Central Hemodynamics Could Explain the Inverse Association Between Height and Cardiovascular Mortality

• Published in: American journal of hypertension 2014-03, Vol.27 (3), p.392-400
• Main Authors: Reeve, Jake C., Abhayaratna, Walter P., Davies, Justin E., Sharman, James E.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Blood Pressure; Blood Pressure Determination - instrumentation; Body Height; Cardiovascular disease; Cardiovascular Diseases - diagnosis; Cardiovascular Diseases - mortality; Cardiovascular Diseases - physiopathology; Cause of Death; Cross-Sectional Studies; Drug therapy; Female; Hemodynamics; Humans; Logistic Models; Male; Manometry; Middle Aged; Older people; Predictive Value of Tests; Pulse Wave Analysis; Risk Assessment; Risk Factors; Sphygmomanometers; Vascular Stiffness
• ISSN: 0895-7061; 1941-7225
• DOI: 10.1093/ajh/hpt222

BACKGROUND Mechanisms underlying the inverse relationship between height and cardiovascular mortality are unknown but could relate to central hemodynamics. We sought to determine the relation of height to central and peripheral hemodynamics, as well as clinical characteristics. METHODS The study population was comprised of 1,152 randomly selected community-dwelling adults (aged 67.7±12.3 years; 48% men). Brachial blood pressure (BP) was recorded by sphygmomanometry; central BP and aortic pulse wave velocity were estimated by applanation tonometry. Stepwise multiple regression analysis was used to determine associations between height and central and peripheral hemodynamics. RESULTS Height was not significantly associated with aortic pulse wave velocity in men or women. The relationship with height and brachial systolic BP was borderline in women (β = −0.115; P = 0.051) but not significant in men (β = −0.096; P = 0.09). Conversely, central systolic BP, estimated by transfer function (β = −0.139 for men [βM]; β = −0.172 for women [βW]) or radial second systolic peak (β M = −0.239; β W = −0.281), augmentation index at 75 bpm (β M = −0.189; β W = −0.224), and aortic pulse wave timing (β M = 0.224; β W = 0.262) were independently associated with height in both sexes (P < 0.003 for all). Both men and women of greater than median height were less likely to have coronary artery disease (P < 0.05), to have systemic hypertension (P < 0.01), or to be taking vasoactive medication (P < 0.001) compared with participants of less than median height. CONCLUSIONS Even after correcting for conventional cardiovascular risk factors, taller individuals have more favorable central hemodynamics and reduced evidence of coronary artery disease compared with shorter individuals. These findings may help explain the decreased cardiovascular risk associated with being taller and also have important clinical consequences regarding therapy.