Key result
Pressure-corrected carotid stiffness measures show no association with changes in mean arterial pressure over time.
Why the study?
Conventional arterial stiffness measures are inherently pressure dependent and statistical adjustments cannot distinguish acute pressure effects from arterial remodeling or guide individual patient evaluation.
Do novel pressure-independent carotid stiffness measures avoid the confounding effect of blood pressure changes compared to conventional measures in an outpatient cohort?
Cohort (n=124)
No
Do novel pressure-independent carotid stiffness measures avoid the confounding effect of blood pressure changes compared to conventional measures in an outpatient cohort?
Effect estimate: β = -0.018 m/s/mm Hg (95% CI -0.040; 0.003)
p-value: p=0.091
Novel pressure-independent carotid stiffness measures successfully avoid the confounding effect of blood pressure changes, allowing for patient-specific risk assessment without statistical correction.
May enable BP-independent carotid stiffness tracking in outpatients; hypothesis-generating pending outcome validation.
BACKGROUND: Conventional measures for assessing arterial stiffness are inherently pressure dependent. Whereas statistical pressure adjustment is feasible in (larger) populations, it is unsuited for the evaluation of an individual patient. Moreover, statistical "correction" for blood pressure may actually correct for: (i) the acute dependence of arterial stiffness on blood pressure at the time of measurement; and/or (ii) the remodeling effect that blood pressure (hypertension) may have on arterial stiffness, but it cannot distinguish between these processes. METHODS: We derived-assuming a single-exponential pressure-diameter relationship-3 theoretically pressure-independent carotid stiffness measures suited for individual patient evaluation: (i) stiffness index β0, (ii) pressure-corrected carotid pulse wave velocity (cPWVcorr), and (iii) pressure-corrected Young's modulus (Ecorr). Using linear regression analysis, we evaluated in a sample of the CATOD study cohort changes in mean arterial pressure (ΔMAP) and comparatively the changes in the novel (Δβ0, ΔcPWVcorr, and ΔEcorr) as well as conventional (ΔcPWV and ΔE) stiffness measures after a 2.9 ± 1.0-year follow-up. RESULTS: We found no association between ΔMAP and Δβ0, ΔcPWVcorr, or ΔEcorr. In contrast, we did find a significant association between ΔMAP and conventional measures ΔcPWV and ΔE. Additional adjustments for biomechanical confounders and traditional risk factors did neither materially change these associations nor the lack thereof. CONCLUSIONS: Our newly proposed pressure-independent carotid stiffness measures avoid the need for statistical correction. Hence, these measures (β0, cPWVcorr, and Ecorr) can be used in a clinical setting for (i) patient-specific risk assessment and (ii) investigation of potential remodeling effects of (changes in) blood pressure on intrinsic arterial stiffness.
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Bruggen et al. (2021) conducted a cohort in Essential hypertension (n=124). Change in mean arterial pressure (ΔMAP) was evaluated on Association between change in mean arterial pressure (ΔMAP) and change in pressure-corrected carotid pulse wave velocity (ΔcPWVcorr) (β = -0.018 m/s/mm Hg, 95% CI -0.040; 0.003, p=0.091). Newly derived pressure-corrected carotid stiffness measures were independent of changes in mean arterial pressure over a 2.9-year follow-up, unlike conventional stiffness measures.
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