Prospective Risk Factors for Increased Central Augmentation Index in Men and Women

Hypertensive target organs are exposed to aortic pressure rather than brachial pressure.1 Wave reflections, which arise in peripheral arteries and return to the proximal aorta during mid-to-late systole, augment central systolic pressure.1 Late systolic pressure augmentation has been linked to both structural (increased concentric remodeling) and functional (impaired diastolic relaxation) changes within the left ventricle.2–5 The central augmentation index (AIx), determined by the relative height of the first and second systolic peaks of the aortic pressure profile, has been shown to predict cardiovascular events.6,7 Furthermore, recent data show that wave reflections are strongly associated with the risk of incident heart failure in the general population.6 Therefore, it is important to characterize the determinants of increased wave reflections and late systolic pressure augmentation in the general population. Central pressure augmentation is markedly influenced by sex (with women having greater augmentation than men) and aging (with a nonlinear increase that is most pronounced until age 50 years).8–10 Although multiple cross-sectional studies have assessed the correlates of AIx9,11–13 and some prospective studies have assessed the effect of aging on AIx,14–16 to the best of our knowledge, prospective data regarding the role of metabolic and inflammatory factors on AIx are not available. This is important because measurements of arterial function assessed at a single time point may not incorporate the lifetime exposure history of individuals. Additionally, identifying predictors of change in AIx may aid in the design of future interventions that favorably impact wave reflections. In this study, we aimed to assess the factors associated with changes in central AIx over an approximately 3-year period among men and women from the general population. Prior work has shown that participants in the PREVENCION study demonstrate particularly high levels of late systolic pressure augmentation, making this a suitable population to investigate determinants of AIx.9