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(Hypertension. 2001;37:1236.)
© 2001 American Heart Association, Inc.
Scientific Contributions |
Aortic Stiffness Is an Independent Predictor of All-Cause and Cardiovascular Mortality in Hypertensive Patients
From the Department of Pharmacology and INSERM U 337, Broussais Hospital (S.L., P.B., I.G., B.L., A.B.), Paris; Institut Cardiovasculaire - ICV (R.A.), Paris; Investigations Préventives et Cliniques (L.G., A.B.), INSERM U 258 (L.G., P.D.), Villejuif, Paris, France.
Correspondence to Prof Stéphane Laurent, Service de Pharmacologie, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015 Paris, France. E-mail stephane.laurent{at}egp.ap-hop-paris.fr
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Abstract |
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Abstract—Although various studies reported that pulse pressure, an indirect index of arterial stiffening, was an independent risk factor for mortality, a direct relationship between arterial stiffness and all-cause and cardiovascular mortality remained to be established in patients with essential hypertension. A cohort of 1980 essential hypertensive patients who attended the outpatient hypertension clinic of Broussais Hospital between 1980 and 1996 and who had a measurement of arterial stiffness was studied. At entry, aortic stiffness was assessed from the measurement of carotid-femoral pulse-wave velocity (PWV). A logistic regression model was used to estimate the relative risk of all-cause and cardiovascular deaths. Selection of classic risk factors for adjustment of PWV was based on their influence on mortality in this cohort in univariate analysis. Mean age at entry was 50±13 years (mean±SD). During an average follow-up of 112±53 months, 107 fatal events occurred. Among them, 46 were of cardiovascular origin. PWV was significantly associated with all-cause and cardiovascular mortality in a univariate model of logistic regression analysis (odds ratio for 5 m/s PWV was 2.14 [95% confidence interval, 1.71 to 2.67, P<0.0001] and 2.35 [95% confidence interval, 1.76 to 3.14, P<0.0001], respectively). In multivariate models of logistic regression analysis, PWV was significantly associated with all-cause and cardiovascular mortality, independent of previous cardiovascular diseases, age, and diabetes. By contrast, pulse pressure was not significantly and independently associated to mortality. This study provides the first direct evidence that aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in patients with essential hypertension.
Key Words: arterial stiffness • cardiovascular diseases • mortality • hypertension, essential • pulse wave velocity • distensibility
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Introduction |
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Cardiovascular disease, which remains the leading cause of death in developed countries, is not entirely predicted by classic risk factors. Increased arterial stiffness may increase cardiovascular morbidity and mortality because of an elevation of systolic blood pressure (SBP), which raises left ventricular afterload, and because of a decrease in diastolic blood pressure (DBP), which alters coronary perfusion.1 2 Most epidemiological studies have singled out SBP as a stronger risk factor for stroke and coronary heart disease than DBP.3 4 5 6 7 8 9 10 Recent studies have shown that, independent of mean blood pressure (MBP), brachial pulse pressure (PP) was a strong determinant of coronary heart disease,5 6 7 8 9 10 stroke,4 and cardiovascular events in hypertensive patients and in a general population.5 6 7 8 9 10 Brachial PP is also a strong independent determinant of recurrent events after myocardial infarction in patients with impaired left ventricular function,11 of risk of heart failure in the elderly,12 and of all-cause mortality in a general population.8 9 10 13 Furthermore, in a cross-sectional study,14 aortic pulse-wave velocity (PWV) was shown to be associated with cardiovascular risk, as calculated from the Framingham equations.
Despite these arguments, it remains to be demonstrated whether arterial stiffness, which is a major determinant of PP, has any independent prognostic relevance for all-cause and cardiovascular mortality.15 To the best of our knowledge, only 3 studies16 17 18 have attempted to determine the impact of arterial stiffness on survival. De Simone et al16 have reported that in 294 hypertensive patients, the stroke volume/PP ratio, an index of total arterial compliance, was an independent predictor of cardiovascular events but not of cardiovascular deaths after adjustment for classic risk factors. Blacher et al17 18 have observed an independent relationship between arterial stiffness (estimated either from carotid incremental modulus of elasticity or from aortic PWV) and all-cause and cardiovascular mortality in patients with end-stage renal disease. However, the latter studies17 18 concerned a specific population at high risk of mortality, and a direct relationship between arterial stiffness and all-cause and cardiovascular mortality remained to be determined in hypertensive patients at lower risk.
Arterial stiffness can be assessed noninvasively in large populations by measurement of PWV, a simple and reproducible method.19 20 21 22 According to the Moens-Korteweg equation,1 19 the PWV, which is related to the square root of the elasticity modulus, rises in stiffer arteries. The elastic properties of the aorta and central arteries are the major determinants of systemic arterial impedance, and the PWV measured along the aortic and aortoiliac pathway is the most clinically relevant. In the present study, we tested the hypothesis that aortic stiffness is a predictor of cardiovascular and all-cause mortality in hypertensive patients after classic cardiovascular risk factors have been controlled.
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Methods |
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Subjects and Study Design
The cohort included the 1980 consecutive patients who attended the outpatient hypertension clinic of Hôpital Broussais between April 1980 and December 1996 and who had a determination of arterial stiffness with PWV. Among them, 483 patients were treated with at least 1 antihypertensive drug at the time of the PWV measurement. The others were referred for clinical and biological investigation before treatment. Demographic data with details of cardiovascular risk factors and previous events were collected on the day when PWV was measured. Diabetes and hypercholesterolemia were indicated by a previous diagnosis or by the use of an oral hypoglycemic agent or a cholesterol-lowering agent. Smoking status was defined as current or past versus never.
A nurse measured supine blood pressure in the right arm with the use of a manual sphygmomanometer. After a 10-minute rest period, pressure was measured 3 times, and the mean of the last 2 measurements was calculated. The first and the fifth Korotkoff’s phases were used to define SBP and DBP. Mean BP was calculated as DBP + [(SBP-DBP)/3].
PWV Measurement
PWV was measured along the descending
thoracoabdominal aorta using the foot-to-foot velocity method, as
previously published and
validated.20 22
Briefly, waveforms were obtained transcutaneously over the common
carotid artery and the right femoral artery, and the time delay (t) was
measured between the feet of the 2 waveforms. The distance (D) covered
by the waves was assimilated to the distance measured between the 2
recording sites. PWV was calculated as PWV=D (meters)/t
(seconds).20 22
Annual mean values of PWV did not change over the study period, which
ruled out any major time or population recruitment effect on the
obtained values.
Mortality
The follow-up study period ended on December 31, 1996
(mean follow-up, 9.3 years). Deceased subjects were identified from the
French mortality records provided by the Institut National de
Statistiques et d’Etudes Economiques. A member of the cohort was
considered to have died when the individual had the same first name,
last name, gender, and date and place of birth as a person recorded
in the Institut National d’Etudes Economiques mortality records
during the period of follow-up. This was confirmed by the death
certificates. Individuals with incomplete matching (n=42) were
contacted by telephone interview or through their general
practitioners, and none of them had died. All other
subjects were considered to be alive at the end of the follow-up
period. On the basis of this procedure, 107 subjects of our cohort died
during the follow-up period. Causes of death were then coded from the
death certificates, as provided by INSERM SC8. Causes of death were
coded according to the International
Classification of Disease (ninth
revision).
Data Analysis
A logistic regression analysis was used to
estimate the relative risk of all-cause and
cardiovascular mortality associated with
PWV.23 The adjusted relative
risk of experiencing an outcome event during follow-up for an increase
in PWV (arbitrarily fixed at 5 m/s) was estimated as the odds ratio
(OR). Adjusted ORs were calculated as the antilogarithm of the ß
coefficient of the logistic regression of the outcome events. The 95%
confidence interval (CI) around the adjusted OR estimates was obtained
with the formula antilogarithm (ß±1.96 SE), in which SE is the
standard error of ß. Similar calculations of ORs were performed for a
10-year increase in age, a 10 mm Hg increase in blood pressure,
and a 10 bpm increase in heart rate (HR). To ensure that any observed
association between PWV and a given outcome was not confounded by the
presence of classic risk factors, we used a
multivariate model of logistic regression that included
all cardiovascular risk factors significantly
associated with mortality in univariate analysis.
Because arterial stiffness is a major determinant of PP
(and SBP), we compared a multivariate model that
included PWV to models that included either PP or SBP.
Gender (1, male; 2, female), previous history of cardiovascular disease (1, no; 2, yes), diabetes (1, no; 2, yes), hypercholesterolemia (1, no; 2, yes), and smoking status (1, no; 2, yes) were used as dummy variables. All analyses were performed with Statview 6.0 statistical software (Adept Software). Data are expressed as mean±SD. A value of P<0.05 was considered significant.
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Results |
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All-Cause Mortality
The characteristics of the population are described in Table 1. In the whole population, 107 fatal events occurred. PWV was significantly associated with all-cause mortality in a univariate model of logistic regression analysis (Table 2). Selection of classic risk factors for adjustment of PWV was based on their influence on all-cause mortality in this cohort with univariate models of logistic regression analysis. Previous cardiovascular disease, age, PP, SBP, HR, and diabetes, were significantly associated with all-cause mortality (Table 2), whereas gender, MBP, DBP, smoking, and hypercholesterolemia were not.
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In a multivariate model of logistic regression analysis, PWV was significantly associated with all-cause mortality, independent of previous cardiovascular disease, age, HR, and diabetes (Model 1, Table 3). By contrast, PP (or SBP) was not significantly and independently associated with mortality (Models 2 and 3, Table 3). Similar results were observed when a separate analysis was performed in men only. The analysis was not possible in women because of the low mortality rate.
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PWV was significantly higher in patients using antihypertensive drugs at baseline than in untreated patients (11.79±3.64 versus 11.39±3.27 m/s, P=0.02). However, this difference was only marginal (+3.5%) and did not affect the relationship between PWV and all-cause mortality. Indeed, when antihypertensive treatment at the original screening (yes/no) was included in a multivariate model of logistic regression analysis, in addition to previous cardiovascular disease, age, and HR, the OR for an increase in PWV of 5 m/s was 1.39 (95% CI, 1.07 to 1.81; P=0.02) for all-cause mortality. This value is similar to that in Table 3, which was obtained without taking into account the administration of antihypertensive drugs.
In the 1798 patients devoid of previous cardiovascular events at entry, PWV significantly predicted all-cause mortality. Indeed, in univariate analysis, the OR for an increase in PWV of 5 m/s was 1.79 (95% CI, 1.45 to 2.14; P<0.001) in this subgroup.
Cardiovascular
Mortality
Among the 107 fatal events, 46 were of
cardiovascular origin, including 19 deaths from
coronary heart disease and 17 fatal strokes. The 10 other fatal
cardiovascular events were coded as follows in the
death certificates: congestive heart failure (n=3), pulmonary
embolism (n=2), hypertension (n=1), diabetes with microvascular disease
(n=1), hypotension (n=1), and viral myocarditis (n=1).
PWV was significantly associated with cardiovascular mortality in a univariate model of logistic regression analysis (Table 4). Selection of classic risk factors for adjustment of PWV was based on their influence on cardiovascular mortality in this cohort, in univariate models of logistic regression analysis. Previous cardiovascular disease, age, PP, SBP, and diabetes were significantly associated with all-cause mortality (Table 4), whereas gender, MBP, DBP, HR, smoking, and hypercholesterolemia were not.
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In a multivariate model of logistic regression analysis, PWV was significantly associated with cardiovascular mortality, independent of previous cardiovascular disease, age, and diabetes (Model 1, Table 5). By contrast, PP was only marginally (P=0.06) associated with cardiovascular mortality (Model 2, Table 5). SBP was significantly and independently associated with cardiovascular mortality (Model 3, Table 5). Similar results were observed when a separate analysis was performed in men only. The analysis was not possible in women because of the low mortality rate.
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When antihypertensive treatment (yes/no) at the original screening was included in a multivariate model of logistic regression analysis, in addition to previous cardiovascular disease and age, the OR for an increase in PWV of 5 m/s was 1.40 (955 CI, 1.08 to 1.80; P=0.01) for cardiovascular mortality. This value is similar to that in Table 5, which was obtained without taking into account the administration of antihypertensive drugs.
In the 1798 patients devoid of previous cardiovascular events at entry, PWV significantly predicted cardiovascular mortality. Indeed, in univariate analysis, the OR for an increase in PWV of 5 m/s was 1.60 (95% CI, 1.12 to 2.13; P=0.011).
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Discussion |
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The present study is the first one to provide a direct relationship between aortic stiffness and mortality in a large cohort of hypertensive patients. Indeed, PWV was independently associated with all-cause and cardiovascular mortality after adjustment for previous cardiovascular disease, age, and diabetes.
Our group4 8 9 and others5 6 7 10 11 have previously reported the positive independent association between brachial PP, an indirect index of arterial stiffness, and all-cause or cardiovascular mortality. However, these studies provided only indirect arguments for an impact of arterial stiffness on mortality. Indeed, PP was calculated from SBP and DBP, both measured with a sphygmomanometer at the site of the brachial artery. Because of the physiological PP amplification between central and peripheral arteries,1 13 24 25 26 27 28 brachial PP may not reflect aortic PP, which influences left ventricular afterload and coronary perfusion. In addition, factors other than arterial stiffness can influence the value of PP, such as HR, cardiac contractility, and venous pressure.1 13 26 Thus, brachial PP is only a surrogate index of arterial stiffness.
The international guidelines for the management of hypertension15 suggested that it would be useful to demonstrate whether arterial stiffness has any independent prognostic relevance for mortality. During the last 20 years, technological progress has allowed arterial stiffness to be determined with simple noninvasive methods and to be used in epidemiological studies. An independent influence of arterial stiffness on survival has recently been demonstrated in patients with end-stage renal disease,17 18 a very specific population at high risk of mortality. This has not been shown in hypertensive patients at lower risk,16 probably because of the small number of patients included in this cohort. Thus, a direct relationship between arterial stiffness and all-cause and cardiovascular mortality remained to be determined in a large population of hypertensive patients.
The present study clearly shows that arterial stiffness may help in the evaluation of the individual risk in hypertensive patients regularly attending the outpatient clinic of a university hospital. Because the population group was only mildly hypertensive at original screening, with the minority on antihypertensive treatment at that time, one might reasonably speculate that the results may apply to the population as a whole. The independent predictability of aortic stiffness can be quantified in the study population: the OR for an increase in PWV of 5 m/s is 1.34 for all-cause mortality (Table 3) and 1.51 for cardiovascular mortality (Table 5). In univariate models of logistic regression analysis, the increased mortality risk because of a 5 m/s increase in PWV is equivalent to that of aging 10 years (Table 2 and 4).
Several mechanisms may explain the association between increased PWV and cardiovascular mortality.1 2 3 4 5 6 7 8 9 10 11 12 Arterial stiffness is a cause of premature return of reflected waves in late systole, increasing central pulse pressure and the load on the ventricle, reducing ejection fraction, and increasing myocardial oxygen demand.1 Arterial stiffness is associated with left ventricular hypertrophy in normotensive and hypertensive patients.4 29 Left ventricular hypertrophy is a known risk factor for congestive heart failure and cardiovascular events.30 The elevation of SBP, which raises left ventricular afterload and myocardial work, and the decrease in DBP, which reduces coronary perfusion, result in subendocardial ischemia.1 31 Arterial stiffness is correlated with atherosclerosis,32 33 probably through the effects of cyclic stress on arterial wall thickening.28 34
Because 483 patients among 1980 were being treated with antihypertensive drugs at the time of PWV measurement, the patients might have lower blood pressure and PWV levels than without treatment. Thus, the predictive value of PWV, observed in the whole population, might not apply to this sub-group. However, when antihypertensive treatment was added to the multivariate model of logistic regression analysis of Table 3, the independent OR for an increase in PWV of 5 m/s remained significant and of similar value than in the original model for both all-cause and cardiovascular mortality.
The subgroup of 182 patients among 1980, who had a history of cardiovascular disease at the baseline PWV examination, might have introduced a bias in the determination of the predictive power of PWV in the whole population, particularly in patients devoid of previous cardiovascular disease at entry, even after adjustment to previous cardiovascular disease in multivariate analysis. Thus, we reanalyzed the subgroup of 1798 patients devoid of previous cardiovascular disease at entry. Univariate analyses in these patients showed that aortic PWV remained significantly predictive of cardiovascular and all-cause deaths.
As expected, we observed significant univariate associations between cardiovascular deaths and either previous cardiovascular disease, age, PP, SBP, and diabetes, with a predominant predictive power for the history of cardiovascular disease.35 The lack of univariate association between MBP and cardiovascular deaths was not unexpected because the present cohort included only patients referred for hypertension, thus reducing the range of MBP values. The lack of prognostic value of DBP on cardiovascular deaths was also not unexpected in the present cohort. Indeed, previous studies10 35 reported a positive association between cardiovascular mortality and DBP before 60 years of age and a negative association thereafter. Thus, the findings of the present study underline the predominant role of PP over MBP, as previously published.8 9
In the present cohort, arterial stiffness had an independent predictive power with respect to all-cause and cardiovascular deaths, whereas PP was not significantly and independently associated with all-cause mortality (Table 3) and was only marginally associated with cardiovascular mortality (Table 5). The stronger independent predictive value of PWV may be explained by pathophysiological considerations (PP amplification, multiplicity of PP determinants), as seen above. In addition, the lack of independent predictive value of PP may be due to the smaller size of the present cohort than previously published ones4 8 9 10 36 and/or to the lower mortality rate of our hypertensive population compared with patients with impaired left ventricular function11 or elderly patients.36 Nevertheless, the present study shows that a direct measurement of stiffness may be of greater help than an indirect index (PP) in the evaluation of the individual risk in a cohort of hypertensive patients regularly attending the outpatient clinic of an university hospital.
We conclude that aortic stiffness is significantly associated with the risk of all-cause and cardiovascular mortality in patients with essential hypertension. Measurement of aortic stiffness retains predictive power with respect to all-cause and cardiovascular deaths, even after classic risk factors have been taken into consideration.
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Acknowledgments |
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This study received financial support from the French Medicine Agency (AFSSAPS) and Institut National de la Santé et de la Recherche Médicale (INSERM). The authors are grateful to Jean-François Morcet for his help in analyzing the data.
Received June 1, 2000; first decision July 5, 2000; accepted October 16, 2000.
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M. Cecelja, B. Jiang, K. McNeill, B. Kato, J. Ritter, T. Spector, and P. Chowienczyk Increased wave reflection rather than central arterial stiffness is the main determinant of raised pulse pressure in women and relates to mismatch in arterial dimensions: a twin study. J. Am. Coll. Cardiol., August 18, 2009; 54(8): 695 - 703. [Abstract] [Full Text] [PDF]
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 M Wong, S P Oakley, L Young, B Y Jiang, A Wierzbicki, G Panayi, P Chowienczyk, and B Kirkham Infliximab improves vascular stiffness in patients with rheumatoid arthritis Ann Rheum Dis, August 1, 2009; 68(8): 1277 - 1284. [Abstract] [Full Text] [PDF]
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 F. Fantin, C. J. Bulpitt, S. Bonapace, J. D. Cameron, and C. Rajkumar Is vascular stiffness associated with the diameter of the abdominal aorta? Age Ageing, July 1, 2009; 38(4): 466 - 469. [Full Text] [PDF]
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 F. Dockery, C. J. Bulpitt, S. Agarwal, C. Vernon, and C. Rajkumar Effect of Androgen Suppression Compared With Androgen Receptor Blockade on Arterial Stiffness in Men With Prostate Cancer J Androl, July 1, 2009; 30(4): 410 - 415. [Abstract] [Full Text] [PDF]
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N. Dhaun, I. M. MacIntyre, V. Melville, P. Lilitkarntakul, N. R. Johnston, J. Goddard, and D. J. Webb Blood Pressure-Independent Reduction in Proteinuria and Arterial Stiffness After Acute Endothelin-A Receptor Antagonism in Chronic Kidney Disease Hypertension, July 1, 2009; 54(1): 113 - 119. [Abstract] [Full Text] [PDF]
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 S. P. L. Rice, N. Agarwal, H. Bolusani, R. Newcombe, M. F. Scanlon, M. Ludgate, and D. A. Rees Effects of Dehydroepiandrosterone Replacement on Vascular Function in Primary and Secondary Adrenal Insufficiency: A Randomized Crossover Trial J. Clin. Endocrinol. Metab., June 1, 2009; 94(6): 1966 - 1972. [Abstract] [Full Text] [PDF]
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 C. E Bolton, J. R Cockcroft, R. Sabit, M. Munnery, C. M McEniery, I. B Wilkinson, S. Ebrahim, J. E Gallacher, D. J Shale, and Y. Ben-Shlomo Lung function in mid-life compared with later life is a stronger predictor of arterial stiffness in men: The Caerphilly Prospective Study Int. J. Epidemiol., June 1, 2009; 38(3): 867 - 876. [Abstract] [Full Text] [PDF]
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 H. Pavlopoulos and P. Nihoyannopoulos Pulse pressure/stroke volume: a surrogate index of arterial stiffness and the relation to segmental relaxation and longitudinal systolic deformation in hypertensive disease Eur J Echocardiogr, June 1, 2009; 10(4): 519 - 526. [Abstract] [Full Text] [PDF]
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F. Natale, M. A. Tedesco, R. Mocerino, V. de Simone, G. M. Di Marco, L. Aronne, M. Credendino, C. Siniscalchi, P. Calabro, M. Cotrufo, et al. Visceral adiposity and arterial stiffness: echocardiographic epicardial fat thickness reflects, better than waist circumference, carotid arterial stiffness in a large population of hypertensives Eur J Echocardiogr, June 1, 2009; 10(4): 549 - 555. [Abstract] [Full Text] [PDF]
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A. O. Robb, N. L. Mills, J. N. Din, I. B.J. Smith, F. Paterson, D. E. Newby, and F. C. Denison Influence of the Menstrual Cycle, Pregnancy, and Preeclampsia on Arterial Stiffness Hypertension, June 1, 2009; 53(6): 952 - 958. [Abstract] [Full Text] [PDF]
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 A Cypiene, M Kovaite, A Venalis, J Dadoniene, R Rugiene, Z Petrulioniene, L Ryliskyte, and A Laucevicius Arterial wall dysfunction in systemic lupus erythematosus Lupus, May 1, 2009; 18(6): 522 - 529. [Abstract] [PDF]
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 M. Yaron, Y. Greenman, J. B Rosenfeld, E. Izkhakov, R. Limor, E. Osher, G. Shenkerman, K. Tordjman, and N. Stern Effect of testosterone replacement therapy on arterial stiffness in older hypogonadal men Eur. J. Endocrinol., May 1, 2009; 160(5): 839 - 846. [Abstract] [Full Text] [PDF]
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 C. Vlachopoulos, P. Xaplanteris, N. Alexopoulos, K. Aznaouridis, C. Vasiliadou, K. Baou, E. Stefanadi, and C. Stefanadis Divergent Effects of Laughter and Mental Stress on Arterial Stiffness and Central Hemodynamics Psychosom Med, May 1, 2009; 71(4): 446 - 453. [Abstract] [Full Text] [PDF]
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S. G. Anderson, T. A.B. Sanders, and J. K. Cruickshank Plasma Fatty Acid Composition as a Predictor of Arterial Stiffness and Mortality Hypertension, May 1, 2009; 53(5): 839 - 845. [Abstract] [Full Text] [PDF]
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T. E. Brinkley, B. J. Nicklas, A. M. Kanaya, S. Satterfield, E. G. Lakatta, E. M. Simonsick, K. Sutton-Tyrrell, S. B. Kritchevsky, and for the Health, Aging, and Body Composition Study Plasma Oxidized Low-Density Lipoprotein Levels and Arterial Stiffness in Older Adults: The Health, Aging, and Body Composition Study Hypertension, May 1, 2009; 53(5): 846 - 852. [Abstract] [Full Text] [PDF]
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G. Deley, G. Picard, and J. A. Taylor Arterial Baroreflex Control of Cardiac Vagal Outflow in Older Individuals Can Be Enhanced by Aerobic Exercise Training Hypertension, May 1, 2009; 53(5): 826 - 832. [Abstract] [Full Text] [PDF]
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 M. Garcia and G. S. Kassab Right coronary artery becomes stiffer with increase in elastin and collagen in right ventricular hypertrophy J Appl Physiol, April 1, 2009; 106(4): 1338 - 1346. [Abstract] [Full Text] [PDF]
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 K. V. Tarasov, S. Sanna, A. Scuteri, J. B. Strait, M. Orru, A. Parsa, P.-I Lin, A. Maschio, S. Lai, M. G. Piras, et al. COL4A1 Is Associated With Arterial Stiffness by Genome-Wide Association Scan Circ Cardiovasc Genet, April 1, 2009; 2(2): 151 - 158. [Abstract] [Full Text] [PDF]
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S. Sakuragi, K. Abhayaratna, K. J. Gravenmaker, C. O'Reilly, W. Srikusalanukul, M. M. Budge, R. D. Telford, and W. P. Abhayaratna Influence of Adiposity and Physical Activity on Arterial Stiffness in Healthy Children: The Lifestyle of Our Kids Study Hypertension, April 1, 2009; 53(4): 611 - 616. [Abstract] [Full Text] [PDF]
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 J. A. Chirinos, S. S. Franklin, R. R. Townsend, and L. Raij Body Mass Index and Hypertension Hemodynamic Subtypes in the Adult US Population Arch Intern Med, March 23, 2009; 169(6): 580 - 586. [Abstract] [Full Text] [PDF]
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 C. A. Peralta, R. Katz, M. Madero, M. Sarnak, H. Kramer, M. H. Criqui, and M. G. Shlipak The Differential Association of Kidney Dysfunction With Small and Large Arterial Elasticity: The Multiethnic Study of Atherosclerosis Am. J. Epidemiol., March 15, 2009; 169(6): 740 - 748. [Abstract] [Full Text] [PDF]
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 B. Ilyas, N. Dhaun, D. Markie, P. Stansell, J. Goddard, D.E. Newby, and D.J. Webb Renal function is associated with arterial stiffness and predicts outcome in patients with coronary artery disease QJM, March 1, 2009; 102(3): 183 - 191. [Abstract] [Full Text] [PDF]
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 K. M Dickinson, J. B Keogh, and P. M Clifton Effects of a low-salt diet on flow-mediated dilatation in humans Am. J. Clinical Nutrition, February 1, 2009; 89(2): 485 - 490. [Abstract] [Full Text] [PDF]
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 K. Kallio, E. Jokinen, M. Hamalainen, M. Saarinen, I. Volanen, T. Kaitosaari, J. Viikari, T. Ronnemaa, O. Simell, and O. T. Raitakari Decreased Aortic Elasticity in Healthy 11-Year-Old Children Exposed to Tobacco Smoke Pediatrics, February 1, 2009; 123(2): e267 - e273. [Abstract] [Full Text] [PDF]
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 N. Bjarnegard, H. J Arnqvist, T.;r. Lindstro;m, L. Jonasson, and T. Lanne Long-term hyperglycaemia impairs vascular smooth muscle cell function in women with type 1 diabetes mellitus Diabetes and Vascular Disease Research, January 1, 2009; 6(1): 25 - 31. [Abstract] [PDF]
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O. Cseprekal, E. Kis, P. Schaffer, T. E. H. Othmane, B. Cs. Fekete, A. Vannay, A. J. Szabo, A. Remport, A. Szabo, T. Tulassay, et al. Pulse wave velocity in children following renal transplantation Nephrol. Dial. Transplant., January 1, 2009; 24(1): 309 - 315. [Abstract] [Full Text] [PDF]
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 J. Sugawara, K. Hayashi, T. Yokoi, and H. Tanaka Age-associated elongation of the ascending aorta in adults. J. Am. Coll. Cardiol. Img., November 1, 2008; 1(6): 739 - 748. [Abstract] [Full Text] [PDF]
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 I. Wakabayashi and H. Masuda Relationships Between Vascular Indexes and Atherosclerotic Risk Factors in Patients With Type 2 Diabetes Mellitus Angiology, October 1, 2008; 59(5): 567 - 573. [Abstract] [PDF]
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 D. Nyhan and D. E. Berkowitz Perioperative Blood Pressure Management: Does Central Vascular Stiffness Matter? Anesth. Analg., October 1, 2008; 107(4): 1103 - 1106. [Full Text] [PDF]
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S. R. Lammers, P. H. Kao, H. J. Qi, K. Hunter, C. Lanning, J. Albietz, S. Hofmeister, R. Mecham, K. R. Stenmark, and R. Shandas Changes in the structure-function relationship of elastin and its impact on the proximal pulmonary arterial mechanics of hypertensive calves Am J Physiol Heart Circ Physiol, October 1, 2008; 295(4): H1451 - H1459. [Abstract] [Full Text] [PDF]
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S.-H. Lee, S. Choi, J.-H. Jung, and N. Lee Effects of Atrial Fibrillation on Arterial Stiffness in Patients With Hypertension Angiology, August 1, 2008; 59(4): 459 - 463. [Abstract] [PDF]
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G. Schillaci, G. V.L. De Socio, G. Pucci, M. R. Mannarino, J. Helou, M. Pirro, and E. Mannarino Aortic Stiffness in Untreated Adult Patients With Human Immunodeficiency Virus Infection Hypertension, August 1, 2008; 52(2): 308 - 313. [Abstract] [Full Text] [PDF]
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A. G. Ruitenbeek, T. J.M. van der Cammen, A. H. van den Meiracker, and F. U.S. Mattace-Raso Age and Blood Pressure Levels Modify the Functional Properties of Central but Not Peripheral Arteries Angiology, July 1, 2008; 59(3): 290 - 295. [Abstract] [PDF]
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S. V. Getov, R. W. Lee, F. Dockery, and C. Rajkumar Androgens, ageing and vascular function Age Ageing, July 1, 2008; 37(4): 361 - 363. [Full Text] [PDF]
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 T. Otsuki, S. Maeda, M. Iemitsu, Y. Saito, Y. Tanimura, R. Ajisaka, and T. Miyauchi Systemic arterial compliance, systemic vascular resistance, and effective arterial elastance during exercise in endurance-trained men Am J Physiol Regulatory Integrative Comp Physiol, July 1, 2008; 295(1): R228 - R235. [Abstract] [Full Text] [PDF]
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 G. Grassi, F. Quarti-Trevano, and G. Mancia Review: Cardioprotective effects of telmisartan in uncomplicated and complicated hypertension Journal of Renin-Angiotensin-Aldosterone System, June 1, 2008; 9(2): 66 - 74. [Abstract] [PDF]
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 N. Steeghs, H. Gelderblom, J. o. t Roodt, O. Christensen, P. Rajagopalan, M. Hovens, H. Putter, T. J. Rabelink, and E. de Koning Hypertension and Rarefaction during Treatment with Telatinib, a Small Molecule Angiogenesis Inhibitor Clin. Cancer Res., June 1, 2008; 14(11): 3470 - 3476. [Abstract] [Full Text] [PDF]
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J. Karalliedde, A. Smith, L. DeAngelis, V. Mirenda, A. Kandra, J. Botha, P. Ferber, and G. Viberti Valsartan Improves Arterial Stiffness in Type 2 Diabetes Independently of Blood Pressure Lowering Hypertension, June 1, 2008; 51(6): 1617 - 1623. [Abstract] [Full Text] [PDF]
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J. S. Orr, C. L. Gentile, B. M. Davy, and K. P. Davy Large Artery Stiffening With Weight Gain in Humans: Role of Visceral Fat Accumulation Hypertension, June 1, 2008; 51(6): 1519 - 1524. [Abstract] [Full Text] [PDF]
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S. S. Najjar, A. Scuteri, V. Shetty, J. G. Wright, D. C. Muller, J. L. Fleg, H. P. Spurgeon, L. Ferrucci, and E. G. Lakatta Pulse Wave Velocity Is an Independent Predictor of the Longitudinal Increase in Systolic Blood Pressure and of Incident Hypertension in the Baltimore Longitudinal Study of Aging J. Am. Coll. Cardiol., April 8, 2008; 51(14): 1377 - 1383. [Abstract] [Full Text] [PDF]
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 M. Delahousse, M. Chaignon, L. Mesnard, P. Boutouyrie, M. E. Safar, T. Lebret, M. Pastural-Thaunat, L. Tricot, A. Kolko-Labadens, A. Karras, et al. Aortic Stiffness of Kidney Transplant Recipients Correlates with Donor Age J. Am. Soc. Nephrol., April 1, 2008; 19(4): 798 - 805. [Abstract] [Full Text] [PDF]
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J. B Keogh, G. D Brinkworth, M. Noakes, D. P Belobrajdic, J. D Buckley, and P. M Clifton Effects of weight loss from a very-low-carbohydrate diet on endothelial function and markers of cardiovascular disease risk in subjects with abdominal obesity Am. J. Clinical Nutrition, March 1, 2008; 87(3): 567 - 576. [Abstract] [Full Text] [PDF]
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M. E. Safar Review: Pulse pressure, arterial stiffness and wave reflections (augmentation index) as cardiovascular risk factors in hypertension Therapeutic Advances in Cardiovascular Disease, February 1, 2008; 2(1): 13 - 24. [Abstract] [PDF]
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L. Ghiadoni, G. Penno, C. Giannarelli, Y. Plantinga, M. Bernardini, L. Pucci, R. Miccoli, S. Taddei, A. Salvetti, and S. Del Prato Metabolic Syndrome and Vascular Alterations in Normotensive Subjects at Risk of Diabetes Mellitus Hypertension, February 1, 2008; 51(2): 440 - 445. [Abstract] [Full Text] [PDF]
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 S. S. DeLoach and R. R. Townsend Vascular Stiffness: Its Measurement and Significance for Epidemiologic and Outcome Studies Clin. J. Am. Soc. Nephrol., January 1, 2008; 3(1): 184 - 192. [Abstract] [Full Text] [PDF]
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S. Celik, S. Kaplan, R. Yilmaz, T. Erdogan, and A. Kiris Relationship Between Aortic Stiffness and the Development of Coronary Collateral in Patients With Coronary Artery Disease Angiology, January 1, 2008; 58(6): 671 - 676. [Abstract] [PDF]
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M. M. Lemos, A. D. B. Jancikic, F. M. R. Sanches, D. M. Christofalo, S. A. Ajzen, M. H. Miname, R. D. Santos, F. C. Fachini, A. B. Carvalho, S. A. Draibe, et al. Pulse wave velocity a useful tool for cardiovascular surveillance in pre-dialysis patients Nephrol. Dial. Transplant., December 1, 2007; 22(12): 3527 - 3532. [Abstract] [Full Text] [PDF]
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M. Yoshida, H. Tomiyama, J. Yamada, Y. Koji, K. Shiina, M. Nagata, and A. Yamashina Relationships among Renal Function Loss within the Normal to Mildly Impaired Range, Arterial Stiffness, Inflammation, and Oxidative Stress Clin. J. Am. Soc. Nephrol., November 1, 2007; 2(6): 1118 - 1124. [Abstract] [Full Text] [PDF]
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D. P. Casey, D. T. Beck, and R. W. Braith Progressive Resistance Training Without Volume Increases Does Not Alter Arterial Stiffness and Aortic Wave Reflection Experimental Biology and Medicine, October 1, 2007; 232(9): 1228 - 1235. [Abstract] [Full Text] [PDF]
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F. Verbeke, W. Van Biesen, P. Peeters, L. M. Van Bortel, and R. C. Vanholder Arterial stiffness and wave reflections in renal transplant recipients Nephrol. Dial. Transplant., October 1, 2007; 22(10): 3021 - 3027. [Abstract] [Full Text] [PDF]
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V. K. Yeragani, R. Kumar, K. J. Bar, P. Chokka, and M. Tancer Exaggerated Differences in Pulse Wave Velocity Between Left and Right Sides Among Patients With Anxiety Disorders and Cardiovascular Disease Psychosom Med, October 1, 2007; 69(8): 717 - 722. [Abstract] [Full Text] [PDF]
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A. Benjo, R. E. Thompson, D. Fine, C. W. Hogue, D. Alejo, A. Kaw, G. Gerstenblith, A. Shah, D. E. Berkowitz, and D. Nyhan Pulse Pressure Is an Age-Independent Predictor of Stroke Development After Cardiac Surgery Hypertension, October 1, 2007; 50(4): 630 - 635. [Abstract] [Full Text] [PDF]
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F. Anan, T. Masaki, Y. Umeno, T. Iwao, H. Yonemochi, N. Eshima, T. Saikawa, and H. Yoshimatsu Correlations of high-sensitivity C-reactive protein and atherosclerosis in Japanese type 2 diabetic patients Eur. J. Endocrinol., September 1, 2007; 157(3): 311 - 317. [Abstract] [Full Text] [PDF]
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M. Marre and A. Leye Effects of perindopril in hypertensive patients with or without type 2 diabetes mellitus, and with altered insulin sensitivity Diabetes and Vascular Disease Research, September 1, 2007; 4(3): 163 - 173. [Abstract] [PDF]
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E. Zintzaras, G. Kitsios, D. Kent, N. J. Camp, L. Atwood, P. N. Hopkins, and S. C. Hunt Genome-Wide Scans Meta-Analysis for Pulse Pressure Hypertension, September 1, 2007; 50(3): 557 - 564. [Abstract] [Full Text] [PDF]
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M. F. O'Rourke and J. Hashimoto Mechanical Factors in Arterial Aging: A Clinical Perspective J. Am. Coll. Cardiol., July 3, 2007; 50(1): 1 - 13. [Abstract] [Full Text] [PDF]
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D. A Stakos, D. P Schuster, E. A Sparks, S. B. Meis, C. F Wooley, K. Osei, and H. Boudoulas Association between glycosylated hemoglobin, left ventricular mass and aortic function in nondiabetic individuals with insulin resistance Eur. J. Endocrinol., July 1, 2007; 157(1): 63 - 68. [Abstract] [Full Text] [PDF]
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M. J. Roman, R. B. Devereux, J. R. Kizer, E. T. Lee, J. M. Galloway, T. Ali, J. G. Umans, and B. V. Howard Central Pressure More Strongly Relates to Vascular Disease and Outcome Than Does Brachial Pressure: The Strong Heart Study Hypertension, July 1, 2007; 50(1): 197 - 203. [Abstract] [Full Text] [PDF]
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M. Flamant, S. Placier, C. Dubroca, B. Esposito, I. Lopes, C. Chatziantoniou, A. Tedgui, J.-C. Dussaule, and S. Lehoux Role of Matrix Metalloproteinases in Early Hypertensive Vascular Remodeling Hypertension, July 1, 2007; 50(1): 212 - 218. [Abstract] [Full Text] [PDF]
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K. G. Moulakakis, D. P. Sokolis, D. N. Perrea, T. Dosios, I. Dontas, M. V. Poulakou, C. A. Dimitriou, G. Sandris, and P. E. Karayannacos The Mechanical Performance and Histomorphological Structure of the Descending Aorta in Hyperthyroidism Angiology, June 1, 2007; 58(3): 343 - 352. [Abstract] [PDF]
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G. F. Mitchell, M. E. Dunlap, W. Warnica, A. Ducharme, J. M. O. Arnold, J.-C. Tardif, S. D. Solomon, M. J. Domanski, K. A. Jablonski, M. M. Rice, et al. Long-Term Trandolapril Treatment Is Associated With Reduced Aortic Stiffness: The Prevention of Events With Angiotensin-Converting Enzyme Inhibition Hemodynamic Substudy Hypertension, June 1, 2007; 49(6): 1271 - 1277. [Abstract] [Full Text] [PDF]
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L. F. Drager, L. A. Bortolotto, A. C. Figueiredo, B. C. Silva, E. M. Krieger, and G. Lorenzi-Filho Obstructive Sleep Apnea, Hypertension, and Their Interaction on Arterial Stiffness and Heart Remodeling Chest, May 1, 2007; 131(5): 1379 - 1386. [Abstract] [Full Text] [PDF]
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C. Tsioufis, K. Dimitriadis, M. Selima, C. Thomopoulos, C. Mihas, I. Skiadas, D. Tousoulis, C. Stefanadis, and I. Kallikazaros Low-grade inflammation and hypoadiponectinaemia have an additive detrimental effect on aortic stiffness in essential hypertensive patients Eur. Heart J., May 1, 2007; 28(9): 1162 - 1169. [Abstract] [Full Text] [PDF]
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G. Schillaci, G. Parati, M. Pirro, G. Pucci, M. R. Mannarino, L. Sperandini, and E. Mannarino Ambulatory Arterial Stiffness Index Is Not a Specific Marker of Reduced Arterial Compliance Hypertension, May 1, 2007; 49(5): 986 - 991. [Abstract] [Full Text] [PDF]
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N. A. Jatoi, P. Jerrard-Dunne, J. Feely, and A. Mahmud Impact of Smoking and Smoking Cessation on Arterial Stiffness and Aortic Wave Reflection in Hypertension Hypertension, May 1, 2007; 49(5): 981 - 985. [Abstract] [Full Text] [PDF]
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