Pulse pressure amplification (PPA) is the brachial-to-aortic pulse pressure ratio and decreases with age and cardiovascular risk factors. This individual-participant meta-analysis of population studies aimed to define an outcome-driven threshold for PPA. Incidence rates and standardized multivariable-adjusted hazard ratios (HRs) of cardiovascular and coronary endpoints associated with PPA, as assessed by the SphygmoCor software, were evaluated in the International Database of Central Arterial Properties for Risk Stratification (n = 5608). Model refinement was assessed by the integrated discrimination (IDI) and net reclassification (NRI) improvement. Age ranged from 30 to 96 years (median 53.6). Over 4.1 years (median), 255 and 109 participants experienced a cardiovascular or coronary endpoint. In a randomly defined discovery subset of 3945 individuals, the rounded risk-carrying PPA thresholds converged at 1.3. The HRs for cardiovascular and coronary endpoints contrasting PPA < 1.3 vs ≥1.3 were 1.54 (95% confidence interval [CI]: 1.00-2.36) and 2.45 (CI: 1.20-5.01), respectively. Models were well calibrated, findings were replicated in the remaining 1663 individuals analyzed as test dataset, and NRI was significant for both endpoints. The HRs associating cardiovascular and coronary endpoints per PPA threshold in individuals <60 vs ≥60 years were 3.86 vs 1.19 and 6.21 vs 1.77, respectively. The proportion of high-risk women (PPA < 1.3) was higher at younger age (<60 vs ≥60 years: 67.7% vs 61.5%; P < 0.001). In conclusion, over and beyond common risk factors, a brachial-to-central PP ratio of <1.3 is a forerunner of cardiovascular coronary complications and is an underestimated risk factor in women aged 30-60 years. Our study supports pulse wave analysis for risk stratification.

1st Department of Cardiology Interventional Electrocardiology and Hypertension Jagiellonian University Medical College Kraków Poland

Biomedical Sciences Group Faculty of Medicine University of Leuven Leuven Belgium

Centro de Nefrología and Departamento de Fisiopatología Hospital de Clínicas Universidad de la República Montevideo Uruguay

Department of Cardiology Shanghai General Hospital Shanghai China

Department of Cardiology The 1st Affiliated Hospital of Sun Yat Sen University Guangzhou Guangdong China

Department of Cardiovascular Medicine Shanghai Key Laboratory of Hypertension Shanghai Institute of Hypertension State Key Laboratory of Medical Genomics National Research Center for Translational Medicine Ruijin Hospital Shanghai Jiaotong University School of Medicine Shanghai China

Department of Chronic Disease Prevention Department of Medicine Turku University Hospital and University of Turku Turku Finland

Department of Medicine University of Padua Padua Italy

Faculty of Medicine Charles University Pilsen Czech Republic

Hypertension Unit Department of Hypertension and Diabetology Medical University of Gdańsk Gdańsk Poland

Non Profit Research Association Alliance for the Promotion of Preventive Medicine Mechelen Belgium

Research Unit Environment and Health Department of Public Health and Primary Care University of Leuven Leuven Belgium

Servicio de Clínica Médica Sección Hipertensión Arterial Hospital Italiano de Buenos Aires Buenos Aires Argentina

Hypertens Res. 2024 Nov;47(11):3270-3272. doi: 10.1038/s41440-024-01880-8. PubMed

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