Ambulatory Arterial Stiffness Index and 24-Hour Ambulatory Pulse Pressure as Predictors of Mortality in Ohasama, Japan

Abstract

Background and Purpose-Ambulatory arterial stiffness index (AASI) and pulse pressure (PP) are indexes of arterial stiffness and can be computed from 24-hour blood pressure recordings. We investigated the prognostic value of AASI and PP in relation to fatal outcomes. Methods-In 1542 Ohasama residents (baseline age, 40 to 93 years; 63.4% women), we applied Cox regression to relate mortality to AASI and PP while adjusting for sex, age, BMI, 24-hour MAP, smoking and drinking habits, diabetes mellitus, and a history of cardiovascular disease. Results-During 13.3 years (median), 126 cardiovascular and 63 stroke deaths occurred. The sex-and age-standardized incidence rates of cardiovascular and stroke mortality across quartiles were U-shaped for AASI and J-shaped for PP. Across quartiles, the multivariate-adjusted hazard ratios for cardiovascular and stroke death significantly deviated from those in the whole population in a U-shaped fashion for AASI, whereas for PP, none of the HRs departed from the overall risk. The hazard ratios for cardiovascular mortality across ascending AASI quartiles were 1.40 (Pϭ0.04), 0.82 (Pϭ0.25), 0.64 (Pϭ0.01), and 1.35 (Pϭ0.03). Additional adjustment of AASI for PP and sensitivity analyses by sex, excluding patients on antihypertensive treatment or with a history of cardiovascular disease, or censoring deaths occurring within 2 years of enrollment, produced confirmatory results. Conclusions-In a Japanese population, AASI predicted cardiovascular and stroke mortality over and beyond PP and other risk factors, whereas in adjusted analyses, PP did not carry any prognostic information.

Pulse pressure and systolic night–day ratio interact in prediction of macrovascular disease in patients with type 2 diabetes mellitus

“…21 AASI has been shown to predict CV morbidity and mortality in various study populations, 14,[25][26][27] but, to our knowledge, not in an exclusively diabetic population. The interpretation and validity of AASI as a marker of arterial stiffness is currently debated.…”

Prediabetes is associated with abnormal circadian blood pressure variability

“…Ambulatory arterial stiffness index is a strong predictor of stroke in normotensive individuals, whereas PP is a predictor of myocardial infarction in hypertensive patients. 31,32 Among all the CVD risk factors detected on ABPM, PP and SBP are most strongly associated with angiographically detected coronary artery calcification. 33 Non-dipping, reverse dipping, nocturnal hypertension, nocturnal hypotension and autonomic failure are patterns that are easily recognized with ABPM, and with this recognition comes an opportunity for intervention and risk reduction.…”

Arterial stiffness index based on home (HASI) vs. ambulatory (AASI) blood pressure measurements

“…2,3 Most importantly, recent studies showed an association of AASI with signs of target organ damage, as well as with non-fatal and fatal strokes and cardiovascular mortality, over and beyond pulse pressure and other risk factors. [3][4][5][6] Taking into account the aforementioned data and that the classic methods of arterial stiffness evaluation require special expensive equipment and trained observers, AASI emerges as an especially applicable measure in clinical practice.…”