High Estimated Pulse Wave Velocity Is Associated With Exaggerated Blood Pressure Response in Young and Middle-Aged Adults

Objective: Estimated pulse wave velocity (ePWV) may be a simple alternative to carotid to femoral pulse wave velocity, which is currently considered as the gold-standard measure of aortic stiffness. This study aimed to investigate the relationship between ePWV and exaggerated blood pressure response (EBPR) during exercise test in young and middle-aged population. Design and method: This study enrolled 2,884 adults between the ages of 20-49 years from the National Health and Nutrition Examination Survey (1999-2004). ePWV was calculated by using a regression equation for age and mean blood pressure (MBP). EBPR was defined as systolic peak blood pressure >210 mmHg in men, >190 mmHg in women. Multivariate logistic regression model was constructed to explore the associations between ePWV and EBPR. The potential nonlinear correlations were explored using restricted cubic spline, and a two-piecewise logistic regression model for both sides of the a two-piecewise logistic regression model for both sides of the inflection point was constructed was conducted. Results: Totally, 224 (7.4%) individuals among 2,884 participants had EBPR. After adjusting for age, sex, race/ethnicity, education, smoking, drinking, physical activity, body mass index, and history of hypertension, diabetes, hyperlipidaemia and chronic kidney disease, multivariable logistic regression analysis has revealed that the risk of EBPR increased 1.3-fold (OR: 2.32,95%CI: 1.58-3.40, p<0.001) as the ePWV increased every one meter per second. Subgroup analyses have found that this association was more obviously in individuals with current drinking(OR: 2.81, 95%CI:1.87-4.24, p<0.001) or without physical activity (OR: 2.45, 95%CI:1.63-3.70, p<0.001). The restricted cubic spline has revealed a nonlinear association between ePWV and EBPR. Moreover, two-piecewise logistic regression analysis has further found that the ePWV value lower than the inflection point (<=6.04) was not associated with the increase of EBPR (OR: 3.52, 95%CI: 0.18-69.85, p=0.388). In contrast, the ePWV value higher than the inflection point (>6.04) was significantly associated with the increase of EBPR (OR: 2.35, 95%CI: 1.50-3.68, p< 0.001). Conclusions: Higher ePWV is positively associated with EBPR in young and middle-aged population of United States,especially in individuals with current drinking or without physical activity.