Indirect 24-hour blood pressure arterial stiffness indexes and pulse wave velocity: insights from an individual patient data analysis

Abstract

Background: Indirect estimates of pulse wave velocity (PWV) have been proposed as a feasible alternative for PWV assessment in clinical practice; however, their validity and clinical applicability remain uncertain. This study aimed to evaluate the relationships between indirect measures of arterial stiffness and directly measured PWV to determine their potential utility in clinical settings. Methods: In this multicentre, international study, data from 4,206 individuals from Brazil, Greece, Korea, and Australia were analysed. The relationships between estimated PWV (ePWV), 24-hour (24h)-pulse pressure (PP), Early Vascular Aging Ambulatory Score (EVAAS), and carotid-femoral (cf-PWV) and/or brachial-ankle (ba-PWV) PWV were assessed through correlation and multivariate linear regression analyses. Subgroup-specific associations were also examined. Results: The study population had a mean age of 57.6 ± 14.3 years, with 42.5% being male and 82.1% having pre-existing hypertension. After adjusting for multiple factors related to arterial stiffness, ePWV demonstrated a strong association with cf-PWV (β = 0.599, P < 0.001) and ba-PWV (β = 1.342, P < 0.001). 24h-PP and EVAAS showed moderate associations with both cf-PWV and ba-PWV. Subgroup analyses indicated that ePWV correlated more strongly with both cf-PWV and ba-PWV in individuals without traditional cardiovascular risk factors. Conclusions: ePWV may be used as a surrogate marker for arterial stiffness, particularly in individuals without major cardiometabolic comorbidities. Although 24h-PP and EVAAS are also associated with PWV, their clinical utility varies across subgroups. Future research should explore their role in improving cardiovascular risk prediction and guiding personalized treatment strategies for vascular aging. Trial Registration: PROSPERO Identifier: CRD420250618863