title: Arterial stiffness is a potential mechanism and promising indicator of orthostatic hypotension in the general population.
abstract: BACKGROUND
  Orthostatic hypotension (OH) is a disease prevalent among middle-aged men and the elderly. The association between arterial stiffness and OH is unclear. This study evaluates whether arterial stiffness is correlated with OH and tests the usefulness of brachial-ankle pulse wave velocity (baPWV), an arterial stiffness marker, with regard to identifying OH.
  
  
  METHODS
  A sample of 1,010 participants was recruited from the general population (64.8 ± 7.7 years; 426 men) who attended health check-ups. BaPWV and the radial augmentation index (rAI) were both assessed as the arterial stiffness markers, and OH was determined using blood pressure (BP) measured in the supine position, as well as 30 seconds and 2 minutes after standing.
  
  
  RESULTS
  The prevalence of OH in this population was 4.9 %. Compared with the non-OH group, both baPWV (20.5 ± 4.5 vs 17.3 ± 3.7, p < 0.001) and rAI (88.1 ± 10.8 vs 84.2 ± 10.7, p < 0.05) were significantly higher in the OH group. In the multiple logistic regression analysis, baPWV (OR, 1.3; 95 % CI, 1.106-1.528; p < 0.05) remained associated with OH. Moreover, the degree of orthostatic BP reduction was related to arterial stiffness. In addition, increases in arterial stiffness predicted decreases in the degree of heart rate (HR) elevation. Finally, a receiver operating characteristic (ROC) curve analysis showed that baPWV was useful in discriminating OH (AUC, 0.721; p < 0.001), with the cut-off value of 18.58 m/s (sensitivity, 0.714; specificity, 0.686).
  
  
  CONCLUSIONS
  Arterial stiffness determined via baPWV, rather than rAI, was significantly correlated with the attenuation of the orthostatic hemodynamic response and the resultant OH. The impaired baroreceptor sensitivity might be the mechanism. In addition, baPWV appears to be a relatively sensitive and reliable indicator of OH in routine clinical practice.
authors.affiliation: Department of Cardiovascular Medicine, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Qingtao
authors.initials: Q
authors.lastname: Meng
authors.affiliation: Department of Cardiovascular Medicine, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Si
authors.initials: S
authors.lastname: Wang
authors.affiliation: Department of Cardiovascular Medicine, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Cardiovascular Medicine, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Shixi
authors.initials: S
authors.lastname: Wan
authors.affiliation: Department of Cardiovascular Medicine, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Kai
authors.initials: K
authors.lastname: Liu
authors.affiliation: Department of Cardiovascular Medicine, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Xiaoyan
authors.initials: X
authors.lastname: Zhou
authors.affiliation: Department of Cardiovascular Medicine, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Guiyou
authors.initials: G
authors.lastname: Zhong
authors.affiliation: Department of Cardiovascular Medicine, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Department of Cardiovascular Medicine, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Xiaoping
authors.initials: X
authors.lastname: Chen
mesh_terms: D000368:Aged; D055109:Ankle Brachial Index; D019540:Area Under Curve; D001794:Blood Pressure; D016009:Chi-Square Distribution; D002681:China / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006339:Heart Rate; D006801:Humans; D007024:Hypotension, Orthostatic / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D063177:Pulse Wave Analysis; D012372:ROC Curve; D012720:Severity of Illness Index; D059289:Vascular Stiffness
keywords: Orthostatic hypotensionl; arterial stiffness; brachial ankle pulse wave velocity; radial augmentation index