The Relationship Between Ambulatory Arterial Stiffness Index and Blood Pressure Variability in Hypertensive Patients

Abstract

Background and ObjectivesAmbulatory arterial stiffness index (AASI) is well known as a predictor of cardiovascular mortality in hypertensive patients. Mathematically, AASI reflect the standard deviation (SD) of blood pressure (BP) variation. AASI is measured higher levels in non-dipper than dipper. Thus, AASI has a possibility of not only reflecting arterial stiffness but also BP variability and/or autonomic nervous dysfunction.Subjects and MethodsConsecutive data from 418 untreated hypertensive patients were analyzed retrospectively. We examined the association between the 24-hour ambulatory BP monitoring (ABPM) parameters and AASI.ResultsAASI had a simple correlation with age (R=0.189, p<0.001), relative wall thickness (RWT) (R=0.115, p=0.019), left ventricular mass index (LVMI) (R=0.192, p<0.001), average systolic BP (SBP) (R=0.232, p<0.001), average pulse pressure (PP) (R=0.363, p<0.001), SD of diastolic BP (DBP) (R=-0.352, p<0.001), SD of PP (R=0.330, p<0.001), SD of heart rate (HR) (R=-0.268, p<0.001), and nocturnal dipping (R=-0.137, p=0.005). In multiple linear regression analysis model including clinical parameters and 24 hour-ABPM parameters, independent predictors of AASI were SD of PP (β=1.246, p<0.001), SD of DBP (β=-1.067, p<0.001), SD of SBP (β=-0.197, p<0.001), and non-dipper (β=0.054, p=0.033).ConclusionAASI is closely correlated with BP variability. The result of this study shows that AASI is not only a parameter for arterial stiffness, but also a parameter for BP variability.

Evaluation of the ambulatory arterial stiffness index in patients with rheumatoid arthritis

“…In addition, nondipper status was found to be a predictor of high AASI in the entire population as well as the RA group. Similar to this result, Lee et al [28] showed nondipper status to be an independent predictor of high AASI and the authors concluded that AASI is affected by autonomic dysregulation. However, although the proportion of nondipper individuals was similar in the two groups (63.6% in the RA group vs. 60.6% in the control group, P = 0.800), a significant association between AASI and nondippers was not found in the control group.…”

Association of Changes in Ambulatory Arterial Stiffness Index and Pulse Wave Velocity During Antihypertensive Treatment: The J-CORE Study

“…Previous studies have shown AASI be affected by the extent of the nocturnal BP fall, 3-7 BP variability expressed as the standard deviation, [12][13][14][15] and baroreflex sensitivity, 16 and therefore antihypertensive treatment which could modify these factors might in turn affect AASI in a manner independent of changes in arterial stiffness. Furthermore, previous findings, [17][18][19] taken together with the present findings, have suggested that AASI represents an integrated measure of ventriculo-arterial coupling, depending on both arterial (arterial stiffness and systemic vascular resistance) and cardiac factors (stroke volume and heart rate).…”

Ambulatory arterial stiffness index correlates with ambulatory pulse pressure but not dipping status in patients with grade 1/grade 2 essential hypertension

“…For example, in one study, pulse pressure variability, systolic BP variability, diastolic BP variability and nondipper status were determined to be independent predictors of AASI, suggesting that AASI is a parameter that reflects BP variability as well as arterial stiffness. 17 Furthermore, systolic BP variation and diastolic BP variation have been shown to correlate with intima-media thickness, pulse wave velocity and AASI, with 24-h diastolic BP variation having a significant association with AASI in a multiple regression analysis. 37 Similarly, AASI has been found to negatively correlate with the morning surge in diastolic BP, daytime diastolic BP, 24-h mean arterial pressure variability, and nocturnal dips in systolic BP, diastolic BP and mean arterial pressure.…”

“…From a mathematical standpoint, the possibility exists that assessment of AASI may be confounded by other parameters derived from ambulatory BP monitoring, including BP variation, pulse pressure, nocturnal dipping, and the morning BP surge. 17,18 These measures of variability in BP have been documented by some reports to be prognostic markers of target-organ damage and cardiovascular disease. [19][20][21][22][23][24] In addition to AASI, several other factors have been reported to correlate with stiffer vessels in patients with hypertension, including a nondipper pattern, and other markers such as pulse pressure.…”