Late systolic central hypertension as a predictor of incident heart failure: the Multi-ethnic Study of Atherosclerosis

Background: experimental studies demonstrate that high aortic pressure in late systole relative to early systole causes greater myocardial remodeling and dysfunction,for any given absolute peak systolic pressure.methods and results: we tested the hypothesis that late systolic hypertension,defined as the ratio of late (last one third of systole) to early (first two thirds of systole) pressure-time integrals (pti) of the aortic pressure waveform,independently predicts incident heart failure (hf) in the general population. aortic pressure waveforms were derived from a generalized transfer function applied to the radial pressure waveform recorded noninvasively from 6124 adults. the late/early systolic pti ratio (l/e(spti)) was assessed as a predictor of incident hf during median 8.5 years of follow-up. the l/e(spti) was predictive of incident hf (hazard ratio per 1% increase=1.22; 95% ci=1.15 to 1.29; p<0.0001) even after adjustment for established risk factors for hf (hr=1.23; 95% ci=1.14 to 1.32: p<0.0001). in a multivariate model that included brachial systolic and diastolic blood pressure and other standard risk factors of hf,l/e(spti) was the modifiable factor associated with the greatest improvements in model performance. a high l/e(spti) (>58.38%) was more predictive of hf than the presence of hypertension. after adjustment for each other and various predictors of hf,the hr associated with hypertension was 1.39 (95% ci=0.86 to 2.23; p=0.18),whereas the hr associated with a high l/e was 2.31 (95% ci=1.52 to 3.49; p<0.0001).conclusions: independently of the absolute level of peak pressure,late systolic hypertension is strongly associated with incident hf in the general population. © 2015 the authors. published on behalf of the american heart association,inc.,by wiley blackwell.