ARTERIAL STIFFNESS ESTIMATED BY BRACHIAL OSCILLOMETRY PREDICTS PROGRESSION TO HYPERTENSION IN PATIENTS WITH NORMAL AMBULATORY BLOOD PRESSURE

Abstract

Objective: There is growing evidence that arterial stiffness can precede hypertension (HTN). This study aimed to assess the predictive value of Pulse Wave Velocity, estimated by brachial oscillometry (ePWV), for incident HTN in patients with initially normal ambulatory BP measurement (ABPM) after one year of follow-up. Design and method: This retrospective, observational, longitudinal study included all consecutive patients referred to a HTN Unit with suspected naïve HTN, without prior pharmacological treatment. EVA was defined according to ePWV exceeding the 90th percentile of its age group (Mobil-O-Graph, IEM®). Incident HTN was defined as ABPM at follow-up > 130/80 mmHg or prescription of antihypertensive medication. Standard clinical tests and ABPM were performed at baseline and after 12 months. Results: 223 consecutive patients with ABPM <130/80 mmHg entered the study, with 155 women (69.5%), a mean age of 47.9 years (±13.5), mean office BP of 128/73 (±13/8), mean ABPM of 118/73 (±7/5) mmHg and mean estimated PWV of 7.74 m/s (±1.7). At baseline, 51.1% of patients showed EVA. At follow-up, after a mean time of 1,1 years, 114 participants presented elevated ABPM. After adjustment for age, gender and ambulatory BP, presence of EVA at baseline was associated with progression to HTN at follow-up (OR:2,5;IC:1,4-4,6;p = 0.003). Furthermore, the pattern of PWV-EVA and incident HTA according to age were superimposable (Image). Arterial stiffness defined as ePWV > 10 m/s was also significantly associated with incident HTN, but showed a completely different distribution in age compared with incident HTN. Of note, arterial stiffness at follow-up was mainly determined by EVA at baseline (OR:6.1;IC:3.2-11.6;p = 0.001), but not by BP traits. Conclusions: Arterial damage, characterized as early vascular aging according to estimated PWV by brachial oscillometry, doubles the probability of sustained HTN one year after initial assessment in naïve patients with normal ABPM at baseline, independently of ambulatory and or office blood pressure at baseline. On the other hand, the main determinant of arterial stiffness at follow-up was elevated ePWV at baseline, but not blood pressure traits.