title: Ambulatory arterial stiffness index and 24-hour ambulatory pulse pressure as predictors of mortality in Ohasama, Japan.
abstract: OBJECTIVE
  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 (P=0.04), 0.82 (P=0.25), 0.64 (P=0.01), and 1.35 (P=0.03). 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.
authors.affiliation: Tohoku University Graduate School of Medicine and Pharmaceutical Science, 1-1 Seiryomachi, Sendai, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kikuya
authors.forename: Jan A
authors.initials: JA
authors.lastname: Staessen
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Ohkubo
authors.forename: Lutgarde
authors.initials: L
authors.lastname: Thijs
authors.forename: Hirohito
authors.initials: H
authors.lastname: Metoki
authors.forename: Kei
authors.initials: K
authors.lastname: Asayama
authors.forename: Taku
authors.initials: T
authors.lastname: Obara
authors.forename: Ryusuke
authors.initials: R
authors.lastname: Inoue
authors.forename: Yan
authors.initials: Y
authors.lastname: Li
authors.forename: Eamon
authors.initials: E
authors.lastname: Dolan
authors.forename: Haruhisa
authors.initials: H
authors.lastname: Hoshi
authors.forename: Junichiro
authors.initials: J
authors.lastname: Hashimoto
authors.forename: Kazuhito
authors.initials: K
authors.lastname: Totsune
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Satoh
authors.forename: Ji-Guang
authors.initials: JG
authors.lastname: Wang
authors.forename: Eoin
authors.initials: E
authors.lastname: O'Brien
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Imai
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001158:Arteries / Q000503:physiopathology; D001794:Blood Pressure / Q000502:physiology; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000401:mortality* / Q000503:physiopathology; D002940:Circadian Rhythm; D015897:Comorbidity; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000401:mortality* / Q000503:physiopathology; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D017678:Sex Distribution; D020521:Stroke / Q000175:diagnosis* / Q000401:mortality* / Q000503:physiopathology; D013997:Time Factors; D016138:Walking / Q000502:physiology
chemical_list: D000959:Antihypertensive Agents