Blood Pressure & Pulse Wave Velocity - References

Blood Pressure & Pulse Wave Velocity — Literature Dossier

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Landmark Peer-Reviewed Studies

1. Lewington et al. (2002) — Age-Specific Relevance of Usual Blood Pressure to Vascular Mortality: A Meta-Analysis of One Million Adults

• Citation: Lewington, S., Clarke, R., Qizilbash, N., Peto, R., Collins, R., & Prospective Studies Collaboration. (2002). Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. The Lancet, 360(9349), 1903–1913.
• Identifiers: DOI: 10.1016/s0140-6736(02)11911-8 (DOI · SciDB · Scholar) | PMID: 12493255 (PubMed · Europe PMC)
• Study Design & Cohort: Individual participant data meta-analysis of 61 prospective observational studies ($N=1,000,000$ adults with no previous vascular disease; $12.7\text{ million}$ person-years at risk and $56,000$ vascular deaths).
• Quantitative Findings & Diagnostic Thresholds:
  • Across ages 40–69, each $20\text{ mmHg}$ increase in usual Systolic BP (or $10\text{ mmHg}$ increase in Diastolic BP) was associated with a more than 2-fold (200%) increase in stroke death rate and a 2-fold increase in ischemic heart disease death rate, with a continuous log-linear slope extending all the way down to $115/75\text{ mmHg}$ with no threshold below which risk ceased to decline.

2. SPRINT Research Group (2015) — A Randomized Trial of Intensive versus Standard Blood-Pressure Control

• Citation: Wright, J. T., Williamson, J. D., Whelton, P. K., Snyder, J. K., Sink, K. M., Rocco, M. V., … & SPRINT Research Group. (2015). A randomized trial of intensive versus standard blood-pressure control. New England Journal of Medicine, 373(22), 2103–2116.
• Identifiers: DOI: 10.1056/NEJMoa1511939 (DOI · SciDB · Scholar) | PMID: 26551272 (PubMed · Europe PMC) | PMCID: PMC4689591 (PMC Full Text)
• Study Design & Cohort: Multicenter randomized controlled trial ($N=9,361$ non-diabetic adults aged $\ge 50$ randomized to an intensive systolic target $<120\text{ mmHg}$ vs. standard target $<140\text{ mmHg}$; terminated early after median 3.26 years due to overwhelming mortality benefit).
• Quantitative Findings & Diagnostic Thresholds:
  • Achieving a mean systolic BP of $121.4\text{ mmHg}$ (vs. $136.2\text{ mmHg}$) reduced the primary composite cardiovascular outcome by 25% ($\text{HR }0.75$, $95\%\text{ CI }0.64–0.89$, $p<0.001$), reduced heart failure by 38% ($\text{HR }0.62$, $p=0.002$), reduced cardiovascular death by 43% ($\text{HR }0.57$, $p=0.005$), and reduced all-cause mortality by 27% ($\text{HR }0.73$, $95\%\text{ CI }0.60–0.90$, $p=0.003$).

3. Vlachopoulos et al. (2010) — Prediction of Cardiovascular Events and All-Cause Mortality With Arterial Stiffness (Pulse Wave Velocity)

• Citation: Vlachopoulos, C., Aznaouridis, K., & Stefanadis, C. (2010). Prediction of cardiovascular events and all-cause mortality with arterial stiffness: a systematic review and meta-analysis. Journal of the American College of Cardiology, 55(13), 1318–1327.
• Identifiers: DOI: 10.1016/j.jacc.2009.10.061 (DOI · SciDB · Scholar) | PMID: 20338492 (PubMed · Europe PMC)
• Study Design & Cohort: Meta-analysis of 17 longitudinal cohort studies ($N=15,877$ subjects followed for a mean of 7.7 years) evaluating carotid-femoral Pulse Wave Velocity (cfPWV).
• Quantitative Findings & Diagnostic Thresholds:
  • Comparing high vs. low aortic PWV tertiles/cutoffs: Pooled relative risks were $2.26$ ($95\%\text{ CI }1.89–2.70$) for total cardiovascular events, $2.02$ ($95\%\text{ CI }1.68–2.42$) for cardiovascular mortality, and $1.90$ ($95\%\text{ CI }1.61–2.24$) for all-cause mortality.
  • Every $1.0\text{ m/s}$ increase in aortic PWV corresponded to an age-, sex-, and risk-factor–adjusted 14% increase in total CV events ($\text{RR }1.14$), 15% increase in CV mortality ($\text{RR }1.15$), and 15% increase in all-cause mortality ($\text{RR }1.15$).

4. Staplin et al. (2023) — Quantifying the Added Value of 24-Hour Ambulatory Blood Pressure Monitoring (Nighttime BP & Reverse Dipping)

• Citation: Staplin, N., de la Sierra, A., Ruilope, L. M., Emberson, J. R., Vinyoles, E., Gorostidi, M., … & Williams, B. (2023). Relationship between clinic and ambulatory blood pressure and mortality: an observational cohort study in 59 124 patients. The Lancet, 401(10393), 2041–2050.
• Identifiers: DOI: 10.1016/S0140-6736(23)00733-X (DOI · SciDB · Scholar) | PMID: 37156250 (PubMed · Europe PMC)
• Study Design & Cohort: Prospective observational cohort from the Spanish Ambulatory Blood Pressure Registry ($N=59,124$ patients followed for median 9.7 years; $7,174$ deaths).
• Quantitative Findings & Diagnostic Thresholds:
  • 24-hour ambulatory blood pressure was 500% more informative (${\chi }^2$ prognostic value) for all-cause and cardiovascular death than clinic blood pressure.
  • Nighttime systolic BP was the single strongest predictor of mortality ($\text{HR }1.55$ per $20\text{ mmHg}$ increment, completely independent of clinic BP); compared to normal nocturnal dippers ($10–20\%$ fall during sleep), non-dippers had an adjusted cardiovascular mortality $\text{HR of }1.27$ and reverse-dippers (“risers”) had a $\text{HR of }1.79$ ($95\%\text{ CI }1.57–2.03$).

5. Edwards et al. (2023) — Exercise Training and Resting Blood Pressure: A Large-Scale Pairwise and Network Meta-Analysis of Randomised Controlled Trials

• Citation: Edwards, J. J., Deenmamode, A. H. P., Griffiths, M., Arnold, O., Cooper, N. J., Wiles, J. D., & O’Driscoll, J. M. (2023). Exercise training and resting blood pressure: a large-scale pairwise and network meta-analysis of randomised controlled trials. British Journal of Sports Medicine, 57(20), 1317–1326.
• Identifiers: DOI: 10.1136/bjsports-2022-106503 (DOI · SciDB · Scholar) | PMID: 37491419 (PubMed · Europe PMC)
• Study Design & Cohort: Systematic review and Bayesian network meta-analysis of 270 randomized controlled trials ($N=15,827$ participants) comparing aerobic, dynamic resistance, combined, HIIT, and isometric exercise training on resting blood pressure.
• Quantitative Findings & Diagnostic Thresholds:
  • Isometric Exercise Training (wall squats and isometric handgrip) ranked #1 with a SUCRA of $98.3\%$, reducing resting blood pressure by $-8.24/-4.00\text{ mmHg}$ ($p<0.001$), compared to Combined Training ($-6.04/-2.54\text{ mmHg}$), Dynamic Resistance Training ($-4.55/-3.04\text{ mmHg}$), Aerobic Training ($-4.49/-2.53\text{ mmHg}$), and HIIT ($-4.08/-2.50\text{ mmHg}$).