Inherent blood pressure dependence of arterial stiffness index beta and cardio-ankle vascular index: assessment of problem and solution

B. Spronck, A. P. Avolio, I. Tan, M. Butlin, K. D. Reesink, T. Delhaas

Research output: Contribution to journalMeeting abstractpeer-review


Objective: Stiffness index beta (β) and cardio-ankle vascular index (CAVI) are proposed pressure-independent measures of arterial stiffness that quantify the intrinsic exponent (βo) of the exponential relationship between arterial pressure and diameter. We aim (i) to demonstrate that β and CAVI do not strictly approximate the pressure-independent parameter βo, and (ii) to provide a suitable correction for the inherent pressure dependency of beta and CAVI. Design and method: The exponential relationship between pressure (P) and diameter (d) (Figure A) is valid when expressed using a reference pressure (Pref) and corresponding diameter (dref): P = Pref*exp[βo(d/dref-1)]. In practice, diastolic blood pressure (BP) and diastolic diameter are substituted for Pref and dref. The resulting β (Figure B) is not equal to βo, and can be analytically shown to depend on BP. This dependence affects both β and CAVI. CAVI calculation also relies on an approximation of incremental stiffness dP/dd (Figure D), which further increases pressure dependence. Both effects can be analytically and fundamentally corrected for to obtain clinically usable equations to estimate pressure-independent βo and CAVIo (Figures C,F). The pressure dependence of CAVI and the proposed corrected parameters were quantified in a numerical simulation of a hypertensive patient group. Simulation was done by randomly assigning to each subject a single pressure-independent βo value (no change in actual P-d relationship), and baseline and treated (lowered) diastolic and pulse pressures (DBP and PP). Values were drawn from normal distributions (mean ± SD: βo 10 ± 2, baseline DBP 110 ± 10 and PP 50 ± 10 mmHg; treated DBP 80 ± 10 and PP 40 ± 10 mmHg). Results: Results of pressure dependence of β and CAVI are shown in Figures B,E. Corrected measures (Figures C,F) showed no change with BP. After power calculation, simulation of n = 154, with systolic/diastolic BP (SBP/DBP) lowered from 160 ± 15/110 ± 11 to 120 ± 14/79 ± 11 mmHg, resulted in pulse wave velocity reduction from 8.2 ± 1.1 to 6.9 ± 1.0 m/s (p < 0.001). CAVI changed significantly from 8.1 ± 2.0 to 7.7 ± 2.1 (p = 0.023), while CAVIo did not change (9.7 ± 2.3 vs. 9.9 ± 2.6, p = 0.393). Conclusions: We conclude that β and CAVI as regularly used inherently exhibit pressure dependence. We derived clinically applicable equations to evaluate intrinsic pressure-independent changes in arterial stiffness.
Original languageEnglish
Article numberPP.37.13
Pages (from-to)e344
Number of pages1
JournalJournal of Hypertension
Issue numbere-Supplement 2
Publication statusPublished - Sep 2016
EventEuropean Meeting on Hypertension and Cardiovascular Protection (26th : 2016) - Paris, France
Duration: 10 Jun 201613 Jun 2016

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