While arterial stiffness is known to be related to atherosclerosis, the association between arterial stiffness and cardiac systolic and diastolic function in hypertension has not been fully evaluated. The present study was conducted to simultaneously evaluate the relationship of brachial-ankle pulse wave velocity (PWV) to parameters reflecting atherosclerosis and to those reflecting the risk of congestive heart failure in patients with hypertension. In 147 patients with hypertension, the left ventricular ejection fraction, the ratio of the peak velocity of early rapid filling and the peak velocity of atrial filling (E/A ratio), and left ventricular mass index were obtained from echocardiographs, the intima-media thickness of the common carotid artery was

ulse wave velocity (PWV) is used in the management of atherosclerotic cardiovascular disease as a validated marker of disease severity and a predictor of future events. [1][2][3][4] Recently, the use of brachial -ankle PWV, which can be obtained by simply wrapping the 4 extremities with blood pressure cuffs, was validated 5-7 and the technique is quite simple it is thus useful for screening the general population; in addition, the ankle -brachial blood pressure index (ABI) can also be simultaneously obtained. [5][6][7] For accurate PWV measurement, a clear recording of the pulse waves is very important, but in cases of severe atherosclerosis, the stenosis of the arteries affects the recording and it is not sufficiently clear. 8,9 ABI is a simple marker of peripheral arterial stenosis 10-15 and can provide information about the prevalence of arterial stenosis in subjects who are undergoing a brachial -ankle PWV recording. However, the cut-off value for ABI at which the accuracy of brachial -ankle PWV measurements is diminished because of arterial stenosis has not been established. Therefore, we proposed and evaluated the following hypothesis. At the site of arterial stenosis, the serial changes in the waveform obscure the foot of the waveform and delay the calculated PWV. 9 The discrepancy in brachial -ankle PWV (abnormal difference) between the 2 sides of the Circulation Journal Vol.69, January 2005body reflects the lack of accuracy of the brachial -ankle PWV measurement on the delayed side because of arterial stenosis. Therefore, we examined the ABI on the side of the delayed brachial -ankle PWV as a marker of the lack of brachial -ankle PWV accuracy in patients with a discrepancy in their brachial -ankle PWV values (abnormal difference). Methods SubjectsOf the patients who visited the outpatient clinic of the Second Department of Internal Medicine of Tokyo Medical University Hospital or were admitted to the department for the diagnosis or treatment of cardiovascular disease between April 2001 and August 2003, patients who underwent a brachial -ankle PWV recording and gave their informed consent were enrolled in the study. Subjects with a plasma creatinine concentration of greater than 176.8 mol/L, with an aortic graft, and those with atrial fibrillation, were excluded. The total number of subjects was 1,361 (60±12 years old). Atherosclerotic cardiovascular diseases were classified according to the criteria of the International Classification of Diseases (10th version) for coronary heart disease, cerebrovascular disease, and peripheral arterial disease. Hypertension, dyslipidemia and diabetes mellitus were diagnosed according to the guidelines of the Japanese Society of Hypertension, 16 the Japan Atherosclerosis Society 17 and the Japan Diabetes Society. 18 The study's protocol was approved by the ethical committee of Tokyo Medical University. Background The present study was conducted to establish the cutoff value of the ankle -brachial pressure index (ABI) at which the accuracy of brachial -ankle pulse wave v...