Key result
Intensive blood pressure treatment (<120 mmHg) decreased total pulse wave velocity by ≥1 m/s in 41.6% of patients versus 33.1% with standard treatment, driven entirely by load-dependent stiffening.
Why the study?
Although intensive blood pressure control reduces total and load-dependent pulse wave velocity without altering structural stiffness, the specific reductions in supine SBP, DBP, and MAP needed to lower these arterial stiffness components remained unquantified.
Does intensive blood pressure reduction improve arterial stiffness (T-PWV, S-PWV, LD-PWV) in hypertensive patients?
RCT (n=516)
randomized
Does intensive blood pressure reduction improve arterial stiffness (T-PWV, S-PWV, LD-PWV) in hypertensive patients?
Blood pressure reduction decreases arterial stiffness entirely by altering load-dependent stiffening rather than structural arterial remodeling.
Answers are grounded in this paper and cite their sources.
Intensive BP control raises the share achieving ≥1 m/s T-PWV reduction; extends SPRINT by quantifying BP thresholds that drive load-dependent PWV improvement.
Background: The SPRINT (Systolic Blood Pressure Intervention Trial) measured arterial stiffness using carotid-femoral pulse wave velocity (PWV) to show that intensive blood pressure (BP) control significantly reduced total PWV (T-PWV) by reducing “pressure-dependent” PWV (load-dependent, LD-PWV), but not structural PWV (S-PWV). This study quantifies the decrease in supine systolic BP (SBP), diastolic BP (DBP), and mean arterial pressure (MAP) necessary to produce a decrease in T-PWV, S-PWV, and LD-PWV. Methods: SPRINT randomized participants to standard (< 140 mmHg) or intensive (< 120 mmHg) SBP treatment for 3 years. Supine BP and carotid femoral PWV were measured annually in a subset of 652 participants. S-PWV and LD-PWV were calculated using participant-specific exponential models. T-PWV, S-PWV, and LD-PWV change values were calculated as year 1 value -year 0 value. T-PWV, S-PWV, and LD-PWV change values were calculated and binned into 4 subgroups: (1) individuals with no change or an increase in PWV (reference group); (2) individuals with a decrease in PWV ranging from −0.5 < Δ < 0 m/s; (3) individuals with a decrease in PWV ranging from −1 < Δ ≤ −0.5 m/s; and (4) individuals with a decrease in PWV of Δ ≤ −1 m/s. Supine BP change values needed to achieve a clinically meaningful change was calculated as least squares mean and corresponding 95% confidence intervals from linear regression models adjusted for treatment group and baseline covariates, including age, sex, race/ethnicity, education, alcohol consumption, smoking status, the number of anti-hypertensive medications, and body mass index. Statistical significance was set at P< 0.05. Results: The analytic sample in this study uses data from years 0 (baseline) and 1 (N=516, age year 0= 71.7 ± 9.5 years, male/female n= 304/212, standard/intensive n= 254/262). After 1 year, 33.1% of participants in the standard treatment and 41.6% of participants in the intensive treatment group saw a decrease in T-PWV ≥ 1 m/s. Relative to those who saw no change or an increase in T-PWV, a 6.18 mmHg decrease in MAP was necessary to elicit a reduction in T-PWV between 1 and 0.5 m/s (95% CI: -10.58 to -1.77). Additionally, a 14.95, 7.44, and 9.94 mmHg decrease in SBP, DBP, and MAP, respectively were necessary to induce a decrease in T-PWV by Δ ≤ −1 m/s (All P< 0.05). No reduction in SBP, DBP, or MAP, were sufficient to alter S-PWV (All P≥0.05). In contrast, stepwise decreases in SBP (-16, -26, and -43 mmHg), DBP (-8.4, -13, and -22 mmHg), and MAP (-11, -17, and -29 mmHg) were sufficient to reduce LD-PWV by −0.5 < Δ < 0 m/s, −1 < Δ ≤ −0.5 m/s, and Δ ≤ −1 m/s (All P< 0.05). Conclusions: Decreases in SBP can elicit reductions in T-PWV and LD-PWV. Changes in BP in response to hypertensive treatment reduces arterial stiffness through a mechanism driven entirely by altering load-dependent stiffening and not arterial remodeling. Anti-hypertensive medications, and resulting changes in BP, do not reduce S-PWV. Novel therapeutic approaches are needed to target arterial stiffness caused by structural This abstract was presented at the American Physiology Summit 2026 and is only available in HTML format. There is no downloadable file or PDF version. The Physiology editorial board was not involved in the peer review process.
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DeConne et al. (2026) conducted an RCT in Hypertension (n=516). Intensive systolic blood pressure treatment vs. Standard systolic blood pressure treatment (< 140 mmHg) was evaluated on Decrease in total pulse wave velocity (T-PWV) ≥ 1 m/s. Intensive blood pressure treatment (<120 mmHg) decreased total pulse wave velocity by ≥1 m/s in 41.6% of patients versus 33.1% with standard treatment, driven entirely by load-dependent stiffening.
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