Hypertension is associated with higher cardiovascular risk as well as several markers of subclinical target organ damage (TOD). Total arterial compliance (TAC) has been recognized as an independent risk factor for cardiovascular events. We hypothesized that there is a relationship between TAC and markers of TOD in never-treated hypertensives.Design and method:
We enrolled 990 consecutive essential hypertensives (mean age 52.6 ± 12.2 years, 526 males) without known cardiovascular disease (CVD). Markers of subclinical TOD [left ventricular mass index (LVMI), pulse wave velocity (PWV), ankle-brachial index (ABI) and estimated glomerular filtration rate (eGFR)] were evaluated in all patients. LVMI was assessed echocardiographically using the Devereux formula. Carotid-femoral PWV was estimated with the Complior device. eGFR was calculated by the Cockcroft-Gault formula. ABI was calculated by dividing the highest ankle systolic blood pressure by the highest brachial systolic blood pressure. The ratio of stroke volume to pulse pressure was measured echocardiographically as a surrogate of TAC.Results:
In multivariable regression analysis, TAC exhibited significant association with LVMI (p = 0.004, adjusted R2 of model = 0.318), PWV (p < 0.001, adjusted R2 of model = 0.335) ABI (p < 0.001, adjusted R2 of model = 0.334) but not with eGFR. In further analysis, TAC was associated with TOD as suggested by the 2013 European Guidelines for Hypertension [left ventricular hypertrophy (LVMI > 115 g/m2 in men and >95 g/m2 in women), increased PWV (PWV > 10 m/s), decreased ABI (ABI < 0.9) and decreased renal function (eGFR<60 ml/min)]. Specifically, TAC exhibited significant association with left ventricular hypertrophy (p = 0.003, adjusted R2 of model = 0.318), increased aortic stiffness (p < 0.001, adjusted R2 of model = 0.325), decreased ABI (p = 0.001, adjusted R2 of model = 0.320) and renal dysfunction (p = 0.003, adjusted R2 of model = 0.318). These associations were independent of age, gender, mean blood pressure, body-mass index, smoking habits, glucose, low-density lipoprotein and C-reactive protein.Conclusions:
Our findings support the close relationship between TAC and TOD in hypertension, as well as, the predictive ability of TAC for TOD.