Arterial stiffness and blood pressure in treated hypertension: a longitudinal study

Objectives:It has been reported that an increase in arterial stiffness precedes an increase in blood pressure (BP) in the general population. Whether BP lowering results from of reducing arterial wall or vice versa in antihypertensive treatment is unclear. This study aimed to investigate the association between arterial stiffness and BP in patients with treated hypertension.Methods:This study included 3277 participants who were treated with antihypertensive agents and with repeated measurements of branchial-ankle pulse wave velocity (baPWV) and BP during 2010-2016 from the Kailuan study. Temporal relation between baPWV and BP was assessed by cross-lagged path analyses.Results:After adjustment for potential confounders, the standard regression coefficient from baseline baPWV to follow-up SBP was 0.14 [95% confidence interval (95% CI), 0.10-0.18], which was significantly greater than that from baseline SBP to follow-up baPWV (0.05; 95% CI, 0.02-0.08) (P < 0.0001 for difference). Similar results were observed for the cross-lagged analysis with changes of baPWV and mean arterial pressure. Further analysis showed that the yearly rate of change in SBP during the follow-up period significantly varied across increasing quartiles of baseline baPWV (P < 0.0001), whereas the yearly rate of change in baPWV showed a nonsignificantly varied trend across quartiles of baseline SBP (P = 0.2443).Conclusion:These findings provided strong evidence that reduction in arterial stiffness through antihypertensive treatment could precede BP lowering.