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Cardiovascular endpoints in relation to the central arterial pressure-time indexes

Hypertension Research (2026)Cite this article

Abstract

Multiple articles focused on the central arterial systolic (SPTI) and diastolic (DPTI) pressure-time indexes and the subendocardial viability ratio (SEVR). However, whether these indexes contribute to risk stratification in the general population is unknown. SPTI, DPTI and SEVR were noninvasively measured by the SphygmoCor technology. Incidence rates and standardized (per 1-SD increment) multivariable-adjusted hazard ratios (HRs) for cardiovascular (primary) and cardiac endpoints and stroke were evaluated in the International Database of Central Arterial Properties for Risk Stratification (n = 5099). Model refinement was assessed by the area under the curve (AUC) and the integrated discrimination (IDI) and net reclassification (NRI) improvement. Over 4 years (median), 215 cardiovascular, 133 cardiac endpoints and 79 strokes occurred. For SPTI, fully adjusted HRs were 1.37 (95% CI: 1.18-1.59), 1.35 (1.11-1.64) and 1.33 (1.05-1.69) for the cardiovascular and cardiac endpoints and stroke. The corresponding HRs for DPTI were 1.49 (1.31-1.69), 1.23 (1.02-1.48) and 1.74 (1.46-2.07). For SEVR, none of the HRs reached significance. Analyses with these indexes categorized by quartiles were confirmatory. Analyses stratified by various risk factors did not reveal subgroup differences. For the cardiovascular endpoint, adding SPTI or DPTI to the base model improved the AUC, while adding SPTI or DPTI combined with mean arterial pressure, increased IDI by ~1.7% and NRI by ~17% (P < 0.001 for all). Whereas cardiovascular and cardiac endpoints and stroke were related with the non-invasively measured SPTI and DPTI, SEVR was not.

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All relevant data are within the article and the online-only Supplemental material. Anonymized data can be made available to investigators for targeted non-commercial research based on a motivated request to be submitted to the corresponding authors and pending approval by the Principal Investigators of the eight participating centers. Data shares terminate three years after approval of the transfer.

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Acknowledgements

The Non-Profit Research Alliance for the Promotion of Preventive Medicine (URL: www.appremed.org) received a non-binding grant from OMRON Healthcare Co., Ltd., Kyoto, Japan. The Guangci Laureate Professorship of Jan A. Staessen is supported by the Guangci Deep Mind Project of Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.

The International database of central arterial properties for risk stratification investigators

L S Aparicio2, J Barochiner2, D M Wei13, J D Melgarejo13, L Thijs13, J A Staessen13, F F Wei13, W Y Yang13, Z Y Zhang13, D W An1, Y B Cheng1, Q H Guo1, J F Huang1, Q F Huang1, Y Li1, C S Sheng1, J G Wang1, J Filipovsky10, J Seidlerova10, E P Juhanoja14, A M Jula14, A S Lindroos14, T J Niiranen14, S S Siven14, E Casiglia8, A Pizzioli8, V Tikhonoff8, B S Chori15, B Danladi15, A N Odili15, H Oshaju15, W Kucharska9, K Kunicka9, N Gilis-Malinowska9, K Narkiewicz9, W Sakiewicz9, E Swierblewska9, K Kawecka-Jaszcz7, K Stolarz-Skrzypek7, M Rajzer7, C Mels16, R Kruger16, G Mokwatsi16, A E Schutte16, G R Norton17, A J Woodiwiss17, D Ackermann18, M Bochud19, G Ehret20, R Alvarez-Vaz4, C Americo4, C Baccino4, L Borgarello4, L Florio4, P Moliterno4, A Noboa4, O Noboa4, A Olascoaga4, P Parnizari4, M Pecora4

Funding

Argentina: The Internal Medicine Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Belgium: European Union (HEALTH-F7-305507 HOMAGE), European Research Council (Advanced Researcher Grant 2011-294713-EPLORE and Proof-of-Concept Grant 713601-uPROPHET), European Research Area Net for Cardiovascular Diseases (JTC2017-046-PROACT) and Research Foundation Flanders, Ministry of the Flemish Community, Brussels, Belgium (G.0881.13); China: The National Natural Science Foundation of China (grants 82270469, 82070432, 81970353), the Ministry of Science and Technology (2022YFC3601302), Beijing, China, and by the Shanghai Commissions of Science and Technology (grants 19ZR1443300), the Shanghai Municipal Health Commission (202340035, 20234Y0036, 201940297 and a Grant for Leading Academics 2022LJ022), and the Shanghai Talent Work Bureau (the Oriental Talent Program BJWS2024086 and QNWS2024013); Czech Republic: European Union (grants LSHM-CT-2006–037093 and HEALTH-F4-2007–201550) and Charles University Research program “Cooperatio – Cardiovascular Science”; Italy: European Union (grants LSHM-CT-2006–037093 and HEALTH-F4-2007–201550); Poland (Gdańsk): European Union (grants LSHM-CT-2006–037093 and HEALTH-F4-2007–201550); Poland (Kraków): European Union (grants LSHM-CT-2006–037093 and HEALTH-F4-2007–201550) and Foundation for Polish Science; Uruguay: Asociación Española Primera en Salud. The funding source had no role had in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Author information

Author notes

  1. These authors contributed equally: Yan Li, Jan A. Staessen

Authors and Affiliations

  1. Department of Cardiovascular Medicine, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China

    Qi-Fang Huang, De-Wei An, Yi-Bang Cheng, Chang-Sheng Sheng, Ji-Guang Wang, Yan Li, Jan A. Staessen, D. W. An, Y. B. Cheng, Q. H. Guo, J. F. Huang, Q. F. Huang, Y. Li, C. S. Sheng & J. G. Wang

  2. Servicio de Clínica Médica, Sección Hipertensión Arterial, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

    Lucas S. Aparicio, L. S. Aparicio & J. Barochiner

  3. Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China

    Fang-Fei Wei

  4. Unidad Académica de Nefrología, Hospital de Clínicas Dr Manuel Quintela, Universidad de la República, Montevideo, Uruguay

    José Boggia, R. Alvarez-Vaz, C. Americo, C. Baccino, L. Borgarello, L. Florio, P. Moliterno, A. Noboa, O. Noboa, A. Olascoaga, P. Parnizari & M. Pecora

  5. Department of Cardiology, Shanghai General Hospital, Shanghai, China

    Wen-Yi Yang

  6. Center for Environmental Sciences, Hasselt University, Diepenbeek, Belgium

    Dries S. Martens & Tim S. Nawrot

  7. First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland

    Katarzyna Stolarz-Skrzypek, Wiktoria Wojciechowska, Marek Rajzer, Kalina Kawecka-Jaszcz, Jan A. Staessen, K. Kawecka-Jaszcz, K. Stolarz-Skrzypek & M. Rajzer

  8. Department of Medicine, University of Padua, Padua, Italy

    Valérie Tikhonoff, Edoardo Casiglia, E. Casiglia, A. Pizzioli & V. Tikhonoff

  9. Hypertension Unit, Department of Hypertension and Diabetology, Medical University of Gdańsk, Gdańsk, Poland

    Natasza Gilis-Malinowska, Krzysztof Narkiewicz, W. Kucharska, K. Kunicka, N. Gilis-Malinowska, K. Narkiewicz, W. Sakiewicz & E. Swierblewska

  10. Faculty of Medicine, Charles University, Pilsen, Czech Republic

    Jitka Seidlerová, Jan Filipovský, J. Filipovsky & J. Seidlerova

  11. Non-Profit Research Association Alliance for the Promotion of Preventive Medicine, Leuven, Belgium

    Jan A. Staessen

  12. Biomedical Sciences Group, Faculty of Medicine, University of Leuven, Leuven, Belgium

    Jan A. Staessen

  13. Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium

    D. M. Wei, J. D. Melgarejo, L. Thijs, J. A. Staessen, F. F. Wei, W. Y. Yang & Z. Y. Zhang

  14. Population Studies Unit, Department of Chronic Disease Prevention, National Institute for Health and Welfare, Turku, Finland

    E. P. Juhanoja, A. M. Jula, A. S. Lindroos, T. J. Niiranen & S. S. Siven

  15. Department of Internal Medicine, Faculty of Clinical Sciences, College of Health Sciences, University of Abuja, Abuja, Nigeria

    B. S. Chori, B. Danladi, A. N. Odili & H. Oshaju

  16. Hypertension in Africa Research Team (HART), South African Medical Research Council and Unit of Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa

    C. Mels, R. Kruger, G. Mokwatsi & A. E. Schutte

  17. Cardiovascular Pathophysiology and Genomics Research Unit, Schools of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

    G. R. Norton & A. J. Woodiwiss

  18. Clinic for Nephrology and Hypertension, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland

    D. Ackermann

  19. Institute of Social and Preventive Medicine, University Hospital of Lausanne, Lausanne, Switzerland

    M. Bochud

  20. Unit of Population Epidemiology, University Hospital of Geneva, Geneva, Switzerland

    G. Ehret

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Consortia

The International database of central arterial properties for risk stratification investigators

  • L. S. Aparicio
  • , J. Barochiner
  • , D. M. Wei
  • , J. D. Melgarejo
  • , L. Thijs
  • , J. A. Staessen
  • , F. F. Wei
  • , W. Y. Yang
  • , Z. Y. Zhang
  • , D. W. An
  • , Y. B. Cheng
  • , Q. H. Guo
  • , J. F. Huang
  • , Q. F. Huang
  • , Y. Li
  • , C. S. Sheng
  • , J. G. Wang
  • , J. Filipovsky
  • , J. Seidlerova
  • , E. P. Juhanoja
  • , A. M. Jula
  • , A. S. Lindroos
  • , T. J. Niiranen
  • , S. S. Siven
  • , E. Casiglia
  • , A. Pizzioli
  • , V. Tikhonoff
  • , B. S. Chori
  • , B. Danladi
  • , A. N. Odili
  • , H. Oshaju
  • , W. Kucharska
  • , K. Kunicka
  • , N. Gilis-Malinowska
  • , K. Narkiewicz
  • , W. Sakiewicz
  • , E. Swierblewska
  • , K. Kawecka-Jaszcz
  • , K. Stolarz-Skrzypek
  • , M. Rajzer
  • , C. Mels
  • , R. Kruger
  • , G. Mokwatsi
  • , A. E. Schutte
  • , G. R. Norton
  • , A. J. Woodiwiss
  • , D. Ackermann
  • , M. Bochud
  • , G. Ehret
  • , R. Alvarez-Vaz
  • , C. Americo
  • , C. Baccino
  • , L. Borgarello
  • , L. Florio
  • , P. Moliterno
  • , A. Noboa
  • , O. Noboa
  • , A. Olascoaga
  • , P. Parnizari
  •  & M. Pecora

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Correspondence to Yan Li or Jan A. Staessen.

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Huang, QF., An, DW., Aparicio, L.S. et al. Cardiovascular endpoints in relation to the central arterial pressure-time indexes. Hypertens Res (2026). https://doi.org/10.1038/s41440-026-02555-2

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