You competent? doctor has been creating protocols to address arterial stiffness for stroke for over a decade, right? Oh NO, DOING NOTHING!
Not being able to provide them means your board of directors is so incompetent they can't recognize incompetence in their hospital!
- Arterial stiffness
(33 posts to May 2013)
- Aortic stiffness
(4 posts to January 2016)
Arterial Stiffness Changes Linked to Development of Dementia in SPRINT Post Hoc Analysis
Persistent elevations or rapid increases in arterial stiffness were linked to incident dementia in adults with hypertension, a SPRINT MIND trial post hoc analysis showed.
In the analysis, each 1 m/s increase in estimated pulse wave velocity was associated with more than twofold higher likelihood of developing probable dementia (adjusted hazard ratio [HR], 2.11; 95% CI, 1.93-2.30) compared with individuals with more stable vascular profiles.
Estimated pulse wave velocity — a marker of vascular aging calculated from blood pressure and age as a surrogate for arterial stiffness — has previously been linked to cardiovascular outcomes, stroke, and cognitive impairment.
A Practical Measure
However, arterial stiffness is difficult to directly measure, said Sula Mazimba, MD, MPH, of the University of Virginia in Charlottesville, Virginia, whose group reported the findings ahead of presentation at American College of Cardiology (ACC) Scientific Session 2026 in New Orleans.
“Estimated pulse wave velocity is to dementia as calcium score is to coronary artery disease,” Mazimba said. “This is one tool that can be used to assess risk and to try and shoot toward treating patients to lower their risk.”
As a noninvasive index derived from routine vitals, this measure could be clinically useful to motive more aggressive blood pressure lowering, said presenter Newton Nyirenda, MD, of Georgetown University in Washington, DC.
The SPRINT trial included 9361 adults aged 50 years or older with a systolic blood pressure between 130 and 180 mm Hg and an increased risk for cardiovascular disease but did not have a history of diabetes or stroke. It randomly assigned them to an aggressive systolic blood pressure treatment target below 120 mm Hg or then-standard 140 mm Hg, showing superiority of an intensive target for risk for heart disease, stroke, and related deaths, as well as death from all causes. The MIND substudy followed cognitive endpoints for 7670 participants, showing a reduction in mild cognitive impairment and similar but nonsignificant trend for less dementia with a tight blood pressure control target.
In the post hoc analysis, the intensive treatment arm had fewer participants with a rapidly increasing trajectory of estimated pulse wave velocity than in the standard management arm (13.6% vs 30.8%).
Study Implications
“We know that both the US and world population is underdiagnosed and undertreated from a hypertension perspective,” said Beth Abramson, MD, MSc, of St. Michael’s Hospital in Toronto, Ontario, Canada, and a spokesperson for the American College of Cardiology. Abramson was not involved in the study.
“This analysis of the SPRINT trial would suggest…wide ranging impact on our patients,” she told Medscape Medical News. However, estimated pulse wave might not be a go-to for routine clinical practice, she said.
“The take-home message is not that we should all be checking the pulse wave velocity, but we should be paying attention to the components of it,” she said. “We can’t turn back the clock when it comes to age, but we can certainly treat blood pressure in our patients and treat it appropriately.”
Analysis Findings
The top and bottom quartiles for estimated pulse wave velocity change over the trial follow-up period had more than 10-fold difference in dementia-free survival probability (HR, 10.86; 95% CI, 6.88-17.16; P < .0001). The findings were adjusted for sex, race or ethnicity, smoking, chronic kidney disease, clinical and subclinical cardiovascular disease, and treatment arm in the trial.
The risk appeared to be concentrated in the top quartile of estimated pulse wave velocity, as the other quartiles did not differ significantly from the bottom quartile, which the researchers said “supports a clinically meaningful threshold.
Their analysis included 8536 adults aged 50 years or older with hypertension from the SPRINT trial who had repeated blood pressure follow-up visits. During the trial, 324 participants developed probable dementia.
Limitations
Although SPRINT was a randomized controlled trial, the post hoc analysis could not establish causality in its findings. Rather, the “findings should be interpreted as risk stratification signals,” the researchers said.
Other limitations included omission of age from models to avoid overadjustment and unknown generalizability to lower risk populations, as all SPRINT participants had both hypertension and cardiovascular risk factors that put them at higher risk for adverse events like dementia.
SPRINT was funded by the National Heart, Lung, and Blood Institute. The researchers and Abramson disclosed having no relevant financial relationships.
Crystal Phend is an award-winning medical journalist with decades of experience reporting on clinical research and healthcare developments across specialties. When not walking the halls at a medical conference, she can be found at a keyboard in upstate New York.
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