ESTIMATED PULSE WAVE VELOCITY AS A INDEPENDANT GLOBAL CARDIOVASCULAR RISK STRATIFICATION TOOL IN HYPERTENSIVE PATIENTS

Objective: To evaluate the value of estimated pulse wave velocity (ePWV) as a risk stratification tool in hypertensive patients.Design and method: The ePWV of 274 hypertensive patients referred to a specialty hospital consultation who underwent 24 h ambulatory blood pressure monitoring was calculated through the formula proposed by Greve et al. Through independent sample T-testing, Kaplan-Meier survival analysis and Cox Regression analysis, its value in predicting major adverse cardiovascular events (MACE), was evaluated. A secondary analysis for heart failure hospitalization alone was also performed. Results: The population in study contained 274 patients, of whom 160 were male (58%) and 114 were female, with a mean age of 59 years. The formula resulted in a mean ePWV of 9.3 m/s (range 6 to 14 m/s), with 30 (11%) being above the 12 m/s proposed cut-off value. In this sample, 156 had dyslipidemia (57%), 109 obesity (40%), and 93 diabetes (34%). The most frequent event was heart failure (HF) hospitalization (n=26), acute coronary syndrome (ACS) (n=19), stroke (n=18) and cardiovascular death (n=12). The ePWV had a positive statistically significant association with MACE, with a two-sided p=0.025. In the Kaplan-Meier survival curve analysis, having a high ePWV resulted in a statistically significant worse prognosis, with a long rank of 3.851 (p=0.050) (Figure 1). The results were evaluated through multivariate testing utilizing the Cox Regression model, with a high ePWV maintaining its predictive value when compared with the different cardiovascular risk factors (HR 2.3, p=0.025), as well as the different office blood pressure values (HR 2.1, p=0.040). A survival curve analysis was also performed for HF hospitalization alone, with high ePWV having statistically significant worse survival, for a log rank 4.000 (p=0.045). Similarly, these results were confirmed through Cox Regression model, with high ePWV maintaining its predictive value when compared to the different cardiovascular risk factors (HR 4.2, p=0.016). Conclusions: In our cohort of hypertensive patients, estimated pulse wave velocity proved to be a valuable risk stratification tool, independently predicting major adverse cardiovascular events. These findings underscore its potential use to enhance risk assessment and inform management strategies.