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Original research article
Influence of arterial stiffness on cardiovascular outcome in patients without high blood pressure
  1. Keishi Ichikawa1,
  2. Satoru Sakuragi1,
  3. Takahiro Nishihara1,
  4. Masahiro Tsuji1,
  5. Atsushi Mori1,
  6. Fumi Yokohama1,
  7. Tadashi Wada1,
  8. Daiji Hasegawa1,
  9. Kenji Kawamoto1,
  10. Machiko Tanakaya1,
  11. Yusuke Katayama1,
  12. Hiroshi Ito2
  1. 1 Department of Cardiovascular Medicine, Iwakuni Clinical Center, Iwakuni, Japan
  2. 2 Department of Cardiovascular Medicine, Graduate School of Medicine and Dentistry, Okayama University, Okayama, Japan
  1. Correspondence to Dr Keishi Ichikawa, Department of Cardiovascular Medicine, Iwakuni Clinical Center, Iwakuni, 740-8510, Japan ; ichikawa1987{at}


Objective Although blood pressure (BP) is a major determinant of arterial stiffness, whether high pulse wave velocity (PWV) adversely influences cardiac parameters and cardiovascular (CV) outcome in patients without high BP remains unclear.

Methods Outpatients without high BP (n=320), defined as systolic BP ≥140 mm Hg, were enrolled in this retrospective study. At baseline, all patients underwent echocardiography and multidetector CT to determine the coronary artery calcification (CAC) score. Arterial stiffness was assessed based on brachial-ankle PWV (baPWV), from which patients were classified into two groups: those with high (≥18 m/s, n=89) and low baPWV (<18 m/s, n=231). Cardiac parameters and CV event incidence during the follow-up period were compared between these groups.

Results In multivariable linear regression analysis, baPWV was significantly associated with CAC score and serum N-terminal pro-brain natriuretic peptide hormone level, after adjustment for confounding factors. In multivariable logistic regression analysis, baPWV ≥18 m/s was significantly associated with CAC score ≥400 (OR 2.466, 95% CI 1.012 to 6.009, p=0.0471). Kaplan-Meier analysis showed that the high-baPWV group experienced more CV events during the 575 days of follow-up (20% vs 6%, p=0.0003).

Conclusions High baPWV was associated with greater CAC and a high risk of a future CV event, especially coronary artery disease, even in patients without high BP.

  • Hypertension
  • Coronary Artery Disease

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  • Contributors KI and SS designed the study. TN, AM, FY, DH, KK and MT collected the data. KI and SS performed the statistical analysis and wrote the paper. MT, TW and HI revised the paper and contributed to discussion. All authors read and approved the final manuscript.

  • Funding This research received no grants from any funding agency in the public, commercial or not for profit sector.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Institutional Review Board of Iwakuni Clinical Center.

  • Provenance and peer review Not commissioned; externally peer reviewed.