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Cited by 47Cardiovascular Health and Disease PreventionBlood Pressure and Hypertension StudiesCardiovascular Function and Risk Factors

Progression of arterial stiffness is associated with midlife diastolic blood pressure and transition to late-life hypertensive phenotypes

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Webb, Alastair John Stewart·2020·Journal of the American Heart Association
DOI 10.1161/jaha.119.014547PMC PMC6988142
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Abstract

Background Hypertension‐associated cardiovascular events are particularly associated with elevated systolic blood pressure ( SBP ) in late life, yet long‐term interactions between SBP , diastolic BP ( DBP ) and arterial stiffness in development of late‐life hypertensive phenotypes remain unclear. Methods and Results In the UK Biobank, we determined associations between arterial stiffness index ( ASI ), SBP , DBP , and their progression, and transition from normotension (<140/90 mm Hg) to hypertension or elevated ASI (>10 m/s). Associations were determined by general linear and logistic regression, adjusted for cardiovascular risk factors and variability of measurements across follow‐ups. Mean values of baseline SBP , DBP , and ASI were determined stratified by deciles of age, blood pressure, and ASI , with CIs determined by bootstrapping. In 169 742 participants at baseline, ASI was more strongly associated with DBP than SBP , before and after adjustment for risk factors (β: SBP , −0.01 [ P <0.001]; DBP , 0.06 [ P <0.001]), while DBP was more strongly associated with progression of ASI (n=13 761; β: SBP, 0.013 [ P =0.01]; DBP , 0.038 [ P <0.001]). Baseline ASI was associated with increasing SBP during follow‐up (β=0.02, P <0.001) but not DBP (β=0.0004, P =0.39), but was associated with a younger age of transition from rising to falling DBP (highest versus lowest quartile: 51.2; 95% CI, 49.9–52.3 versus 60.4; 95% CI, 59.6–61.3 [ P <0.001]). ASI predicted the development of isolated systolic hypertension (odds ratio, 1.30; 95% CI, 1.22–1.39), particularly after adjustment for measurement variability (odds ratio, 2.29). Conclusions Midlife DBP was the strongest predictor of progression of arterial stiffness, while arterial stiffness was associated with earlier transition to a falling DBP . Prevention of long‐term harms associated with arterial stiffness may require more intensive control of midlife DBP .

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  • The increased risk of death at lower values of diastolic blood pressure is likely to reflect, at least in part, reverse causation due to the effects of arterial ageing, stiffening, and subclinical disease, all of which are associated with a widened pulse pressure and lower diastolic pressure.

    “The increased risk of death at lower values of diastolic blood pressure is likely to reflect, at least in part, reverse causation due to the effects of arterial ageing, stiffening, and subclinical disease, all of which are associated with a widened pulse pressure and lower diastolic pressure.39”

    From Relationship between clinic and ambulatory blood pressure and mortality: an observational cohort study in 59 124 patients (2023) · cites this paper as [39]

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Cited by

Sorted by citations

Authors
Webb, A. J. S.
Affiliations
John Radcliffe Hospital (GB)
Corresponding author
Webb, Alastair John Stewart
ORCID
Webb, Alastair John Stewart
Venue
Journal of the American Heart Association
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2020-01-07
Volume
9
Issue
1
Pages
e014547-e014547
ISSN
2047-9980 (ISSN-L)
DOI
10.1161/jaha.119.014547
PMC
PMC6988142
OpenAlex
W2995401830
Cited by
47
References
7
Citations by year
2026: 4 · 2025: 6 · 2024: 4 · 2023: 8 · 2022: 9 · 2021: 8 · 2020: 8
FWCI
5.11
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Journal of the American Heart Association (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Funders
  • Wellcome Trust (Z/17/Z, 206589/Z/17/Z)
  • Alzheimer's Society (450-AS-PG-18-018)
  • British Heart Foundation (PG/16/38/32080)
  • Medical Research Council (MC_PC_17228, MC_PC_12028)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
Keywords
arterial stiffness, diastolic blood pressure, isolated systolic hypertension, arterial stiffness index, midlife blood pressure, systolic blood pressure, cardiovascular risk factors, measurement variability, UK Biobank, cardiovascular disease prevention, hypertension phenotypes, cardiovascular risk stratification, cardiovascular risk prediction
MeSH terms
Adult, Age Factors, Aged, Cross-Sectional Studies, Female, United Kingdom, Humans, Hypertension, Longitudinal Studies, Male, Middle Aged, Phenotype, Risk Factors, Time Factors, Disease Progression, Risk Assessment, Vascular Stiffness, Arterial Pressure

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