An outcome-driven threshold for pulse pressure amplification
Authors: Huang Qi-Fang , An De-Wei , Aparicio Lucas S. , Cheng Yi-Bang , Wei Fang-Fei , Yu Yu-Ling , Sheng Chang-Sheng , Yang Wen-Yi , Niiranen Teemu J. , Boggia José , Stolarz-Skrzypek Katarzyna , Tikhonoff Valérie , Gilis-Malinowska Natasza , Wojciechowska Wiktoria , Casiglia Edoardo , Narkiewicz Krzysztof , Filipovský Jan , Kawecka-Jaszcz Kalina , Nawrot Tim S. , Wang Ji-Guang , Li Yan , Staessen Jan A. ,   The International Database of Central Arterial Properties for Risk Stratification (IDCARS) Investigators, Aparicio Lucas S. , Barochiner Jessica , Mujaj Blerim , Thijs Lutgarde , Staessen Jan A. , Wei Fang-Fei , Yang Wen-Yi , Zhang Zhen-Yu , An De-Wei , Cheng Yi-Bang , Guo Qian-Hui , Huang Jian-Feng , Huang Qi-Fang , Kang Yuan-Yuan , Li Yan , Liu Chang-Yuan , Sheng Chang-Sheng , Wang Ji-Guang , Wang Ying , Zhang Dong-Yan , Zhang Wei , Filipovský Jan , Seidlerová Jitka , Juhanoja Eeva P. , Jula Antti M. , Lindroos Annika S. , Niiranen Teemu J. , Sivén Sam S. , Casiglia Edoardo , Pizziol Alessandra , Tikhonoff Valérie , Chori Babangida S. , Danladi Benjamin , Odili Augustine N. , Oshaju Henry , Kucharska Wiesława , Kunicka Katarzyna , Gilis-Malinowska Natasza , Narkiewicz Krzysztof , Sakiewicz Wojciech , Swierblewska Ewa , Kawecka-Jaszcz Kalina , Stolarz-Skrzypek Katarzyna , Mels Catharina M. C. , Kruger Ruan , Mokwatsi Gontse G. , Schutte Aletta E. , Norton Gavin R. , Woodiwiss Angela , Ackermann Daniel , Bochud Murielle , Ehret Georg , Álvarez-Vaz Ramón , Rios Anna C. , Carusso Florencia , Sottolano Mariana , Boggia José , Borgarello Luciana , Robaina Sebastián , Moliterno Paula , Noboa Oscar , Olascoaga Alicia , da Rosa Alicia , Krul Nadia , Pécora Matias 
Published: July 2024

Pulse pressure amplification (PPA) is the brachial-to-aortic pulse pressure ratio and decreases with age and cardiovascular risk factors. This individual-participant meta-analysis of population studies aimed to define an outcome-driven threshold for PPA. Incidence rates and standardized multivariable-adjusted hazard ratios (HRs) of cardiovascular and coronary endpoints associated with PPA, as assessed by the SphygmoCor software, were evaluated in the International Database of Central Arterial Properties for Risk Stratification (n = 5608). Model refinement was assessed by the integrated discrimination (IDI) and net reclassification (NRI) improvement. Age ranged from 30 to 96 years (median 53.6). Over 4.1 years (median), 255 and 109 participants experienced a cardiovascular or coronary endpoint. In a randomly defined discovery subset of 3945 individuals, the rounded risk-carrying PPA thresholds converged at 1.3. The HRs for cardiovascular and coronary endpoints contrasting PPA < 1.3 vs ≥1.3 were 1.54 (95% confidence interval [CI]: 1.00–2.36) and 2.45 (CI: 1.20–5.01), respectively. Models were well calibrated, findings were replicated in the remaining 1663 individuals analyzed as test dataset, and NRI was significant for both endpoints. The HRs associating cardiovascular and coronary endpoints per PPA threshold in individuals <60 vs ≥60 years were 3.86 vs 1.19 and 6.21 vs 1.77, respectively. The proportion of high-risk women (PPA < 1.3) was higher at younger age (<60 vs ≥60 years: 67.7% vs 61.5%; P < 0.001). In conclusion, over and beyond common risk factors, a brachial-to-central PP ratio of <1.3 is a forerunner of cardiovascular coronary complications and is an underestimated risk factor in women aged 30–60 years. Our study supports pulse wave analysis for risk stratification.