Arterial stiffness has prognostic value in the general community and in those with hypertension, and there has been growing evidence recently of an association between systemic inflammation and arterial stiffness. Is systemic inflammation important in the pathogenesis of arterial stiffness, and what are the clinical implications?

Arterial stiffness as determined by aortic pulse wave velocity, is an independent risk factor for future vascular events in those with end-stage renal disease, in those with essential hypertension, in those with non-insulin-dependent diabetes mellitus, and also in apparently healthy individuals (1-4). The augmentation index is a composite measurement reflecting aortic stiffness and left ventricular ejection, and has been found to predict cardiovascular and all-cause mortality in patients with end-stage renal disease (5).

Men and women with hypertension have higher high-sensitivity C-reactive protein (hs-CRP) levels (6), reflecting low-grade systemic inflammation. Hs-CRP levels were also previously shown to predict the future development of hypertension in normotensive individuals (7). What then is the relationship between hs-CRP and arterial stiffness? A recent study by Kullo and colleagues found these two variables (log transformed hs-CRP and pulse wave velocity) to be related in asymptomatic subjects from the community (8).

The present study by Prof. Feely's group investigated whether there is an independent relationship between pulse wave velocity or augmentation index, and hs-CRP and other markers of inflammation, in a group of seventy-eight untreated hypertensive individuals (9). Prof. Feely talks about these findings and some new data on the relationship of hs-CRP and pulse wave velocity in treated hypertensive patients (10).

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After viewing this presentation the participant will be able to discuss:

- Arterial stiffness as a predictor of future vascular events
- Hs-CRP levels in hypertensive individuals
- The prognostic value of hs-CRP for the future development of hypertension
- The relationship between hs-CRP and arterial stiffness in hypertensive individuals
- Possible therapeutic implications

1. Jacques Blacher, MD; Alain P. Guerin, MD; Bruno Pannier, MD; Sylvain J. Marchais, MD; Michel E. Safar, MD; Gérard M. London, MD. Impact of Aortic Stiffness on Survival in End-Stage Renal Disease Circulation. 1999;99:2434-2439.

2. Stéphane Laurent; Pierre Boutouyrie; Roland Asmar; Isabelle Gautier; Brigitte Laloux; Louis Guize; Pierre Ducimetiere; Athanase Benetos. Aortic Stiffness Is an Independent Predictor of All-Cause and Cardiovascular Mortality in Hypertensive Patients Hypertension. 2001;37:1236.

3. Kennedy Cruickshank, MB, MD; Lisa Riste, PhD; Simon G. Anderson, PhD; John S. Wright, PhD; Graham Dunn, PhD; Ray G. Gosling, PhD. Aortic Pulse-Wave Velocity and Its Relationship to Mortality in Diabetes and Glucose Intolerance: An Integrated Index of Vascular Function? Circulation. 2002;106:2085.

4. Mattace-Raso FU, van der Cammen TJ, Hofman A, van Popele NM, Bos ML, Schalekamp MA, Asmar R, Reneman RS, Hoeks AP, Breteler MM, Witteman JC.Arterial Stiffness and Risk of Coronary Heart Disease and Stroke: The Rotterdam Study Circulation. 2006;113:657-663.

5. Gérard M. London; Jacques Blacher; Bruno Pannier; Alain P. Guérin; Sylvain J. Marchais; Michel E. Safar. Arterial Wave Reflections and Survival in End-Stage Renal Failure Hypertension. 2001;38:434.

6. Lakoski SG, Cushman M, Palmas W, Blumenthal R, D'Agostino RB Jr, Herrington DM.The Relationship Between Blood Pressure and C-Reactive Protein in the Multi-Ethnic Study of Atherosclerosis (MESA) J Am Coll Cardiol. 2005 Nov 15;46(10):1869-74.

7. Howard D. Sesso, ScD, MPH; Julie E. Buring, ScD; Nader Rifai, PhD; Gavin J. Blake, MD, MPH; J. Michael Gaziano, MD, MPH; Paul M. Ridker, MD, MPH C-Reactive Protein and the Risk of Developing Hypertension JAMA. 2003;290:2945-2951.

8. Kullo IJ, Seward JB, Bailey KR, Bielak LF, Grossardt BR, Sheedy PF 2nd, Peyser PA, Turner ST.C-Reactive Protein Is Related to Arterial Wave Reflection and Stiffness in Asymptomatic Subjects From the Community Am J Hypertens. 2005 Aug;18(8):1123-9.

9. Azra Mahmud; John Feely. Arterial Stiffness Is Related to Systemic Inflammation in Essential Hypertension Hypertension. 2005;46:1118.

10. Kim JS, Kang TS, Kim JB, Seo HS, Park S, Kim C, Ko YG, Choi D, Jang Y, Chung N.Significant association of C-reactive protein with arterial stiffness in treated non-diabetic hypertensive patients Atherosclerosis. 2006 Jun 16; [Epub ahead of print].