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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

Stéphane Laurent; Pierre Boutouyrie; Roland Asmar; Isabelle Gautier; Brigitte Laloux; Louis Guize; Pierre Ducimetiere; Athanase Benetos

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

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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				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]

				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]

				D. Levy, S.-J. Hwang, A. Kayalar, E. J. Benjamin, R. S. Vasan, H. Parise, M. G. Larson, T. J. Wang, J. Selhub, P. F. Jacques, et al. Associations of Plasma Natriuretic Peptide, Adrenomedullin, and Homocysteine Levels With Alterations in Arterial Stiffness: The Framingham Heart Study Circulation, June 19, 2007; 115(24): 3079 - 3085. [Abstract] [Full Text] [PDF]

				Authors/Task Force Members:, G. Mancia, G. De Backer, A. Dominiczak, R. Cifkova, R. Fagard, G. Germano, G. Grassi, A. M. Heagerty, S. E. Kjeldsen, et al. 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) Eur. Heart J., June 11, 2007; (2007) ehm236v1. [Full Text] [PDF]

				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]

				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]

				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]

				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]

				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]

				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]