Arterial Stiffness and Cardiovascular Events in Hypertensives
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HYPERTENSION (M SAFAR, SECTION EDITOR)
Arterial Stiffness and Cardiovascular Events in Hypertensives Stéphane Laurent & Pierre Boutouyrie
Published online: 5 April 2013 # Springer Science+Business Media New York 2013
Abstract A major reason for measuring arterial stiffness routinely in clinical practice in hypertensive patients comes from the recent demonstration that arterial stiffness has predictive value for cardiovascular events, which is independent of classical risk scores. In primary prevention, some “imaging biomarkers,” such as arterial stiffness, enhance risk prediction to a higher extent than “circulating biomarkers.” The aim of the present brief review is to address the concept of “surrogate endpoint” and to determine whether aortic stiffness meets the criteria that are requested by international guidelines: (1) Proof of concept: Do novel marker levels differ between subjects with and without outcome? (2) Prospective validation: Does the novel marker predict development of future outcomes in a prospective cohort or nested case-cohort study? (3) Incremental value: Does the novel marker add predictive information to established, standard risk markers? (4) Clinical utility: Does the novel risk marker change predicted risk sufficiently to change recommended therapy? (5) Clinical outcomes: Does use of the novel risk marker improve clinical outcomes, especially when tested in a randomized clinical trial? (6) Cost-effectiveness: Does use of the novel risk marker improve clinical outcomes sufficiently to justify the additional costs? In conclusion, although aortic stiffness meets the first 4 criteria, there is still a need for studies comparing aortic stiffnessS. Laurent : P. Boutouyrie INSERM U970; Department of Pharmacology and Hôpital Européen Georges Pompidou, Université Paris-Descartes, Assistance-Publique Hôpitaux de Paris, Paris, France S. Laurent (*) Department of Pharmacology and INSERM U970, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France e-mail: [email protected]
guided therapeutic strategies with classic guidelinesguided strategies for preventing cardiovascular events. Keywords Arterial stiffness . Biomarker . Cardiovascular events . Central blood pressure . Large artery . Organ damage
Introduction In hypertension, large arteries stiffen and pulse pressure increases, due to wave reflections. A major reason for measuring arterial stiffness routinely in clinical practice in hypertensive patients comes from the recent demonstration that arterial stiffness has predictive value for CV events, which is independent of classical risk scores. Indeed, classical risk scores may underestimate the risk of cardiovascular (CV) events in specific risk groups suitable for primary prevention, such as asymptomatic hypertensive subjects [1]. Particularly, those considered at intermediate risk may benefit the most from a reassessment of their CV risk using novel biomarkers [2]. In primary prevention, some imaging biomarkers, such as arterial st
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