Clinical and demographic determinants of pulse wave velocity trajectories in hypertensive patients: a retrospective study

Objective: Arterial stiffness (AS) is a strong predictor of cardiovascular disease and all-cause mortality. Its behaviour over time, assessed through repeated measurements, is still largely unexplored. The aim of this study was to assess the clinical and demographic determinants of trajectories of carotid-femoral pulse wave velocity (cf-PWV) in a cohort of French hypertensive adults. Design and method: From a population of 7806 patients referred to HEGP Pharmacology Unit (Paris, France) from 1981 to 2022, we selected those who had at least 3 cf-PWV recordings over time. Those with missing treatment information or rare vascular diseases were excluded. Cluster of trajectories analysis was performed and multinomial regression was used to detect differences in baseline characteristics between the identified clusters. Results: 564 patients were included in the analysis (median follow-up was 4.2 [3.2-6.4] years). Four clusters of stiffness trajectories were identified: low-stable (A, n = 199), medium-stable (B, n = 184), high-increasing (C, n = 127), and high-low-high (D, n = 54) clusters (Figure 1). Mean BP (MBP) and cf-PWV at baseline were progressively higher in the medium-stable, high-increasing, and high-low-high clusters compared to the stable one (MBP was 96 ± 12, 99 ± 12 and 101 ± 15 mmHg in clusters B, C, and D vs 92 ± 12 mmHg in cluster A; cf-PWV was 9.7 ± 1.2, 11.6 ± 1.6 and 15.3 ± 2.7 m/s in clusters B, C, and D vs 7.7 ± 1.0 m/s in cluster A; all p < 0.001). On multinomial regression analysis, older age, higher MBP, and diabetes were associated to increased probability of belonging to either C or D clusters when compared to the stable one. Anti-hypertensive treatment with blockers of renin-angiotensin system (RAS) was associated with a decreased probability of belonging to the C or D clusters (Table 1). Conclusions: This real-life data obtained by repeated cf-PWV assessments on a large time span shows that patients who will experience PWV worsening over time are characterized by older age, higher MBP and diabetes at baseline. The use of RAS blockers has a protective effect on PWV trajectories.