Published Online
on February 22, 2007

A more recent version of this article appeared on April 1, 2007

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Submitted on May 12, 2006
Revised on September 25, 2006
Accepted on October 17, 2006

Ambulatory Arterial Stiffness Index and 24-Hour Ambulatory Pulse Pressure as Predictors of Mortality in Ohasama, Japan

Masahiro Kikuya MD, PhD; Jan A. Staessen MD, PhD; Takayoshi Ohkubo MD, PhD; Lutgarde Thijs MSc; Hirohito Metoki MD; Kei Asayama MD, PhD; Taku Obara MS; Ryusuke Inoue MD, PhD; Yan Li MD, PhD; Eamon Dolan MD, PhD; Haruhisa Hoshi MD, PhD; Junichiro Hashimoto MD, PhD; Kazuhito Totsune MD, PhD; Hiroshi Satoh MD, PhD; Ji-Guang Wang MD, PhD; Eoin O’Brien MD, PhD; and Yutaka Imai MD, PhD^*

From the Tohoku University Graduate School of Medicine and Pharmaceutical Science (M.K., T. Ohkubo, H.M., K.A., T Obara, R.I., J.H., K.T., H.S., Y.I.), Sendai, Japan; the Studies Coordinating Centre (M.K., J.A.S., L.T., Y.L.), Department of Cardiovascular Diseases, University of Leuven, Belgium; the Shanghai Institute of Hypertension (Y.L., J.-G.W.), Shanghai Jiaotong University Medical School, China; the ADAPT Centre, Beaumont Hospital, and Department of Clinical Pharmacology (E.D., E.O.’B.), Royal College of Surgeons in Ireland, Dublin, Ireland; and Ohasama Hospital (H.H.), Hanamaki, Japan.

^* To whom correspondence should be addressed. E-mail: imai{at}tinet-i.ne.jp.

Background and Purpose--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.

Key words: ambulatory blood pressure • epidemiology • hypertension • prognosis • stroke

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