Reversed L-shaped Association Between Baseline Brachial-ankle Pulse Wave Velocity and Short-Term Risk of First Stroke in Patients With Hypertension: A Population-based Cohort Study

Background: Brachial–ankle pulse wave velocity (baPWV) is available as a noninvasive measure of arterial stiffness. However, little information is available on the association between baPWV and the short-term risk of stroke in patients with hypertension. Therefore, our current study aimed to assess the association between baseline baPWV and short-term risk of first stroke. We were particularly interested in identifying those individuals at high risk of developing stroke among patients with hypertension.Methods: From January 1, 2017, to December 31, 2017, a total of 9787 individuals without preexisting stroke from the China Hypertension Registry Study were included in this analysis. Follow-up continued until December 31, 2018. The primary outcome was first stroke. The crude and adjusted risks of first stroke were estimated by hazard ratios (HRs) and 95% CIs using Cox proportional hazards models, without or with adjusting for pertinent covariates, respectively.Results: During a median follow-up of 20.8 months, there were 138 total first strokes including 123 first ischemic strokes and 15 first hemorrhagic strokes. Smooth curve showed that the relationship between baPWV and risk of first stroke and first ischemic stroke was curvilinear and reversed L-shaped. High baPWV levels (≥ 21.31 m/s) was associated with increased risk of first stroke (HR = 1.52; 95% CI: 1.05-2.21) and first ischemic stroke (HR = 1.53; 95% CI: 1.03-2.26) compared to low baPWV levels (< 21.31 m/s). E-value analysis suggested robustness to unmeasured confounding. Our findings may propose the applicability of baPWV measurement for prediction of stroke development, especially in subjects with a low cardiovascular (CVD) risk.Conclusions: High baPWV levels (≥ 21.31 m/s) were associated with increased the short-term risk of first stroke among Chinese hypertensive adults, compared to low baPWV levels, supporting a reversed L-shaped association. Our findings warrant additional investigation.