4.3 ABNORMAL PRESSURE WAVE REFLECTION ACCELERATES THE DEVELOPMENT OF HYPERTENSION VIA THE INCREASE OF ARTERIAL STIFFNESS

Abstract

Objectives: It is noted that not only arterial stiffness but also abnormal pressure wave reflection are risks for the development of hypertension. However, the association between arterial stiffness and pressure wave reflection in the development of hypertension has not been fully clarified. The present study was conducted to examine whether the abnormal pressure wave reflection accelerates the development of hypertension via the increase of arterial stiffness. Methods: In 3102 middle-aged healthy Japanese men without hypertension at baseline, systolic/diastolic blood pressures, brachial-ankle pulse wave velocity (baPWV), and radial augmentation index (rAI) were annually measured during a 9-year study period. Results: In multivariate linear regression analysis and in mixed model linear regression analysis, baPWV was not longitudinally associated with rAI. Linear regression analysis demonstrated that the higher rAI at the baseline was associated with the larger longitudinal increase of baPWV (beta = 0.17, p < 0.01). At the end of study period, 404 subjects were developed to hypertension. The prevalence rate of the development of hypertension during the study period was higher in subjects with higher baPWV and higher rAI at the baseline (220 in 939 subjects: 23%) than that in other 3 groups classified by the status of baPWV and rAI at the baseline (e.g. 52 in 942 subjects with low baPWV combined with low rAI: 6%, p < 0.01). Conclusion: The abnormal pressure wave reflection, which may be derived from both arterial stiffness and peripheral vascular damages, may be an accelerator for the development of hypertension via the increase of arterial stiffness.