Impact of Stiffer Arteries on the Response to Antihypertensive Treatment: A Longitudinal Study of the SardiNIA Cohort.
Edward G Lakatta, Danilo AlunniFegatelli, Christopher H Morrell and 7 others
PMID 31884052WHAT IT FOUND
Antihypertensive treatment was associated with greater declines in systolic blood pressure over time, and with greater declines in arterial stiffness in people whose arteries were already stiffer.
Key findings
01In participants with baseline pulse wave velocity ≤10 m/s, those taking antihypertensive medication had a significantly greater decline in systolic blood pressure over time, whether or not blood pressure was controlled.
02In participants with baseline pulse wave velocity >10 m/s, antihypertensive treatment was accompanied by a significantly greater decrease in systolic blood pressure over time.
03In participants with stiffer arteries, pulse wave velocity significantly decreased over time, and treatment was associated with a greater decrease than in hypertensive participants not achieving blood pressure control.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Because this was a longitudinal population study and not a randomised trial, it cannot prove that antihypertensive treatment caused the observed changes. The authors say the results cannot be generalised and need confirmation. The average interval between assessments was about 3 years, which may make blood pressure and pulse wave velocity trajectories less precise. The sample was too small to analyse specific antihypertensive drug classes, so the study cannot say whether effects came from blood pressure lowering, direct effects on the artery, or adverse reactions and treatment discontinuation. The authors note that regression to the mean, poor adherence, and the need for multiple drugs in hypertension may complicate interpretation. Participants with visit-to-visit pulse wave velocity changes greater than 5 m/s were excluded, which may affect the measured stiffness trajectories.
Declared interests
The authors declared no conflicts of interest. The paper is listed as NIH extramural research support.
The easy way to misread this
Do not conclude that antihypertensive treatment causes reduced arterial stiffness or that stiffer arteries mean a better response to treatment. This was a longitudinal population study, not a randomised trial, and the authors could not analyse specific drug classes or separate adherence, regression to the mean, and treatment effects.