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Brachial-ankle pulse wave velocity is a stronger predictor than blood pressure for atherosclerotic cardiovascular diseases and all-cause mortality: a cohort study

Hypertension Research volume 46, pages 2100–2112 (2023)Cite this article

Abstract

Whether brachial-ankle pulse wave velocity (baPWV) is a better predictive indicator than blood pressure (BP) for atherosclerotic cardiovascular diseases (ASCVD) events and all-cause mortality in the general population has not yet been established. The current study included 47,659 participants from the Kailuan cohort in China, who underwent the baPWV test and were free of ASCVD, atrial fibrillation, and cancer at baseline. The hazard ratios (HRs) of ASCVD and all-cause mortality were evaluated using the Cox proportional hazards model. The predictive ability of baPWV, systolic BP (SBP), and diastolic BP (DBP) for ASCVD and all-cause mortality was evaluated using the area under the curve (AUC) and concordance index (C-index). Within the median follow-up period of 3.27 and 3.32 person-years, 885 ASCVD events and 259 deaths occurred, respectively. The HRs of ASCVD and all-cause mortality increased with the increase of baPWV, SBP, and DBP. When baPWV, SBP, and DBP were analyzed as continuous variables, the adjusted HRs were 1.29 (95% CI, 1.22–1.37), 1.28 (95% CI, 1.20–1.37), and 1.26 (95% CI, 1.17–1.34) for each standard deviation increase, respectively. The AUC and C-index for baPWV in predicting ASCVD and all-cause mortality were 0.744 and 0.750, respectively, while those for SBP were 0.697 and 0.620, those for DBP were 0.666 and 0.585. The AUC and C-index of baPWV were higher than those of SBP and DBP (P < 0.001). Therefore, baPWV is an independent predictor of ASCVD and all-cause mortality in the general Chinese population, and its predictive ability is superior to that of BP.

baPWV is a more ideal screening method for ASCVD in large-scale population.

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Data that support the findings of this study are available from the corresponding author upon reasonable request and approval.

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Acknowledgements

We thank all members of the Kailuan Study for their contributions and participants for their data.

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  1. These authors contributed equally: Yingping Yang, Dankang Li

Authors and Affiliations

  1. Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, Wuhan, 430030, China

    Yingping Yang, Dankang Li, Run Liu & Yaohua Tian

  2. Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, Wuhan, 430030, China

    Yingping Yang, Dankang Li, Run Liu & Yaohua Tian

  3. Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No.38 Xueyuan Road, Beijing, 100191, China

    Yonghua Hu

  4. Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, No.57 Xinhua East Road, Tangshan City, 063001, China

    Shuohua Chen & Shouling Wu

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DKL, SLW, and YHT: designed and conducted the research; DKL and YPY: analyzed the data and wrote the paper; and all authors: critically revised the manuscript for any relevant intellectual content and read and approved the final manuscript.

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Yang, Y., Li, D., Liu, R. et al. Brachial-ankle pulse wave velocity is a stronger predictor than blood pressure for atherosclerotic cardiovascular diseases and all-cause mortality: a cohort study. Hypertens Res 46, 2100–2112 (2023). https://doi.org/10.1038/s41440-023-01313-y

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