Aortic stiffness is an independent predictor for all-causes cardiovascular events and pulse wave velocity (PWV). We have previously shown that PWV kept decreasing after 5 years of mean follow-up in well-controlled hypertensives (Ait Ouffela 2009). Whether this decrease in PWV is still observed for longer follow-up is unknown. Our working hypothesis is that in well controlled hypertensives, the initial decrease in PWV is followed by an aging process with increase in PWV. We propose here an extension of follow-up for the implemented Sargent cohort.Design and method:
This longitudinal observational study was conducted in 211 patients (63 ± 10 yrs, 99 women) with treated essential hypertension attending the outpatient hypertension clinic at Pompidou Hospital and considered as well controlled on automated BP. Aortic stiffness was determined with applanation tonometry for usual care. Mean follow-up was 4.69 years (48 days to 21years, 3.26 visits), 133 patients were followed less or equal than 5 years, 78 patients were followed more than 5 years. We used mixed models to test the influence of time and BP on PWV.Results:
Patients followed less or more than 5 years did not differ significantly. The number of treatments was unchanged. PWV did not change significantly during the whole duration of follow-up, however, we observed a quadratic trend in most patients with a nadir at 5 years. PWV decreased significantly by −0.4445 m/s/year, (p < 0.001) before 5 years, then increased after 5 years by 0.1303m/s/year (p < 0.001). Blood pressure decreased significantly by −1.01 mmHg/year, P = 0,03 before 5 years), and did not change after 5 years 0.30 mmHg/y P = 0,34). Results remained similar when time and SBP were included in the mixed model, suggesting that one part only of changes is pressure dependent.Conclusions:
These results indicate that the marked decrease in aortic stiffness is essentially obtained during the first 5 years of follow-up, then PWV increases again, but with a smaller slope. These changes are essentially pressure/independent. This demonstrates that, aging process takes over despite antihypertensive treatment.