RESEARCH ARTICLE
Pulse wave velocity and central aortic pressure in systolic blood pressure intervention trial participants
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OPEN ACCESS Citation: Supiano MA, Lovato L, Ambrosius WT, Bates J, Beddhu S, Drawz P, et al. (2018) Pulse wave velocity and central aortic pressure in systolic blood pressure intervention trial participants. PLoS ONE 13(9): e0203305. https://doi.org/10.1371/ journal.pone.0203305 Editor: Yan Li, Shanghai Institute of Hypertension, CHINA
Mark A. Supiano1*, Laura Lovato2, Walter T. Ambrosius2, Jeffrey Bates3, Srinivasan Beddhu4, Paul Drawz5, Jamie P. Dwyer6, Naomi M. Hamburg7, Dalane Kitzman8, James Lash9, Eva Lustigova10, Cynthia M. Miracle11, Suzanne Oparil12, Dominic S. Raj13, Daniel E. Weiner14, Addison Taylor3, Joseph A. Vita7†, Reem Yunis15, Glenn M. Chertow15‡, Michel Chonchol16‡ 1 Geriatrics Division University of Utah School of Medicine and VA Salt Lake City Geriatric Research, Education and Clinical Center, Salt Lake City, Utah, United States of America, 2 Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston Salem, North Carolina, United States of America, 3 Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas, United States of America, 4 Nephrology Division University of Utah and Salt Lake City VA Medical Center, Salt Lake City, Utah, United States of America, 5 Division of Renal Diseases & Hypertension, University of Minnesota, Minneapolis, Minnesota, United States of America, 6 Division of Nephrology/Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America, 7 Section of Vascular Biology, Boston University School of Medicine, Boston, Massachusetts, United States of America, 8 Sections on Cardiovascular Medicine and Geriatrics, Wake Forest School of Medicine, Winston Salem, North Carolina, United States of America, 9 Section of Nephrology, University of Illinois at Chicago, Chicago, Illinois, United States of America, 10 Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America, 11 Division of Nephrology and Hypertension, University of California San Diego and VA San Diego Healthcare System, San Diego, California, United States of America, 12 Vascular Biology and Hypertension Program, Division of Cardiovascular Disease, Department of Medicine, School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, United States of America, 13 Division of Kidney Diseases and Hypertension, George Washington University, Washington, DC, United States of America, 14 Division of Nephrology, Tufts Medical Center, Boston, Massachusetts, United States of America, 15 Division of Nephrology, Stanford University School of Medicine, Palo Alto, California, United States of America, 16 Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Denver, Colorado, United States of America
Received: March 5, 2018 Accepted: August 16, 2018 Published: September 26, 2018 Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication. Data Availability Statement: The SPRINT data used to report our primary results in the New England Journal of Medicine (2015; 373:2103-16) has been available through BioLINCC, the NHLBI data repository since late 2016. We have now developed a process to release this data directly to SPRINT investigators through the website. To be approved for access to this data, log on to the website and from the drop-down menu at the upper left, select “Internal Data Release”. You should see two directories, one named “Application Process” and one named “BioLINCC Data”. In the
† Deceased. ‡ These authors are joint senior authors on this work. *
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Abstract Arterial stiffness, typically assessed as the aortic pulse wave velocity (PWV), and central blood pressure levels may be indicators of cardiovascular disease (CVD) risk. This ancillary study to the Systolic Blood Pressure Intervention Trial (SPRINT) obtained baseline assessments (at randomization) of PWV and central systolic blood pressure (C-SBP) to: 1) characterize these vascular measurements in the SPRINT cohort, and 2) test the hypotheses that PWV and C-SBP are associated with glucose homeostasis and markers of chronic kidney disease (CKD). The SphygmoCor® CPV device was used to assess carotid-femoral PWV and its pulse wave analysis study protocol was used to obtain C-SBP. Valid results were obtained from 652 participants. Mean (±SD) PWV and C-SBP for the SPRINT cohort were 10.7 ± 2.7 m/s and 132.0 ± 17.9 mm Hg respectively. Linear regression analyses for PWV and C-SBP results adjusted for age, sex, and race/ethnicity in relation to several markers of
PLOS ONE | https://doi.org/10.1371/journal.pone.0203305 September 26, 2018
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Pulse wave velocity and central aortic pressure in SPRINT participants
“Application Process” directory are four files, one of which contains the instructions below while the others are application forms. The process is intended to be straightforward yet provide some assurance regarding use of the data and protection of participant information. Funding: This SPRINT ancillary study was funded by a grant from the National Heart, Lung, and Blood Institute (NHLBI R01 HL107241 - MAS). AtCor Medical graciously provided the SphygmoCor devices that were utilized for this study. The Systolic Blood Pressure Intervention Trial is funded with Federal funds from the National Institutes of Health (NIH), including the National Heart, Lung, and Blood Institute (NHLBI), the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), the National Institute on Aging (NIA), and the National Institute of Neurological Disorders and Stroke (NINDS), under Contract Numbers HHSN268200900040C, HHSN268200900046C, HHSN268200900047C, HHSN268200900048C, HHSN268200900049C, and Inter-Agency Agreement Number A-HL-13002-001. It was also supported in part with resources and use of facilities through the Department of Veterans Affairs. The SPRINT investigators acknowledge the contribution of study medications (azilsartan and azilsartan combined with chlorthalidone) from Takeda Pharmaceuticals International, Inc. All components of the SPRINT study protocol were designed and implemented by the investigators. The investigative team collected, analyzed, and interpreted the data. All aspects of manuscript writing and revision were carried out by the coauthors. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH, the U.S. Department of Veterans Affairs, or the United States Government. For a full list of contributors to SPRINT, please see the supplementary acknowledgement list: https://www. sprinttrial.org/public/dspScience.cfm. We also acknowledge the support from the following CTSAs funded by NCATS: CWRU: UL1TR000439, OSU: UL1RR025755, U Penn: UL1RR024134& UL1TR000003, Boston: UL1RR025771, Stanford: UL1TR000093, Tufts: UL1RR025752, UL1TR000073 & UL1TR001064, University of Illinois: UL1TR000050, University of Pittsburgh: UL1TR000005, UT Southwestern: 9U54TR00001706, University of Utah: UL1TR000105-05, Vanderbilt University: UL1 TR000445, George Washington University: UL1TR000075, University of CA, Davis: UL1 TR000002, University of Florida: UL1 TR000064, University of Michigan: UL1TR000433, Tulane University: P30GM103337
glucose homeostasis and CKD did not identify any significant associations with the exception of a marginally statistically significant and modest association between PWV and urine albumin-to-creatinine ratio (linear regression estimate ± SE, 0.001 ± 0.0006; P-value 0.046). In a subset of SPRINT participants, PWV was significantly higher than in prior studies of normotensive persons, as expected. For older age groups in the SPRINT cohort (age > 60 years), PWV was compared with a reference population of hypertensive individuals. There were no compelling associations noted between PWV or C-SBP and markers of glucose homeostasis or CKD. Clinical Trial Registration: NCT01206062.
Introduction Arterial stiffness–typically assessed as central (aortic) carotid-femoral pulse wave velocity (PWV)–is an indicator of cardiovascular disease (CVD) risk independent of both the peripheral (brachial) BP and pulse pressure.[1–3] Recent meta-analyses have identified PWV as a predictor of future CVD events and all-cause mortality independent of blood pressure.[4, 5] Additional studies have demonstrated an association between PWV and subsequent declines in both kidney function and cognitive function.[6–11] Furthermore, many studies have demonstrated that measures of central aortic blood pressure are associated with CV outcomes and mortality independent of peripheral brachial arterial pressure, and may provide a better measure to guide antihypertensive therapy. [12] The Systolic Blood Pressure Intervention Trial (SPRINT, clinicaltrials.gov: NCT01206062) was designed to test the hypothesis that treatment to a more intensive systolic blood pressure (SBP) target of < 120 mm Hg would reduce cardiovascular morbidity and mortality versus a standard SBP target of
