Association between long-term blood pressure control and ten-year progression in carotid arterial stiffness among hypertensive individuals: The multiethnic study of atherosclerosis

Background: Arterial stiffness was shown to be higher among hypertensive patients with diabetes than those without diabetes and among older than younger hypertensive patients. We examined whether the association between long-term blood pressure (BP) control and 10-year progression in carotid arterial stiffness varies by diabetes status and age. Methods: Participants were 906 individuals with hypertension at baseline and three follow-up visits in the Multi-Ethnic Study of Atherosclerosis (mean age 63.7 years, 44% males). Participants with SBP of less than 140mmHg and DBP of less than 90mmHg were considered to have a controlled BP. Arterial stiffness was measured using distensibility coefficient × 10^-4/mmHg and Young's elastic modulus (YEM × 10²mmHg) at baseline and after a mean of 9.5 years (visit 5). Multiple linear regression model was used for the analysis. Results: Having controlled BP at three visits (distensibility coefficient: β = 3.6, P- 0.004; YEM: β = -6.8, P = 0.07) or four visits (distensibility coefficient: β = 2.4, P=0.04; YEM: β = -6.8, P=0.05), when compared with having uncontrolled BP at all four visit, was associated with lesser progression in arterial stiffness. In a stratified analysis, arterial stiffness progression was slower only among nondiabetics with controlled BP at three visits (distensibility coefficient: β = 4.3, P- 0.002; YEM: β = -8.8, P = 0.04) or four visits (β = 3.7, P = 0.01; YEM: β = -10.4, P = 0.01) and among those less than 70 years with controlled BP at three visits (distensibility coefficient: β = 4.9, P- 0.004; YEM: β = -10.6, P=0.01) or four visits (distensibility coefficient: β = 2.9, P=0.07; YEM: β = -7.6, P = 0.03). Conclusion: These findings suggest that controlling BP alone may not be sufficient to slow progression of arterial stiffness among hypertensive patients with concurrent diabetes and elderly hypertensive patients.