Prognostic impact of increased pulse pressure/stroke index in a registry of hypertensive patients: the Campania Salute Network

Objectives: Increased arterial stiffness is associated with advanced arteriosclerosis, abnormal left ventricular (LV) geometry and function. Whether increased arterial stiffness is associated with incident cardiovascular (CV) event (MACE), independent of other markers of target organ damage needs to be clarified.Methods: We selected hypertensive participants of the Campania Salute Network free of prevalent CV disease, with available echocardiogram and carotid ultrasound, ejection fraction >= 50%, and <= stage III Chronic Kidney Disease (n=6907). Median follow-up was 63 months. End-point was incident MACE (fatal and non-fatal stroke and myocardial infarction, sudden cardiac death, carotid stenting and heart failure requiring hospitalization). Arterial stiffness was assessed from ratio of brachial pulse pressure/stroke index (i.e. normalized for body height in meter to 2.04 power) (PP/SVi). High PP/SVi (n=980) was defined as >95th sex-specific percentile of the normal distribution from a reference normal population (>2.63/>2.82mmHg/ml in men and women, respectively).Results: Patients with high PP/SVi were more likely to be women, older, diabetic, with higher systolic blood pressure (BP) and heart rate, more LV concentric geometry, left atrial dilatation and more carotid plaque (all p<.01). At given increase in SVi, patients with high PP/SVi exhibited two-fold increase in PP compared to normal PP/SVi. In Cox regression, patients with high PP/SVi had 63% increased hazard of MACE [95% CI (1.02-2.59) p=.04], independently of significant effect of older age, male sex, carotid plaque and less frequent anti-RAS therapy.Conclusions: In treated hypertensive patients, high PP/SVi predicted increased rate of MACE, independent of common confounders.