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Changes in baPWV and the risk of clinical outcomes: a cohort study of Chinese community-based population


It has not been fully investigated whether improved arterial stiffness (AS) can reduce the clinical outcomes risk in community population-based study. In this prospective study, a total of 5247 individuals with abnormal AS (at baseline) and repeated brachial-ankle pulse wave velocity (baPWV) measurement before 2018 years were enrolled from the Kailuan Study. According the second baPWV measurement, we divided the participants into two groups, improved AS (defined as transfer elevated AS status to normal) and persistent AS (defined as maintaining elevated AS status). The outcome was a composite event of stroke, myocardial infraction, and all-cause mortality. We used Cox proportional hazards regression to examine the association between AS status at the follow-up and the subsequent outcome. During a median of 5.2 years follow-up, we observed 413 end point events. After adjusted for potential confounders, comparing with the persistent AS group, individuals in the improved AS group had a 43% (hazard ratio [HR], 0.57; 95% confidence interval [CI] 0.35–0.94) decreased the risk of the primary composite events. We also found a baPWV decrease of 1 m/s was associated with a 3% decreased risk (HR, 0.97; 95% CI 0.94–0.99) for primary composite events. We further demonstrated that younger than 60 years, non-smoker, non-hypertension, and non-diabetes were associated with improved the AS status. In conclusion, improving AS status may reduce the risk of clinical events. In the future, more research should be performed to explore the target for improving the AS status.

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Fig. 1: Cumulative incidence of clinical events in participants with improved AS or persistent AS.
Fig. 2
Fig. 3: Factors associated with improved arterial stiffness.

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Data are available to researchers on request for purposes of reproducing the results or replicating the procedure by directly contacting the corresponding author.


  1. Tuttolomondo A, Casuccio A, Della Corte V, Maida C, Pecoraro R, Di Raimondo D, et al. Endothelial function and arterial stiffness indexes in subjects with acute ischemic stroke: relationship with TOAST subtype. Atherosclerosis. 2017;256:94–9.

    Article  CAS  PubMed  Google Scholar 

  2. Vaccarino V, Holford TR, Krumholz HM. Pulse pressure and risk for myocardial infarction and heart failure in the elderly. J Am Coll Cardiol. 2000;36:130–8.

    Article  CAS  PubMed  Google Scholar 

  3. Laurent S, Boutouyrie P, Asmar R, Gautier I, Laloux B, Guize L, et al. Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in hypertensive patients. Hypertension (Dallas, Tex: 1979). 2001;37:1236–41.

    Article  CAS  PubMed  Google Scholar 

  4. Vlachopoulos C, Aznaouridis K, Stefanadis C. Prediction of cardiovascular events and all-cause mortality with arterial stiffness: a systematic review and meta-analysis. J Am Coll Cardiol. 2010;55:1318–27.

    Article  PubMed  Google Scholar 

  5. El Dayem SM, Battah AA, El Bohy Ael M, El Shehaby A, El Ghaffar EA. Relationship of plasma level of chemerin and vaspin to early atherosclerotic changes and cardiac autonomic neuropathy in adolescent type 1 diabetic patients. J Pediatr Endocrinol Metab. 2015;28:265–73.

    Article  PubMed  Google Scholar 

  6. Van Bortel LM, Struijker-Boudier HA, Safar ME. Pulse pressure, arterial stiffness, and drug treatment of hypertension. Hypertension (Dallas, Tex: 1979). 2001;38:914–21.

    Article  PubMed  Google Scholar 

  7. Laurent S, Chatellier G, Azizi M, Calvet D, Choukroun G, Danchin N, et al. SPARTE study: normalization of arterial stiffness and cardiovascular events in patients with hypertension at medium to very high risk. Hypertension. 2021;78:983–95.

    Article  CAS  PubMed  Google Scholar 

  8. Toto-Moukouo JJ, Achimastos A, Asmar RG, Hugues CJ, Safar ME. Pulse wave velocity in patients with obesity and hypertension. Am heart J. 1986;112:136–40.

    Article  CAS  PubMed  Google Scholar 

  9. Hirai T, Sasayama S, Kawasaki T, Yagi S. Stiffness of systemic arteries in patients with myocardial infarction. A noninvasive method to predict severity of coronary atherosclerosis. Circulation. 1989;80:78–86.

    Article  CAS  PubMed  Google Scholar 

  10. Lehmann ED, Gosling RG, Sönksen PH. Arterial wall compliance in diabetes. Diabet Med. 1992;9:114–9.

    Article  CAS  PubMed  Google Scholar 

  11. Lehmann ED, Watts GF, Gosling RG. Aortic distensibility and hypercholesterolaemia. Lancet. 1992;340:1171–2.

    Article  CAS  PubMed  Google Scholar 

  12. Tropeano AI, Boutouyrie P, Pannier B, Joannides R, Balkestein E, Katsahian S, et al. Brachial pressure-independent reduction in carotid stiffness after long-term angiotensin-converting enzyme inhibition in diabetic hypertensives. Hypertension (Dallas, Tex: 1979). 2006;48:80–6.

    Article  CAS  PubMed  Google Scholar 

  13. Ong KT, Delerme S, Pannier B, Safar ME, Benetos A, Laurent S, et al. Aortic stiffness is reduced beyond blood pressure lowering by short-term and long-term antihypertensive treatment: a meta-analysis of individual data in 294 patients. J Hypertens. 2011;29:1034–42.

    Article  CAS  PubMed  Google Scholar 

  14. Ben-Shlomo Y, Spears M, Boustred C, May M, Anderson SG, Benjamin EJ, et al. Aortic pulse wave velocity improves cardiovascular event prediction: an individual participant meta-analysis of prospective observational data from 17,635 subjects. J Am Coll Cardiol. 2014;63:636–46.

    Article  PubMed  Google Scholar 

  15. Townsend RR, Wilkinson IB, Schiffrin EL, Avolio AP, Chirinos JA, Cockcroft JR, et al. Recommendations for Improving and Standardizing Vascular Research on Arterial Stiffness: A Scientific Statement From the American Heart Association. Hypertension (Dallas, Tex: 1979). 2015;66:698–22.

    Article  CAS  PubMed  Google Scholar 

  16. Verwoert GC, Elias-Smale SE, Rizopoulos D, Koller MT, Steyerberg EW, Hofman A, et al. Does aortic stiffness improve the prediction of coronary heart disease in elderly? The Rotterdam Study. J Hum Hypertens. 2012;26:28–34.

    Article  CAS  PubMed  Google Scholar 

  17. Ohkuma T, Ninomiya T, Tomiyama H, Kario K, Hoshide S, Kita Y, et al. Brachial-ankle pulse wave velocity and the risk prediction of cardiovascular disease: an individual participant data meta-analysis. Hypertension (Dallas, Tex: 1979). 2017;69:1045–52.

    Article  CAS  PubMed  Google Scholar 

  18. Yamashina A, Tomiyama H, Takeda K, Tsuda H, Arai T, Hirose K, et al. Validity, reproducibility, and clinical significance of noninvasive brachial-ankle pulse wave velocity measurement. Hypertens Res. 2002;25:359–64.

    Article  PubMed  Google Scholar 

  19. Lee JW, Lee DC, Im JA, Shim JY, Kim SM, Lee HR. Insulin resistance is associated with arterial stiffness independent of obesity in male adolescents. Hypertens Res. 2007;30:5–11.

    Article  CAS  PubMed  Google Scholar 

  20. van de Laar RJ, Stehouwer CD, Boreham CA, Murray LM, Schalkwijk CG, Prins MH, et al. Continuing smoking between adolescence and young adulthood is associated with higher arterial stiffness in young adults: the Northern Ireland Young Hearts Project. J Hypertens. 2011;29:2201–9.

    Article  PubMed  Google Scholar 

  21. Wu S, Huang Z, Yang X, Zhou Y, Wang A, Chen L, et al. Prevalence of ideal cardiovascular health and its relationship with the 4-year cardiovascular events in a northern Chinese industrial city. Circ Cardiovasc Qual outcomes. 2012;5:487–93.

    Article  PubMed  Google Scholar 

  22. Wu S, Li Y, Jin C, Yang P, Li D, Li H, et al. Intra-individual variability of high-sensitivity C-reactive protein in Chinese general population. Int J Cardiol. 2012;157:75–9.

    Article  CAS  PubMed  Google Scholar 

  23. Li W, Jin C, Vaidya A, Wu Y, Rexrode K, Zheng X, et al. Blood Pressure Trajectories and the Risk of Intracerebral Hemorrhage and Cerebral Infarction: A Prospective Study. Hypertension (Dallas, Tex: 1979). 2017;70:508–14.

    Article  CAS  PubMed  Google Scholar 

  24. Zheng M, Zhang X, Chen S, Song Y, Zhao Q, Gao X, et al. Arterial stiffness preceding diabetes: a longitudinal study. Circ Res. 2020;127:1491–8.

    Article  CAS  PubMed  Google Scholar 

  25. Chen S, Li W, Jin C, Vaidya A, Gao J, Yang H, et al. Resting heart rate trajectory pattern predicts arterial stiffness in a community-based Chinese cohort. Arterioscler Thromb Vasc Biol. 2017;37:359–64.

    Article  CAS  PubMed  Google Scholar 

  26. Zhou Z, Xing AJ, Zhang JN, Xia WH, Su C, Xu SY, et al. Hypertension, Arterial Stiffness, and Clinical Outcomes: A Cohort Study of Chinese Community-Based Population. Hypertension (Dallas, Tex: 1979). 2021;78:333–41.

    Article  CAS  PubMed  Google Scholar 

  27. Yamashina A, Tomiyama H, Arai T, Hirose K, Koji Y, Hirayama Y, et al. Brachial-ankle pulse wave velocity as a marker of atherosclerotic vascular damage and cardiovascular risk. Hypertens Res. 2003;26:615–22.

    Article  PubMed  Google Scholar 

  28. Tian X, Zuo Y, Chen S, Liu Q, Tao B, Wu S, et al. Triglyceride-glucose index is associated with the risk of myocardial infarction: an 11-year prospective study in the Kailuan cohort. Cardiovasc Diabetol. 2021;20:19.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Wang A, Sun Y, Liu X, Su Z, Li J, Luo Y, et al. Changes in proteinuria and the risk of myocardial infarction in people with diabetes or pre-diabetes: a prospective cohort study. Cardiovasc Diabetol. 2017;16:104.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Zuo Y, Li H, Chen S, Tian X, Mo D, Wu S, et al. Joint association of modifiable lifestyle and metabolic health status with incidence of cardiovascular disease and all-cause mortality: a prospective cohort study. Endocrine. 2021;75:82–91.

    Article  PubMed  Google Scholar 

  31. Ren Y, Zuo Y. Diabetes modifies the association of prehypertension with cardiovascular disease and all-cause mortality. J Clin Hypertens (Greenwich). 2021;23:1221–8.

    Article  PubMed  Google Scholar 

  32. Stroke–1989. Recommendations on stroke prevention, diagnosis, and therapy. Report of the WHO Task Force on Stroke and other Cerebrovascular Disorders. Stroke. 1989;20:1407–31.

    Article  Google Scholar 

  33. Tunstall-Pedoe H, Kuulasmaa K, Amouyel P, Arveiler D, Rajakangas AM, Pajak A. Myocardial infarction and coronary deaths in the World Health Organization MONICA Project. Registration procedures, event rates, and case-fatality rates in 38 populations from 21 countries in four continents. Circulation. 1994;90:583–12.

    Article  CAS  PubMed  Google Scholar 

  34. Wang C, Yuan Y, Zheng M, Pan A, Wang M, Zhao M, et al. Association of age of onset of hypertension with cardiovascular diseases and mortality. J Am Coll Cardiol. 2020;75:2921–30.

    Article  PubMed  Google Scholar 

  35. Shahin Y, Khan JA, Chetter I. Angiotensin converting enzyme inhibitors effect on arterial stiffness and wave reflections: a meta-analysis and meta-regression of randomised controlled trials. Atherosclerosis. 2012;221:18–33.

    Article  CAS  PubMed  Google Scholar 

  36. Zhang G, Fan Y, Qiu Y, Zhou Z, Zhang J, Wang Z, et al. Allisartan isoproxil improves endothelial function and vascular damage in patients with essential hypertension: a single-center, open-label, randomized controlled trial. Adv Ther. 2020;37:3551–61.

    Article  CAS  PubMed  Google Scholar 

  37. Karalliedde J, Smith A, DeAngelis L, Mirenda V, Kandra A, Botha J, et al. Valsartan improves arterial stiffness in type 2 diabetes independently of blood pressure lowering. Hypertension (Dallas, Tex: 1979). 2008;51:1617–23.

    Article  CAS  PubMed  Google Scholar 

  38. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH guidelines for the management of arterial hypertension. Eur Heart J. 2018;39:3021–104.

    Article  PubMed  Google Scholar 

  39. Tomiyama H, Hashimoto H, Tanaka H, Matsumoto C, Odaira M, Yamada J, et al. Continuous smoking and progression of arterial stiffening: a prospective study. J Am Coll Cardiol. 2010;55:1979–87.

    Article  CAS  PubMed  Google Scholar 

  40. Vaitkevicius PV, Fleg JL, Engel JH, O’Connor FC, Wright JG, Lakatta LE, et al. Effects of age and aerobic capacity on arterial stiffness in healthy adults. Circulation. 1993;88:1456–62.

    Article  CAS  PubMed  Google Scholar 

  41. Clifton PM, Keogh JB, Foster PR, Noakes M. Effect of weight loss on inflammatory and endothelial markers and FMD using two low-fat diets. Int J Obes (2005). 2005;29:1445–51.

    Article  CAS  Google Scholar 

  42. Keogh JB, Brinkworth GD, Noakes M, Belobrajdic DP, Buckley JD, Clifton PM. Effects of weight loss from a very-low-carbohydrate diet on endothelial function and markers of cardiovascular disease risk in subjects with abdominal obesity. Am J Clin Nutr. 2008;87:567–76.

    Article  CAS  PubMed  Google Scholar 

  43. Dengo AL, Dennis EA, Orr JS, Marinik EL, Ehrlich E, Davy BM, et al. Arterial destiffening with weight loss in overweight and obese middle-aged and older adults. Hypertension (Dallas, Tex: 1979). 2010;55:855–61.

    Article  CAS  PubMed  Google Scholar 

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We thank all the survey teams of the Kailuan Study group for their contribution and the study participants who contributed their information.


This study was supported by National Key Research and Development Program of China (2022YFC3600600), Beijing Natural Science Foundation Haidian original innovation joint fund (L222123), Fund for Young Talents of Beijing Medical Management Center (QML20230505), and the high-level public health talents (xuekegugan-02-47). Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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YZ wrote the manuscript, and are equal contributors in this study, thus share first authorships. XT participated in the data analysis. SC participated in the data collection, study management and study coordination. AW and SW contributed to the discussion, reviewed, and edited the manuscript. All authors read and approved the final manuscript.

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Correspondence to Shouling Wu or Anxin Wang.

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Zuo, Y., Chen, S., Tian, X. et al. Changes in baPWV and the risk of clinical outcomes: a cohort study of Chinese community-based population. J Hum Hypertens 38, 460–466 (2024).

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