Longitudinal Study on Independent and Joint Effect of Brachial‐Ankle Pulse Wave Velocity and Blood Pressure Control on Incident Stroke in Hypertensive Patients

Abstract

BackgroundPulse wave velocity (PWV) has been shown to affect the effects of anti‐hypertensive treatment in prevention of cardiovascular diseases. Data are very limited regarding whether PWV is an independent predictor of stroke above and beyond hypertension control. In their current guidelines for the management of arterial hypertension, the European Society of Hypertension included PWV as a potential consideration in managing middle‐aged hypertensive patients with increased aortic stiffness. However, none of the current stroke prevention guidelines have considered PWV due to limited data.ObjectiveThis longitudinal analysis examined the independent and joint effect of brachial‐ankle PWV (baPWV) with hypertension control on the risk of first stroke.MethodsThis report included 3,310 hypertensive adults (age: 59.6 ± 7.5 years), a subset of the China Stroke Primary Prevention Trial (CSPPT) with baseline measurement for baPWV. All the participants had no prior history of stroke or myocardial infarction (MI).ResultsMean baseline baPWV was 18.76 (SD: 3.82) m/sec. During a median follow‐up of 4.5 years, 111 participants developed first stroke. The risk of stroke was higher among participants with baPWV in the highest quartile than that in the lower range (6.3% vs. 2.4%). Similarly, the participants with inadequate hypertension control had a higher risk of stroke than those with adequate control (5.1% vs. 1.8%). When baPWV and hypertension control were examined jointly, participants in the highest baPWV quartile and with inadequate control had the highest risk of stroke compared to their counterparts as demonstrated by Kaplan‐Meier curves (log rank test p<0.0001) and Cox proportional hazard modeling (hazard ratio (HR): 3.6; 95% confidence interval (CI): 1.9–6.8, p<0.001), after adjusting for demographic and cardiovascular risk factors. Furthermore, there was a significant and independent effect of high baPWV on stroke as shown among participants with adequate hypertension control (HR=2.3, 95%CI: 1.1–4.8, p=0.029).ConclusionAmong hypertensive patients, baPWV and hypertension control were demonstrated to independently and jointly affect the risk of first stroke. Participants with high baPWV and inadequate hypertension control had the highest risk of stroke compared to other groups. Our findings warrant additional investigation and raise a possibility that baPWV may serve as a simple noninvasive screening tool in clinical or community settings to identify hypertensive adults at high‐risk of stroke. It may also offer a novel therapeutic target to further reduce stroke risk beyond conventional management.