Risk stratification for mortality in patients with refractory hypertension based on estimated pulse wave velocity: insights from the nhanes 1999-2020 cohort
W Bao, X B LiuAbstract
Background
Refractory hypertension (RH) carries a disproportionately high risk of cardiovascular disease (CVD) and target organ damage. While arterial stiffness is a recognized driver of RH, the clinical utility of estimated pulse wave velocity (ePWV) for prognostic risk stratification in this specific population remains unclear.
Purpose
To evaluate the independent association between ePWV, a surrogate marker of arterial stiffness, and mortality risks, aiming to establish reliable prognostic cut-offs for patients with RH.
Methods
This prospective cohort study analysed 943 adult patients with RH from the National Health and Nutrition Examination Survey (NHANES) 1999-2020. Participants were stratified into quartiles based on baseline ePWV. Multivariable Cox proportional hazards models were utilized to assess the relationship between ePWV and both all-cause and CVD mortality. The MaxStat method was applied to identify optimal prognostic cut-off values, followed by Kaplan-Meier survival analysis
Results
Among 943 patients with RH (45.07% male), significant baseline differences were observed across ePWV quartiles regarding age, race, and renal function (all P<0.05). In the fully adjusted model (Model 4), ePWV as a continuous variable was an independent risk factor for both all-cause mortality (hazard ratio [HR] 1.55, 95% CI: 1.31-1.83, P<0.001) and CVD mortality (HR 1.45, 95% CI: 1.09-1.93, P=0.011). Compared to the lowest quartile (Q1), patients in the highest quartile (Q4: 13.3-16.7 m/s) exhibited a dramatically increased risk of all-cause mortality (HR 6.41, 95% CI: 2.30-17.85, P<0.001). MaxStat identified optimal predictive cut-offs of 12.10 m/s for all-cause mortality and 13.78 m/s for CVD mortality (Figure 1). Subsequent Kaplan-Meier analysis confirmed that patients exceeding these respective ePWV thresholds experienced significantly higher cumulative mortality rates (Figure 2).
Conclusion
Elevated ePWV is independently associated with increased all-cause and CVD mortality in patients with RH. Utilizing ePWV cut-offs of 12.10 m/s and 13.78 m/s provides a robust, non-invasive method for early mortality risk stratification, offering valuable guidance for intensive clinical management in high-risk RH patients.Figure1For image description, please refer to the figure legend and surrounding text.Figure2For image description, please refer to the figure legend and surrounding text.