Published Online
on November 10, 2008

A more recent version of this article appeared on December 1, 2008

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Submitted on July 26, 2008
Revised on August 12, 2008

Determinants of the Ambulatory Arterial Stiffness Index in 7604 Subjects From 6 Populations

Ahmet Adiyaman; Dirk G. Dechering; José Boggia; Yan Li; Tine W. Hansen; Masahiro Kikuya; Kristina Björklund-Bodegård; Tom Richart; Lutgarde Thijs; Christian Torp-Pedersen; Takayoshi Ohkubo; Eamon Dolan; Yutaka Imai; Edgardo Sandoya; Hans Ibsen; Jiguang Wang; Lars Lind; Eoin O'Brien; Theo Thien; Jan A. Staessen^*; on behalf of the International Database on Ambulatory Blood Pressure Monitoring in Relation to Cardiovascular Outcomes Investigators

From the Studies Coordinating Centre (A.A., D.G.D., L.T., J.A.S.), Division of Hypertension and Cardiovascular Rehabilitation, Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium; University Medical Centre Sint Radboud (A.A., D.G.D., T.T.), Department of General Internal Medicine, Radboud University, Nijmegen, The Netherlands; Departamento de Fisiopatología (J.B.), Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay; Center for Epidemiological Studies and Clinical Trials (Y.L., J.W.), Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; Research Center for Prevention and Health and Department of Clinical Physiology (T.W.H.), Faculty of Health Sciences Hvidovre University Hospital, Copenhagen, Denmark; Tohoku University Graduate School of Pharmaceutical Sciences and Medicine (M.K., T.O., Y.I.), Sendai, Japan; Section of Geriatrics (K.B.-B., L.L.), Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Department of Epidemiology (T.R., J.A.S.), Maastricht University, Maastricht, The Netherlands; Copenhagen University Hospital (T.W.H., C.T.-P., H.I.), Copenhagen, Denmark; Cambridge University Hospitals (E.D.), Addenbrook's Hospital, Cambridge, United Kingdom; Asociación Española Primera de Socorros Mutuos (E.S.), Montevideo, Uruguay; and Conway Institute of Biomolecular and Biomedical Research (E.O.B.), University College Dublin, Dublin, Ireland.

^* To whom correspondence should be addressed. E-mail: jan.staessen{at}med.kuleuven.be.

Abstract—The ambulatory arterial stiffness index (AASI) is derived from 24-hour ambulatory blood pressure recordings. We investigated whether the goodness-of-fit of the AASI regression line in individual subjects (r²) impacts on the association of AASI with established determinants of the relation between diastolic and systolic blood pressures. We constructed the International Database on the Ambulatory Blood Pressure in Relation to Cardiovascular Outcomes (7604 participants from 6 countries). AASI was unity minus the regression slope of diastolic on systolic blood pressure in individual 24-hour ambulatory recordings. AASI correlated positively with age and 24-hour mean arterial pressure and negatively with body height and 24-hour heart rate. The single correlation coefficients and the mutually adjusted partial regression coefficients of AASI with age, height, 24-hour mean pressure, and 24-hour heart rate increased from the lowest to the highest quartile of r². These findings were consistent in dippers and nondippers (night:day ratio of systolic pressure 0.90), women and men, and in Europeans, Asians, and South Americans. The cumulative z score for the association of AASI with these determinants of the relation between diastolic and systolic blood pressures increased curvilinearly with r², with most of the improvement in the association occurring above the 20th percentile of r² (0.36). In conclusion, a better fit of the AASI regression line enhances the statistical power of analyses involving AASI as marker of arterial stiffness. An r² value of 0.36 might be a threshold in sensitivity analyses to improve the stratification of cardiovascular risk.

Key words: ambulatory arterial stiffness index • arterial stiffness • blood pressure measurement/monitoring • epidemiology • population science • statistical analysis

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