Identification of distinct arterial waveform clusters and a longitudinal evaluation of their clinical usefulness
Author(s)
Type
Journal Article
Abstract
Clustering of arterial blood pressure (BP) waveform parameters could summarize complex information into distinct elements, which could be used to investigate cumulative (nonredundant) associations. We investigated this hypothesis in a large, adult population-based study (ViDA trial [Vitamin D Assessment] trial). To interpret the clusters and evaluate their usefulness, we examined their predictors and associations with cardiovascular events. In 4253 adults (mean age 65 years; 55% male) without a prior cardiovascular event, suprasystolic oscillometry was performed, yielding aortic pressure waveforms and several hemodynamic parameters. Participants were followed up for 4.6 years (median), accruing 300 cardiovascular events. Principal component analysis reduced 14 arterial waveform parameters to 3 uncorrelated factors that together explained 90% of the variability of the original data. Factors 1, 2, and 3 appeared to represent BP pulsatility, mean BP, and wave reflection, respectively. Across 6 antihypertensive drug classes, there were no differences in brachial systolic (P=0.23) and diastolic (P=0.13) BP; but there were significant variations in factor 3 (P<0.0001), especially for β-blocker use. The first and third factors were positively associated with cardiovascular events (multivariable-adjusted standardized hazard ratio [95% CI]=1.33 [1.18–1.50] and 1.15 [1.02–1.30], respectively), whereas the second factor had a J-shaped relationship, with a nadir corresponding to a brachial diastolic BP of ≈75 mm Hg. In conclusion, BP pulsatility, mean BP, and wave reflection are prognostically meaningful, distinct aspects of arterial function that can be used to summarize physiological variations in multiple arterial waveform parameters and identify truly cumulative associations when used as cardiovascular risk outcomes.
Date Issued
2019-10
Date Acceptance
2019-04-29
Citation
Hypertension, 2019, 74 (4), pp.921-928
ISSN
0194-911X
Publisher
American Heart Association
Start Page
921
End Page
928
Journal / Book Title
Hypertension
Volume
74
Issue
4
Copyright Statement
© 2019 American Heart Association, Inc. Sluyter, John D., et al. "Identification of distinct arterial waveform clusters and a longitudinal evaluation of their clinical usefulness." Hypertension 74.4 (2019): 921-928.
Identifier
https://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000486010100028&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=a2bf6146997ec60c407a63945d4e92bb
Subjects
ALL-CAUSE MORTALITY
ATENOLOL
blood pressure
BLOOD-PRESSURE
cardiovascular disease
Cardiovascular System & Cardiology
HEMODYNAMICS
hypertension
Life Sciences & Biomedicine
Peripheral Vascular Disease
PREDICTS CARDIOVASCULAR EVENTS
principal component analysis
REFLECTIONS
RESERVOIR
risk
RISK-FACTORS
Science & Technology
STIFFNESS
STROKE
Publication Status
Published
Date Publish Online
2019-08-26