Abstract Carotid-femoral (cfPWV) and brachial-ankle pulse wave velocity (baPWV) are reliable indicators of arterial stiffness with independent associations with target organ damage (TOD). However, it remains unclear whether the associations of TOD with the two PWVs might differ, especially when comparing TOD between patients with isolated (discordant) or concordant elevation of the two PWVs. Consecutive untreated outpatients referred for 24-hour ambulatory blood pressure monitoring at Ruijin Hospital were recruited. Measures of TOD included pulsatility index of cerebral arteries, carotid intima-media thickness (IMT), estimated glomerular filtration rate (eGFR), and log-transformed urinary albumin-to-creatinine ratio (log-UACR). Among 1798 participants, 1170 (65.1%) had ambulatory hypertension. CfPWV (mean± SD, 7.9 ± 1.3 m/s) and baPWV (14.6 ± 2.2 m/s) were closely intercorrelated (r=0.67, P<0.001). Both cfPWV and baPWV, as continuous variables, were significantly (P<0.001) associated with TOD measures in a similar strength (P≥0.11). In multivariable-adjusted categorical analyses, when the cfPWV/baPWV <9/<16 m/s group was set as the reference, participants with isolated elevations of either cfPWV or baPWV had similarly (P≥0.057) worse TOD measures, and concordant elevations in both PWVs demonstrated the most severe TOD in continuous measures (P<0.001), including increased pulsatility index (90.2 vs 83.2 % for right middle cerebral artery), carotid IMT (648.3 vs 627.9 µm), and log-UACR (-0.10 vs -0.35 mg/mmol), except eGFR (104.0 vs 104.6 mL/min/1.73 m², P=0.22). In conclusion, both cfPWV and baPWV are similarly independently associated with TOD with similar strength. Isolated elevations of either PWV showed comparable TOD, while dual elevations were associated with significant TOD, suggesting that the two PWV measures may capture overlapping yet distinct vascular damage.
Introduction: Carotid-femoral pulse wave velocity (cfPWV) and brachial-ankle pulse wave velocity (baPWV) are both used to assess arterial stiffness, but their agreement in identifying elevated central arterial stiffness remains uncertain. Methods: This prospective observational study included 222 adults who underwent standardized baseline vascular function testing. The primary phenotype analysis included 205 participants with available cfPWV, maximum bilateral baPWV (baPWVmax), and minimum ankle-brachial index data. Elevated central arterial stiffness was defined as cfPWV ≥10 m/s and elevated baPWV as baPWVmax ≥14 m/s. Associations between cfPWV and baPWVmax were assessed using Spearman correlation and residual correlation after adjustment for age, sex, and systolic blood pressure. Threshold agreement, receiver operating characteristic analysis, and alternative baPWVmax thresholds were evaluated. Results: cfPWV and baPWVmax showed a moderate positive correlation (Spearman ρ = 0.36, p <0.001), but their residual correlation was no longer significant after adjustment for age, sex, and systolic blood pressure (ρ = −0.05, p = 0.456). baPWVmax showed limited discrimination for elevated cfPWV, with an area under the curve of 0.669 (95% confidence interval, 0.592–0.745). At the commonly used baPWV threshold of 14 m/s, sensitivity was 40.3%, specificity was 75.9%, and Cohen’s κ was 0.17. Overall, 75 of 205 participants (36.6%) had discordant cfPWV-baPWV classification. The most frequent discordant phenotype was cfPWV-only elevation, which accounted for 43 participants (21.0%) and 59.7% of those with elevated cfPWV. The Youden-derived baPWV threshold was 11.75 m/s, which improved sensitivity to 70.8% but reduced specificity to 60.2%. Discordance persisted using alternative baPWV thresholds and after excluding participants with an ankle-brachial index <0.90. Conclusion: cfPWV and baPWV are correlated at the group level but show limited interchangeability for individual threshold-based classification. A baPWV value below 14 m/s should not be interpreted as excluding elevated central arterial stiffness. baPWV remains a practical vascular risk assessment tool, but cfPWV is still needed when the clinical or research focus is central arterial stiffness.
Introduction: An exaggerated increase in systolic blood pressure (SBP) during exercise is associated with future hypertension. While previous studies evaluated peak SBP or two-point slopes, we aimed to identify SBP response patterns from the full SBP time-series during maximal incremental exercise and assess their value for predicting future hypertension diagnosis. Methods: In this cohort study, we analysed SBP recordings from 3,486 normotensive adults (mean age 50.6 years; 45% women) undergoing maximal cycle ergometry. Group-based trajectory modelling (GBTM) extracted sex-specific responses from the full SBP time-series. Associations with incident hypertension were evaluated using multivariable Cox analyses by sex and stratified by prehypertensive status (SBP 130–150 mm Hg or DBP 85–90 mm Hg). Results: In both sexes, GBTM identified three SBP response profiles, reflecting low, mid, and high responders. Over 7.9 years, 171 (8.8%) men and 169 (10.9%) women were diagnosed with hypertension. Incidence was markedly higher in high versus low responders (e.g., in women: 27.8 vs. 2.5 events per 1,000 follow-up years). The increased risk was independent of traditional risk factors, including resting SBP (hazard ratio relative to average risk (HRadj): 1.26 [95% confidence interval: 1.00–1.57] in men, 1.59 [1.22–2.07] in women). The association attenuated with increasing resting SBP in women (pinteraction = 0.003). Notably, high SBP response was independently associated with future hypertension diagnosis in those without prehypertension (e.g., in women, HRadj: 2.17 [1.49–3.17]), but not in those with prehypertension. Reclassification analyses indicated incremental predictive value beyond resting and peak SBP in women without prehypertension. Conclusions: Time-series analysis of exercise SBP revealed distinct response profiles predicting future hypertension diagnosis beyond resting blood pressure. Comprehensive interpretation of exercise SBP may improve risk stratification, particularly in women without prehypertension.
Background: Cuffless wearable technologies for blood pressure (BP) monitoring have emerged as a promising alternative to conventional cuff-based methods, offering the possibility of continuous, real-world assessment. Summary: Ring-based devices estimate BP from peripheral signals, including photoplethysmography and pulse wave features. Although early studies have shown encouraging correlations with reference standards, these systems do not directly measure arterial pressure. Their performance is affected by physiological variability, calibration dependence, and population heterogeneity. Current evidence suggests that these devices may provide useful information about BP dynamics, but their accuracy and reliability remain insufficient for routine clinical decision-making. Key Messages: Cuffless BP monitoring represents an important technological advance, but it remains constrained by fundamental methodological challenges. Broader validation in diverse populations and outcome-based clinical trials are needed before widespread clinical adoption.
Introduction: Flow-mediated slowing (FMS), the decrease in pulse wave velocity (PWV) in response to elevated shear stress, is a simpler, operator-independent alternative to assessing arterial diameter (DIA) increase via flow-mediated dilation (FMD). Traditional flow-mediated assessment uses reactive hyperemia, yet sustained shear (ss) stress is a more ubiquitous in vivo physiological occurrence. This study aimed to determine the agreement between sustained-shear FMD (ssFMD) and sustained-shear FMS (ssFMS) in response to a sustained shear stress stimulus designed to enhance endothelial function. Methods: In 19 participants (12 male, 28 ± 8 years), brachial artery DIA and brachial-radial PWV were measured in experimental and control arms. Following baseline, sustained stepwise increases in shear rate were induced using upper-limb heating (10 min) at 47.5°c and 52.5°c, and handgrip exercise (4 min) at 0.33 Hz and 0.67 Hz in the experimental arm. The agreement was tested by modeling the overall association using a linear mixed-effects model. Results: The sustained shear protocol elicited a large increase in mean shear rate in the experimental arm (Δ 299 1/s, p < 0.001). This resulted in a significant time × condition interaction in the experimental arm, with a moderate increase in DIA (Δ 0.04 cm, ∼13%; p < 0.001) and a moderate decrease in PWV (Δ −1.7 m/s, ∼20%; p < 0.001). There was a significant within-person inverse association between ssFMD and ssFMS (β = −0.200, p < 0.001) in the experimental arm. Conclusion: ssFMS demonstrates a response consistent with ssFMD following a sustained shear stress protocol. Findings support ssFMS as a viable tool for assessing acute improvements in endothelial function.
