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Association between baseline brachial–ankle pulse wave velocity and short-term risk of first stroke among Chinese hypertensive adults

Journal of Human Hypertension volume 36, pages 1085–1091 (2022)Cite this article

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Abstract

Little information is available on the association between brachial–ankle pulse wave velocity (baPWV) and the risk of stroke in Chinese H-type hypertension patients. Therefore, our study aimed to assess this association between baseline baPWV and short-term risk of first stroke and to propose a cutoff value of baPWV that could predict near cerebrovascular events. A total of 9787 hypertension patients without preexisting stroke who underwent baPWV measurement were included. The primary end points were first symptomatic stroke. Secondary end points were first ischemic stroke and first hemorrhagic stroke. During a median follow-up of 20.8 months, there was a total of 138 first strokes including 123 first ischemic strokes and 15 first hemorrhagic strokes. When baPWV was categorized in quartiles, the higher risks of first stroke (HR = 1.52; 95% CI: 1.05–2.21) and first ischemic stroke (HR = 1.53; 95% CI: 1.03–2.26) were found in participants in quartile 4 (≥21.31 m/s), compared with those in quartile 1–3 (<21.31 m/s). In receiver operating characteristic curve analysis, the best cutoff value of baPWV that could predict first stroke was 21.43 m/s. Higher baPWV (≥21.43 m/s) was significantly associated with increased risk of first stroke (HR = 1.60; 95% CI: 1.10–2.32) and first ischemic stroke (HR = 1.60; 95% CI: 1.08–2.37). In conclusion, higher baPWV levels were associated with an increased risk of first stroke among Chinese H-type hypertensive patients. In addition, a cutoff value of 21.43 m/s of baPWV was proposed that could predict the next two years’ cerebrovascular events.

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Fig. 1: Flow chart of study populations.
Fig. 2: Kaplan–Meier survival curves for unadjusted first stroke and first ischemic stroke according to quartiles of baseline baPWV.
Fig. 3: The association between baseline baPWV and incident risk of first stroke and first ischemic stroke.

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

References

  1. Wang W, Jiang B, Sun H, Ru X, Sun D, Wang L, et al. Prevalence, incidence, and mortality of stroke in China: results from a nationwide population-based survey of 480 687 adults. Circulation 2017;135:759–71.

    Article  Google Scholar 

  2. GBD SC. Global, regional, and national burden of stroke, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol 2019;18:439–58.

    Article  Google Scholar 

  3. Meschia JF, Bushnell C, Boden-Albala B, Braun LT, Bravata DM, Chaturvedi S, et al. Guidelines for the primary prevention of stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014;45:3754–832.

    Article  Google Scholar 

  4. Huo Y, Li J, Qin X, Huang Y, Wang X, Gottesman RF, et al. Efficacy of folic acid therapy in primary prevention of stroke among adults with hypertension in China: the CSPPT randomized clinical trial. JAMA 2015;313:1325–35.

    Article  CAS  Google Scholar 

  5. Liu LS. 2010 Chinese guidelines for the management of hypertension. Zhonghua Xin Xue Guan Bing Za Zhi 2011;39:579–615.

    Google Scholar 

  6. Towfighi A, Markovic D, Ovbiagele B. Pronounced association of elevated serum homocysteine with stroke in subgroups of individuals: a nationwide study. J Neurol Sci 2010;298:153–7.

    Article  CAS  Google Scholar 

  7. Li J, Jiang S, Zhang Y, Tang G, Wang Y, Mao G, et al. H-type hypertension and risk of stroke in chinese adults: a prospective, nested case-control study. J Transl Int Med 2015;3:171–8.

    Article  Google Scholar 

  8. Ohkuma T, Ninomiya T, Tomiyama H, Kario K, Hoshide S, Kita Y, et al. Brachial-ankle pulse wave velocity and the risk prediction of cardiovascular disease: an individual participant data meta-analysis. Hypertension 2017;69:1045–52.

    Article  CAS  Google Scholar 

  9. Kim HL, Lim WH, Seo JB, Kim SH, Zo ZH, Kim MA. Prediction of cardiovascular events using brachial-ankle pulse wave velocity in hypertensive patients. J Clin Hypertens (Greenwich). 2020;22:1659–65.

    Article  Google Scholar 

  10. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Bohm M, et al. ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2013;31:1281–357.

    Article  CAS  Google Scholar 

  11. Tomiyama H, Matsumoto C, Shiina K, Yamashina A, Brachial-Ankle PWV. Current status and future directions as a useful marker in the management of cardiovascular disease and/or cardiovascular risk factors. J Atheroscler Thromb 2016;23:128–46.

    Article  CAS  Google Scholar 

  12. Kim J, Song TJ, Kim EH, Lee KJ, Lee HS, Nam CM, et al. Brachial-ankle pulse wave velocity for predicting functional outcome in acute stroke. Stroke 2014;45:2305–10.

    Article  Google Scholar 

  13. Song Y, Xu B, Xu R, Tung R, Frank E, Tromble W, et al. Independent and joint effect of brachial-ankle pulse wave velocity and blood pressure control on incident stroke in hypertensive adults. Hypertension 2016;68:46–53.

    Article  CAS  Google Scholar 

  14. Kim YB, Park K, Chung P, Kim JM, Moon HS, Youn YC. Brachial-ankle pulse wave velocity is associated with both acute and chronic cerebral small vessel disease. Atherosclerosis 2016;245:54–59.

    Article  CAS  Google Scholar 

  15. Kawai T, Ohishi M, Onishi M, Ito N, Takeya Y, Oguro R, et al. Prognostic impact of regional arterial stiffness in hypertensive patients. Heart Vessels 2015;30:338–46.

    Article  Google Scholar 

  16. Munakata M, Konno S, Miura Y, Yoshinaga K. Prognostic significance of the brachial-ankle pulse wave velocity in patients with essential hypertension: final results of the J-TOPP study. Hypertens Res 2012;35:839–42.

    Article  CAS  Google Scholar 

  17. Chen SC, Chang JM, Liu WC, Tsai YC, Tsai JC, Hsu PC, et al. Brachial-ankle pulse wave velocity and rate of renal function decline and mortality in chronic kidney disease. Clin J Am Soc Nephrol 2011;6:724–32.

    Article  Google Scholar 

  18. Yamashina A, Tomiyama H, Takeda K, Tsuda H, Arai T, Hirose K, et al. Validity, reproducibility, and clinical significance of noninvasive brachial-ankle pulse wave velocity measurement. Hypertens Res 2002;25:359–64.

    Article  Google Scholar 

  19. Liu Z, Yang Y, Zhang Y, et al. Association of brachial-ankle pulse wave velocity and carotid plaque in Chinese hypertensive adults: effect modification by age. Hypertension Res 2020;43:808–16.

    Article  Google Scholar 

  20. Sun P, Liu L, Liu C, Zhang Y, Yang Y, Qin X, et al. Carotid intima-media thickness and the risk of first stroke in patients with hypertension. Stroke 2020;51:379–86.

    Article  Google Scholar 

  21. Vanderweele TJ, Ding P. Sensitivity analysis in observational research: introducing the E-value. Ann Intern Med 2017;167:268–74.

    Article  Google Scholar 

  22. Ohkuma T, Ninomiya T, Tomiyama H, Kario K, Hoshide S, Kita Y, et al. Brachial-ankle pulse wave velocity and the risk prediction of cardiovascular disease. Hypertension 2017;69:1045–52.

    Article  CAS  Google Scholar 

  23. Li T, Wu XJ, Chen XM, Wang SB, Liu KD, Xing YQ. Ankle-brachial index and brachial-ankle pulse wave velocity are risk factors for ischemic stroke in patients with Type 2 diabetes. Neural Regen Res 2017;12:1853–9.

    Article  Google Scholar 

  24. Ohkuma T, Tomiyama H, Ninomiya T, Kario K, Hoshide S, Kita Y, et al. Proposed cutoff value of brachial-ankle pulse wave velocity for the management of hypertension. Circ J 2017;81:1540–2.

    Article  Google Scholar 

  25. Morimoto S, Yurugi T, Aota Y, Sakuma T, Jo F, Nishikawa M, et al. Prognostic significance of ankle-brachial index, brachial-ankle pulse wave velocity, flow-mediated dilation, and nitroglycerin-mediated dilation in end-stage renal disease. Am J Nephrol 2009;30:55–63.

    Article  Google Scholar 

  26. Nakamura M, Yamashita T, Yajima J, Oikawa Y, Sagara K, Koike A, et al. Brachial-ankle pulse wave velocity as a risk stratification index for the short-term prognosis of type 2 diabetic patients with coronary artery disease. Hypertens Res 2010;33:1018–24.

    Article  Google Scholar 

  27. Meguro T, Nagatomo Y, Nagae A, Seki C, Kondou N, Shibata M, et al. Elevated arterial stiffness evaluated by brachial-ankle pulse wave velocity is deleterious for the prognosis of patients with heart failure. Circ J 2009;73:673–80.

    Article  Google Scholar 

  28. Kitahara T, Ono K, Tsuchida A, Kawai H, Shinohara M, Ishii Y, et al. Impact of brachial-ankle pulse wave velocity and ankle-brachial blood pressure index on mortality in hemodialysis patients. Am J Kidney Dis 2005;46:688–96.

    Article  Google Scholar 

  29. Zeki AHA, Newman AB, Simonsick E, Sink KM, Sutton TK, Watson N, et al. Pulse wave velocity and cognitive decline in elders: the Health, Aging, and Body Composition study. Stroke 2013;44:388–93.

    Article  Google Scholar 

  30. Webb AJ, Simoni M, Mazzucco S, Kuker W, Schulz U, Rothwell PM. Increased cerebral arterial pulsatility in patients with leukoaraiosis: arterial stiffness enhances transmission of aortic pulsatility. Stroke 2012;43:2631–6.

    Article  Google Scholar 

  31. Palombo C, Kozakova M. Arterial stiffness, atherosclerosis and cardiovascular risk: pathophysiologic mechanisms and emerging clinical indications. Vasc Pharmacol 2016;77:1–7.

    Article  CAS  Google Scholar 

  32. Liu X, Sun N, Yu T, Fan F, Zheng M, Qian G, et al. The independent and joint association of blood pressure, serum total homocysteine, and fasting serum glucose levels with brachial-ankle pulse wave velocity in chinese hypertensive adults. Int Heart J 2016;57:627–33.

    Article  CAS  Google Scholar 

  33. Saji N, Kimura K, Kawarai T, Shimizu H, Kita Y. Arterial stiffness and progressive neurological deficit in patients with acute deep subcortical infarction. Stroke 2012;43:3088–90.

    Article  Google Scholar 

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Acknowledgements

We acknowledge the contribution of all staff who participated in this study as well as the study participants who shared their time with us.

Funding

The study was supported by funding from the following: Peking University Medicine Fund of Fostering Young Scholars’ Scientific & Technological Innovation [grant 34254]; the National Key Research and Development Program of China [2016YFE0205400, 2018ZX09739010, 2018ZX09301034003]; the Science and Technology Program of Guangdong, China [2020B121202010]; the Science and Technology Planning Project of Guangzhou, China [201707020010]; the Science, Technology, and Innovation Committee of Shenzhen, China [GJHS20170314114526143, JSGG20180703155802047]; the Economic, Trade, and Information Commission of Shenzhen Municipality, China [20170505161556110, 20170505160926390, 201705051617070]; Peking University Medicine Fund of Fostering Young Scholars’ Scientific & Technological Innovation (grant 34254) Peking University Medicine Fund of Fostering Young Scholars’ Scientific & Technological Innovation (grant 34254).

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Authors and Affiliations

  1. Department of Cardiology, Peking University First Hospital, Beijing, China

    Lihua Hu, Yan Zhang, Yong Huo & Jianping Li

  2. People’s Hospital of Rongcheng, Rongcheng, Shandong, China

    Chonglei Bi & Chongqian Fang

  3. Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China

    Lishun Liu, Yun Song & Xiping Xu

  4. Shenzhen Evergreen Medical Institute, Shenzhen, China

    Yun Song & Binyan Wang

  5. State Key Laboratory of Natural Medicines, Research Center of Biostatistics and Computational Pharmacy, China Pharmaceutical University, Nanjing, China

    Yue Zhang

  6. Institute of Biomedicine, Anhui Medical University, Hefei, China

    Binyan Wang

  7. Health and Family planning Commission, Rongcheng, Shandong, China

    Hai Ma

  8. Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China

    Xiao Huang, Huihui Bao, Ping Li & Xiaoshu Cheng

  9. Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA

    Xiaobin Wang

  10. Key Laboratory of Molecular Cardiovascular Science of Ministry of Education, Peking University, Beijing, China

    Jianping Li

  11. NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Beijing, China

    Jianping Li

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  1. Lihua Hu
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Contributions

Conceptualization and methodology: XPX, YH, JPL. Software: LHH, LSL. Validation: YS, YZ. Formal analysis: LHH, YZ. Investigation: LHH, CLB, LSL, BYW, CQF, HM, XH, YZ. Data curation: LSL, YS, YZ. Writing (original draft preparation): LHH. Writing (review and editing): CLB, LSL, YS, BYW, CQF, HM, XH, YZ, XPX, XBW, YH, JPL. Supervision: XPX, YH, JPL. Project administration: CLB, LSL, YS, BYW, HM, JPL. Funding acquisition: XPX, XH, LHH. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Jianping Li.

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The authors declare no competing interests.

Ethical approval

The study was approved by the Ethics Committee of the Institute of Biomedicine, Anhui Medical University, Hefei, China.

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Hu, L., Bi, C., Liu, L. et al. Association between baseline brachial–ankle pulse wave velocity and short-term risk of first stroke among Chinese hypertensive adults. J Hum Hypertens 36, 1085–1091 (2022). https://doi.org/10.1038/s41371-021-00611-7

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