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Publications

Journal Article Ahead of print

PubMed: 41503706 DOI: 10.1161/HYPERTENSIONAHA.125.25442

End Point-Based Threshold for the Ambulatory Arterial Stiffness Index.

Hypertension

Authors: Yi-Bang Cheng, De-Wei An, Dong-Yan Zhang, Yu-Ling Yu, Jesus D Melgarejo, José Boggia, Dries S Martens, Tine W Hansen, Kei Asayama, Takayoshi Ohkubo, Katarzyna Stolarz-Skrzypek, Qi-Fang Huang, Sofia Malyutina, Edoardo Casiglia, Lars Lind, Gladys E Maestre, Ji-Guang Wang, Masahiro Kikuya, Kalina Kawecka-Jaszcz, Eamon Dolan, Edgardo Sandoya, Marek Rajzer, Tim S Nawrot, Krzysztof Narkiewicz, Wen-Yi Yang, Peter Verhamme, Jan Filipovský, Auxiliadora Graciani, José R Banegas, Yan Li, Jan A Staessen

Affiliations

  • Department of Cardiovascular Medicine, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, National Research Centre for Translational Medicine, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, China. (Y.-B.C, D.-W.A. D.-Y.Z. Q.-F.H. J.G.W. Y.L. J.A.S).
  • Non-Profit Research Association Alliance for the Promotion of Preventive Medicine, Mechelen, Belgium (D.-Y.Z. Y.-L.Y, T.W.H. K.A. K.S.-S. G.E.M. J.A.S).
  • Research Unit Environment and Health, KU Leuven Department of Public Health and Primary Care, University of Leuven, Belgium. (D.-Y.Z. Y.-L.Y. T.S.N.).
  • Institute of Neuroscience, Neuro and Behavioral Health Integrated Service Unit, University of Texas Rio Grande Valley, Harlingen (J.D.M. G.E.M).
  • South Texas Alzheimer's Disease Research Center, San Antonio/Harlingen (J.D.M. G.E.M).
  • Faculty of Medicine, Laboratory of Neurosciences, University of Zulia, Venezuela (J.D.M. G.E.M).
  • Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (J.R.B.).
  • Center for Environmental Sciences, Hasselt University, Diepenbeek, Belgium (D.S.M. T.S.N.).
  • The Steno Diabetes Center Copenhagen and Center for Health, Denmark (T.W.H.).
  • Department of Clinical Medicine, University of Copenhagen, Denmark (T.W.H.).
  • Tohoku Institute for Management of Blood Pressure, Sendai, Japan (K.A.).
  • Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A. T.O. M.K.).
  • The First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland (K.S.-S. K.K.-J. M.R. J.A.S).
  • Institute of Internal and Preventive Medicine-Branch of the Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Sciences, Novosibirsk (S.M.).
  • Department of Medicine, University of Padua, Italy (E.C.).
  • Section of Geriatrics, Department of Public Health and Caring Sciences, Uppsala University, Sweden (L.L.).
  • School of Medicine, Stroke Service, University College Cork, Ireland (E.D.).
  • Asociación Española, Montevideo, Uruguay (E.S.).
  • Hypertension Unit, Department of Hypertension and Diabetology, Medical University of Gdańsk, Poland (K.N.).
  • Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China. (W.-Y.Y.).
  • Center for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium. (P.V.).
  • Department of Internal Medicine II, University Hospital, Charles University Medical School, Pilsen, Czech Republic (J.F.).
  • Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/CIBERESP, Spain (A.G. J.R.B).
  • Biomedical Research Group, Faculty of Medicine, University of Leuven, Belgium. (J.A.S).

Abstract

BACKGROUND

The ambulatory arterial stiffness index (AASI) is increasingly used in clinical research and practice. This individual-participant meta-analysis aims to consolidate the prognostic accuracy of AASI in the general population and to derive an end point-based AASI risk threshold.

METHODS

In 12 558 individuals enrolled in 14 population studies (48.8% women; mean age, 59.3 years), AASI was derived by regressing 24-hour diastolic on systolic blood pressure (mm Hg/mm Hg). Using Cox regression, the risk-carrying AASI threshold was established by examining stepwise increasing AASI levels and by determining the AASI level, yielding a 10-year risk similar to an office systolic pressure of 140 mm Hg.

RESULTS

Over 10.7 years (median), 3027 all-cause deaths and 2183 cardiovascular end points occurred. In all participants, multivariable-adjusted hazard ratios expressing the all-cause deaths and cardiovascular end point risk per 1-SD AASI increment were 1.08 (95% CI, 1.04-1.13) and 1.13 (95% CI, 1.07-1.18). In a randomly defined subset of 8189 individuals, the risk-carrying AASI thresholds converged to 0.50 with hazard ratios (≥0.50 versus <0.50) of 1.14 (95% CI, 1.04-1.26) for all-cause deaths and 1.13 (95% CI, 1.01-1.26) for cardiovascular end point. In the replication sample (n=4369), these hazard ratios were 1.13 (95% CI, 1.01-1.26) and 1.19 (95% CI, 1.04-1.35). AASI continuous or per threshold significantly improved model performance. Analyses of secondary end points and subgroups stratified by sex, age, hypertension status and treatment, history of cardiovascular disease, and nocturnal dipping were confirmatory.

CONCLUSIONS

Over and beyond traditional risk factors, AASI improves risk stratification. Exceeding the risk-carrying 0.50 AASI threshold necessitates increased vigilance in managing risk factors before irreversible cardiovascular complications occur.

MeSH

Mortality, Cardiovascular Diseases, Blood Pressure, Risk Factors, Morbidity, Hemodynamics, Vascular Stiffness