outcome incidence in hypertension: 7. Effects of more vs. less intensive blood pressure lowering and different achieved blood pressure levels—updated overview and meta-analyses of randomized trials. J Hypertens. 2016;34:613–22.
Bundy JD, Li C, Stuchlik P, Bu X, Kelly TN, Mills KT, et al. Systolic blood pressure reduction and risk of cardiovascular disease and mortality: a systematic review and network meta-analysis. JAMA Cardiol. 2017;2:775–81.
Bangalore S, Kumar S, Volodarskiy A, Messerli FH. Blood pressure targets in patients with coronary artery disease: observations from traditional and Bayesian random effects meta-analysis of randomised trials. Heart. 2013;99:601–13.
Okamoto R, Kumagai E, Kai H, Shibata R, Ohtsubo T, Kawano H, et al. Effects of lowering diastolic blood pressure to <80 mmHg on cardiovascular mortality and events in patients with coronary artery disease: a systematic review and meta-analysis. Hypertens Res. 2019;42:650–9.
Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. Hypertension. 2018;71:e13–115.
Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension: the task force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. J Hypertens. 2018;36:1953–2041.
Umemura S, Arima H, Arima S, Asayama K, Dohi Y, Hirooka Y, et al. The Japanese Society of Hypertension guidelines for the management of hypertension (JSH 2019). Hypertens Res. 2019;42:1235–481.
Tomiyama H, Matsumoto C, Shiina K, Yamashina A. Brachial-ankle PWV: current status and future directions as a useful marker in the management of cardiovascular disease and/or cardiovascular risk factors. J Atheroscler Thromb. 2016;23:128–46.
Song Y, Xu B, Xu R, Tung R, Frank E, Tromble W, et al. Independent and joint effect of brachial-ankle pulse wave velocity and blood pressure control on incident stroke in hypertensive adults. Hypertension. 2016;68:46–53.
Ohkuma T, Tomiyama H, Ninomiya T, Kario K, Hoshide S, Kita Y, et al. Proposed cutoff value of brachial-ankle pulse wave velocity for the management of hypertension. Circ J. 2017;81:1540–2.
Ohkuma T, Ninomiya T, Tomiyama H, Kario K, Hoshide S, Kita Y, et al. Brachial-ankle pulse wave velocity and the risk prediction of cardiovascular disease: an individual participant data meta-analysis. Hypertension. 2017;69:1045–52.
Tomiyama H, Kohro T, Higashi Y, Takase B, Suzuki T, Ishizu T, et al. A multicenter study design to assess the clinical usefulness of semi-automatic measurement of flow-mediated vasodilatation of the brachial artery. Int Heart J. 2012;53:170–5.
Maruhashi T, Soga J, Fujimura N, Idei N, Mikami S, Iwamoto Y, et al. Endothelial dysfunction, increased arterial stiffness, and cardiovascular risk prediction in patients with coronary artery disease: FMD-J (Flow-mediated Dilation Japan) Study A. J Am Heart Assoc. 2018;7:e008588.
Ogihara S, editor. The Japanese Society of Hypertension guidelines for the management of hypertension (JSH 2009). Tokyo: Lifescience; 2009, p. 8–23.
American Diabetes Association: clinical practice recommendations 1999. Diabetes Care. 1999;22 (Suppl 1):S1–114.
Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel pIII). JAMA. 2001;285:2486–97.
Sugawara J, Hayashi K, Yokoi T, Cortez-Cooper MY, DeVan AE, Anton MA, et al. Brachial-ankle pulse wave velocity: an index of central arterial stiffness? J Hum Hypertens. 2005;19:401–6.
Tanaka H, Munakata M, Kawano Y, Ohishi M, Shoji T, Sugawara J, et al. Comparison between carotid-femoral and brachial-ankle pulse wave velocity as measures of arterial stiffness. J Hypertens. 2009;27:2022–7.
Munakata M, Konno S, Miura Y, Yoshinaga K, Group JTS. Prognostic significance of the brachial-ankle pulse wave velocity in patients with essential hypertension: final results of the J-TOPP study. Hypertens Res. 2012;35:839–42.
Nakamura M, Yamashita T, Yajima J, Oikawa Y, Sagara K, Koike A, et al. Brachial-ankle pulse wave velocity as a risk stratification index for the short-term prognosis of type 2 diabetic patients with coronary artery disease. Hypertens Res. 2010;33:1018–24.
Sugamata W, Nakamura T, Uematsu M, Kitta Y, Fujioka D, Saito Y, et al. Combined assessment of flow-mediated dilation of the brachial artery and brachial-ankle pulse wave velocity improves the prediction of future coronary events in patients with chronic coronary artery disease. J Cardiol. 2014;64:179–84.
Yamashina A, Tomiyama H, Arai T, Koji Y, Yambe M, Motobe H, et al. Nomogram of the relation of brachial-ankle pulse wave velocity with blood pressure. Hypertens Res. 2003;26:801–6.
Lantelme P, Mestre C, Lievre M, Gressard A, Milon H. Heart rate: an important confounder of pulse wave velocity assessment. Hypertension. 2002;39:1083–7.
Acknowledgements
We thank Megumi Wakisaka, Miki Kumiji, Ki-ichiro Kawano, and Satoko Michiyama for their excellent secretarial assistance.
Funding
Grant-in-aid for Scientific Research from the Ministry of Education, Science, and Culture of Japan (18590815 and 21590898 to YH) and a grant-in-aid of Japanese Arteriosclerosis Prevention Fund (to YH).
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Maruhashi, T., Soga, J., Fujimura, N. et al. Increased arterial stiffness and cardiovascular risk prediction in controlled hypertensive patients with coronary artery disease: post hoc analysis of FMD-J (Flow-mediated Dilation Japan) Study A. Hypertens Res 43, 781–790 (2020). https://doi.org/10.1038/s41440-020-0420-6
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DOI: https://doi.org/10.1038/s41440-020-0420-6
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