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Independent prognostic value of the ambulatory arterial stiffness index and aortic pulse wave velocity in a general population

Journal of Human Hypertension volume 22, pages 214–216 (2008)Cite this article

Aortic pulse wave velocity (aPWV) and the Ambulatory Arterial Stiffness Index (AASI) both reflect arterial stiffness and predict cardiovascular outcome. To elucidate the independent contributions of both indexes to risk stratification, we studied a random population sample of 1678 Danes. In multivariate-adjusted Cox regression models including both indexes, AASI (standardized hazard ratio, 1.68; P =0.01) but not aPWV (0.91; P =0.62) predicted stroke, whereas the opposite was true for the composite of all cardiovascular events (aPWV, 1.15; P =0.03 and AASI, 1.04; P =0.68).

Aortic pulse wave velocity (aPWV), which is determined in the most pulsatile segment of the arterial circulation, is the gold standard to measure arterial stiffness.1 Furthermore, aPWV has a large amount of epidemiological evidence supporting its predictive value for cardiovascular events.2, 3, 4 However, measurement of aPWV requires special equipment and trained observers. From regular 24-h ambulatory blood pressure (BP) recordings, we defined the Ambulatory Arterial Stiffness Index (AASI) as one minus the regression slope of diastolic on systolic BP in individual subjects.5 AASI reflects the dynamic relation between diastolic and systolic BP during the day. Conceptually consistent with a hypothesis put forward in 1914,6 the stiffer the arterial tree, the closer the regression slope and AASI are to 0 and unity, respectively. However, the range of systolic and diastolic BP values, which itself depends on the duration of the awake and asleep periods and on the intensity of physical activity during daytime, might additionally influence AASI.7 Schillaci8 suggested that AASI is inversely correlated with the nocturnal BP fall and is lower in dippers than non-dippers (night-to-day BP ratio >0.90). Therefore, the degree of nocturnal BP fall could be an important confounder when assessing the clinical relevance of AASI. In three recently published cohort studies,9, 10, 11 AASI predicted cardiovascular mortality and morbidity, in particular stroke. However, none of these studies did adjust for the nocturnal BP fall.

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Authors and Affiliations

  1. Research Center for Prevention and Health, Copenhagen, Denmark

    T W Hansen

  2. University Hospital, Copenhagen, Denmark

    T W Hansen, J Jeppesen, S Rasmussen, H Ibsen & C Torp-Pedersen

  3. Shanghai Institute of Hypertension, Centre for Epidemiological Studies and Clinical Trials, Ruijin Hospital, Shanghai Jiaotong University Medical School, Shanghai, China

    Y Li & J-G Wang

  4. Division of Hypertension and Cardiovascular Rehabilitation, Department of Cardiovascular Diseases, Studies Coordinating Centre, University of Leuven, Leuven, Belgium

    J A Staessen & L Thijs

  5. Faculty of Medicine Paris-Descartes, Diagnosis Centre, Hτtel-Dieu Hospital, Paris-Descartes University, France

    M E Safar

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  1. T W Hansen
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  2. Y Li
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  3. J A Staessen
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  4. J Jeppesen
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  6. J-G Wang
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  7. L Thijs
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  8. H Ibsen
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  9. M E Safar
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  10. C Torp-Pedersen
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Correspondence to T W Hansen.

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Supplementary Information accompanies the paper on the Journal of Human Hypertension website (http://www.nature.com/jhh)

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Hansen, T., Li, Y., Staessen, J. et al. Independent prognostic value of the ambulatory arterial stiffness index and aortic pulse wave velocity in a general population. J Hum Hypertens 22, 214–216 (2008). https://doi.org/10.1038/sj.jhh.1002295

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