Background: Hypertension accelerates vascular ageing, leading to aortic stiffening and dilatation. We have few data about ascending aorta diameter (AoAsc) remodeling in hypertension. Recently published reference values for AoAsc enable us to evaluate the remodeling process.

Aim of our study was to evaluate in a cohort of essential hypertensives the association between the AscAo remodeling and markers of hypertension related organ damage as left ventricular mass (LVM) and aortic stiffening (cfPWV).

Methods: 629 essential hypertensives were included (age 53.2±13.4 yo; 73,6% men; Systo-diastolic blood pressure:139/82±16.9/11.4 mmHg). All subjects underwent a transthoracic echocardiography for the evaluation of LVM and AoAsc; we also measured aortic stiffening as carotid-femoral PWV (cfPWV) with validated tonometric device (SphygmoCor). Remodeling of AoAsc was defined as the difference between measured and expected aortic diameters in relation to age, BSA and sex.

Results: In this cohort mean AoAsc diameter was 35.6±5.38 mm, with a mean AoAsc remodeling of 3.26±4.28 mm. AoAsc remodeling was related to systolic, diastolic and mean blood pressure (MBP) (for MBP r=0.11; p=0.024). LVM (r=0.26; p<0.001) and cfPWV (r=0.14; p<0.001) were related to aortic remodeling: in multivariate analysis these associations were confirmed, independently from MBP (LVM:beta 0.23; cfPWV beta 0.18; p<0.05). AoAsc remodeling progressively increased from subjects with normal LVM and geometry to patients with concentric remodeling, eccentric and concentric hypertrophy (ANOVA p<0.001).

Conclusions: Essential hypertension leads to AoAsc remodeling (3 mm), related to both cardiac and vascular (cfPWV) damage: AoAsc remodeling could be a marker of early vascular ageing, carrying a potential prognostic value