Low Blood Pressure, Comorbidities, and Ischemic Stroke Mortality in US Veterans

Stroke ◽  
2021 ◽  
Author(s):  
Hugo J. Aparicio ◽  
Laura M. Tarko ◽  
David Gagnon ◽  
Lauren Costa ◽  
Ashley Galloway ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Mortality Risk ◽  
Cardiovascular Mortality ◽  
Pulse Pressure ◽  
Hazard Ratio ◽  
Stroke Mortality ◽  
Cox Models ◽  
Low Blood Pressure ◽  
Us Veterans

Background and Purpose: Low blood pressure (BP) is associated with higher stroke mortality, although the factors underlying this association have not been fully explored. We investigated prestroke BP and long-term mortality after ischemic stroke in a national sample of US veterans. Methods: Using a retrospective cohort study design of veterans hospitalized between 2002 and 2007 with a first ischemic stroke and with ≥1 outpatient BP measurements 1 to 18 months before admission, we defined 6 categories each of average prestroke systolic BP (SBP) and diastolic BP, and 7 categories of pulse pressure. Patients were followed-up to 12 years for primary outcomes of all-cause and cardiovascular mortality. We used Cox models to relate prestroke BP indices to mortality and stratified analyses by the presence of preexisting comorbidities (smoking, myocardial infarction, heart failure, atrial fibrillation/flutter, cancer, and dementia), race and ethnicity. Results: Of 29 690 eligible veterans with stroke (mean±SD age 67±12 years, 98% men, 67% White), 2989 (10%) had average prestroke SBP<120 mm Hg. During a follow-up of 4.1±3.3 years, patients with SBP<120 mm Hg experienced 61% all-cause and 27% cardiovascular mortality. In multivariable analyses, patients with the lowest SBP, lowest diastolic BP, and highest pulse pressure had the highest mortality risk: SBP<120 versus 130 to 139 mm Hg (hazard ratio=1.26 [95% CI, 1.19–1.34]); diastolic BP <60 versus 70 to 79 mm Hg (hazard ratio=1.35 [95% CI, 1.23–1.49]); and pulse pressure ≥90 versus 60 to 69 mm Hg (hazard ratio=1.24 [95% CI, 1.15–1.35]). Patients with average SBP<120 mm Hg and at least one comorbidity (smoking, heart disease, cancer, or dementia) had the highest mortality risk (hazard ratio=1.45 [95% CI, 1.37–1.53]). Conclusions: Compared with normotension, low prestroke BP was associated with mortality after stroke, particularly among patients with at least one comorbidity.

MO570PULSE PRESSURE: A PREDICTOR OF CARDIOVASCULAR CALCIFICATION AND CARDIOVASCULAR MORTALITY IN HEMODIALYSIS PATIENTS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Merita Rroji (Molla) ◽  
Saimir Seferi ◽  
Majlinda Cafka ◽  
Erjola Likaj ◽  
Vilma Cadri ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Arterial Stiffness ◽  
Abdominal Aorta ◽  
Cardiovascular Mortality ◽  
Pulse Pressure ◽  
Univariate Analysis ◽  
Hemodialysis Patients ◽  
Case Series Study ◽  
Increased Risk ◽  
Elevated Systolic Blood Pressure

Abstract Background and Aims The mortality rate is extremely high in chronic kidney disease (CKD), primarily due to the high prevalence of cardiovascular disease (CVD). Increased pulse pressure (PP), defined as the difference between inappropriately elevated systolic blood pressure (SBP) and reduced diastolic blood pressure (DBP) at any value of mean arterial pressure (MAP), is a surrogate measure of increased arterial stiffness of central elastic arteries (aorta and its major branches). CKD-MBD anomalies leading to calcification contribute to increased arterial stiffness and pulse pressure. This study aimed to evaluate the relationship of pulse pressure parameter with valve calcification and abdominal aortic calcification in hemodialysis patients and its impact on cardiovascular mortality. Method We performed a prospective case series study with 3 years follow- up. Plain X-ray images of the lateral lumbar spine from all subjects were studied to obtain images of the lower abdominal aorta using semiquantitative scores as described by Kauppila et al. Cardiac valve calcifications were evaluated by two-dimensional echocardiography with an HDI 5000 Sono CT echocardiographic machine with a 3.3-MHz multiphase array probe in subjects lying in the left decubitus position an according to the recommendations of the European Association of Echocardiography. The patient was evaluated as having vascular calcification if he had the presence of calcification in at least one of the site examined: a mitral valve, aortic valve or abdominal aorta. Results We studied 85 chronic stable hemodialysis patients. Mean age and meantime is therapy was 49.9±12.4 years and 51.5±28.7 months, respectively. Mean pulse pressure was 55.72±14.2 mmHg. Fifty-nine patients (69.4%) were identified with aortic abdominal calcification, and the mean Kauppila score was 4.91 ± 4.05. Sixty patients (70.5%) had at least one valve calcified, while thirty-three patients (38.8%) had both valves calcified. Univariate analysis revealed that every 1 mmHg increase in pulse pressure was associated with increased cardiovascular calcification risk p=0.020. In multivariate analysis, after adjustment for age, gender, diabetes mellitus, cholesterol, and triglyceride serum levels, the association also remained strong, where every increase of 1 mm Hg in pulse pressure was associated with increased risk for cardiovascular calcification (HR 1.02, 95% CI (1.00-1.03), p= 0.038). Besides, pulse pressure was an independent predictor for cardiovascular mortality (HR 1.03, 95% CI (1.02-1.05), p=0.002). Conclusion Pulse pressure may identify hemodialysis patients with subclinical cardiovascular calcification who need further evaluation. Wide pulse pressure is associated with increased cardiovascular mortality.

The Association of Blood Pressure and Collateral Circulation in Hyperacute Ischemic Stroke Patients Treated with Intravenous Thrombolysis

2015 ◽  
Vol 39 (2) ◽  
pp. 130-137 ◽  
Author(s):  
Harri Rusanen ◽  
Jukka T. Saarinen ◽  
Niko Sillanpää
Keyword(s):  
Blood Pressure ◽  
Multivariate Analysis ◽  
Ischemic Stroke ◽  
Mean Arterial Pressure ◽  
Clinical Outcome ◽  
Thrombolytic Therapy ◽  
Systolic Blood Pressure ◽  
Pulse Pressure ◽  
Collateral Circulation ◽  
Stroke Patients

Background: The integrity of collateral circulation is a major prognostic factor in ischemic stroke. Patients with good collateral status have larger penumbra and respond better to intravenous thrombolytic therapy. High systolic blood pressure is linked with worse clinical outcome in patients with acute ischemic stroke treated with intravenous thrombolytic therapy. We studied the effect of different blood pressure parameters on leptomeningeal collateral circulation in patients treated with intravenous thrombolytic therapy (<3 h) in a retrospective cohort. Methods: Anterior circulation thrombus was detected with computed tomography angiography and blood pressure was measured prior to intravenous thrombolytic therapy in 104 patients. Baseline clinical and imaging information were collected. Group comparisons were performed; Collateral Score (CS) was assessed and entered into logistic regression analysis. Results: Fifty-eight patients out of 104 displayed good collateral filling (CS ≥2). Poor CS was associated with more severe strokes according to National Institutes of Health Stroke Scale (NIHSS) at arrival (16 vs. 11, p = 0.005) and at 24 h (15 vs. 3, p < 0.001) after the treatment. Good CS was associated with higher systolic blood pressure (p = 0.03), but not with diastolic blood pressure (p = 0.26), pulse pressure (p = 0.20) or mean arterial pressure (p = 0.07). Good CS was associated with better Alberta Stroke Program Early CT Score (ASPECTS) in 24 h follow-up imaging (p < 0.001) and favorable clinical outcome at three months (mRS ≤2, p < 0.001). Median CS was the highest (CS = 3) when systolic blood pressure was between 170 and 190 mm Hg (p = 0.03). There was no significant difference in the number of patients with good (n = 11) and poor (n = 12) CS who received intravenous antihypertensive medication (p = 0.39) before or during the thrombolytic therapy. In multivariate analysis age (p = 0.02, OR 0.957 per year, 95% CI 0.92-0.99), time from the onset of symptoms to treatment (p = 0.005, OR 1.03 per minute, 95% CI 1.01-1.05), distal clot location (p = 0.02, OR 3.52, 95% CI 1.19-10.35) and systolic blood pressure (p = 0.04, OR 1.03 per unit mm Hg, 95% CI 1.00-1.05) predicted good CS. Higher systolic blood pressure (p = 0.049, OR 0.96 per unit mm Hg, 95% CI 0.93-1.00) and pulse pressure (p = 0.005, OR 0.94 per unit mm Hg, 95% CI 0.90-0.98) predicted unfavorable clinical outcome at three months in multivariate analysis. Conclusion: Moderately elevated systolic blood pressure is associated with good collateral circulation in patients treated with intravenous thrombolytic therapy. However, there is an inverse association of systolic blood pressure with the three-month clinical outcome. Diastolic blood pressure, mean arterial pressure and pulse pressure are not statistically and significantly associated with collateral status.

scholarly journals Anxiety and mortality risk in community-dwelling elderly people

2013 ◽  
Vol 203 (4) ◽  
pp. 303-309 ◽  
Author(s):  
Isabelle Carrière ◽  
Joanne Ryan ◽  
Joanna Norton ◽  
Jacqueline Scali ◽  
Robert Stewart ◽  
...  
Keyword(s):  
Anxiety Disorder ◽  
Elderly People ◽  
Mortality Risk ◽  
Cardiovascular Mortality ◽  
Univariate Analysis ◽  
Community Dwelling ◽  
Cox Models ◽  
Anxiety Trait ◽  
Specific Association ◽  
Using Data

BackgroundThere are conflicting data on the role of anxiety in predicting mortality.AimsTo evaluate the 10-year mortality risk associated with anxiety in community-dwelling elderly people.MethodUsing data from 718 men and 1046 women aged 65 years and over, gender-stratified associations of anxiety symptoms (Spielberger State–Trait Anxiety Inventory, third tertile) and current DSM-IV anxiety disorder including generalised anxiety disorder (GAD) and phobia with all-cause and cardiovascular mortality were determined.ResultsIn women, mortality risk was increased for anxiety disorder and GAD in multivariate Cox models (hazard ratio (HR) = 1.53, 95% Cl 1.02-2.27 and HR = 2.04, 95% Cl 1.08-3.86 respectively), whereas for phobia it was nearly significant (HR= 1.52, 95% Cl 0.94-2.47). Anxiety trait symptoms became non-significant as a result of the confounding effect of depressive symptoms. Anxiety disorder was associated with cardiovascular mortality in univariate analysis (HR = 2.42, 95% Cl 1.16-5.07). No significant associations were found in men.ConclusionsOur study suggests a gender-specific association of anxiety and mortality.

scholarly journals Heart Failure and Atrial Fibrillation Modify the Associations of Nocturnal Blood Pressure Dipping Pattern With Mortality in Hemodialysis Patients

Hypertension ◽  
2020 ◽  
Vol 76 (4) ◽  
pp. 1231-1239
Author(s):  
Christopher C. Mayer ◽  
Christoph Schmaderer ◽  
Charalampos Loutradis ◽  
Julia Matschkal ◽  
Marrieta Theodorakopoulou ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Blood Pressure ◽  
Cardiovascular Mortality ◽  
Hemodialysis Patients ◽  
Hazard Ratio ◽  
End Points ◽  
Nocturnal Blood Pressure ◽  
Blood Pressure Dipping ◽  
Nocturnal Blood Pressure Dipping

Heart failure (HF), hypertension, and abnormal nocturnal blood pressure dipping are highly prevalent in hemodialysis patients. Atrial fibrillation (AF) and HF might be important mediators for the association of abnormal dipping patterns with worse prognosis. Thus, the aim of this study is to investigate the association of dipping with mortality in hemodialysis patients and to assess the influence of AF and HF. In total, 525 hemodialysis patients underwent 24-hour ambulatory blood pressure monitoring. All-cause and cardiovascular mortality served as end points. Patients were categorized according to their systolic dipping pattern (dipper, nondipper, and reverse dipper). Cox regression analysis was performed to determine the association between dipping pattern and study end points with dipping as reference. Subgroup analysis was performed for patients with and without AF or HF. In total, 185 patients with AF or HF and 340 patients without AF or HF were included. During a median follow-up of 37.8 months, 177 patients died; 81 from cardiovascular causes. Nondipping and reverse dipping were significantly associated with all-cause mortality in the whole cohort (nondipper: hazard ratio, 1.95 [1.22–3.14]; P =0.006; reverse dipper: hazard ratio, 2.31 [1.42–3.76]; P <0.001) and in patients without AF or HF (nondipper: hazard ratio, 2.78 [1.16–6.66]; P =0.02; reverse dipper: hazard ratio, 4.48 [1.87–10.71]; P <0.001) but not in patients with AF or HF. For cardiovascular mortality, associations were again significant in patients without AF or HF and in the whole cohort. The observed associations remained significant after adjustment for possible confounders. This study provides well-powered evidence for the association between abnormal dipping patterns and mortality in hemodialysis patients and suggests that HF or AF modifies this association.

scholarly journals Association Between Low Blood Pressure and Clinical Outcomes in Patients With Acute Ischemic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (1) ◽  
pp. 338-341
Author(s):  
Merelijne A. Verschoof ◽  
Adrien E. Groot ◽  
Jan-Dirk Vermeij ◽  
Willeke F. Westendorp ◽  
Sophie A. van den Berg ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Ischemic Stroke ◽  
Gastrointestinal Bleeding ◽  
Hospital Mortality ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Odds Ratio ◽  
Increased Risk ◽  
Low Blood Pressure

Background and Purpose— Low blood pressure is uncommon in patients with acute ischemic stroke (AIS). We assessed the association between baseline low blood pressure and outcomes in patients with AIS. Methods— Post hoc analysis of the PASS (Preventive Antibiotics in Stroke Study). We compared patients with AIS and low (<10th percentile) baseline systolic blood pressure (SBP) to patients with normal SBP (≥10th percentile <185 mm Hg). The first SBP measured at the Emergency Department was used. Outcomes included in-hospital mortality, major complications <7 days of stroke onset, and functional outcome at 90 days (modified Rankin scale score). We used regression analysis to calculate (common) odds ratios and adjusted for predefined prognostic factors. Results— Two thousand one hundred twenty-four out of 2538 patients had AIS. The cutoff for low SBP was 130 mm Hg (n=212; range, 70–129 mm Hg). One thousand four hundred forty patients had a normal SBP (range, 130–184 mm Hg). Low SBP was associated with an increased risk of in-hospital mortality (8.0% versus 4.2%; adjusted odds ratio [aOR], 1.58; 95% CI, 1.13–2.21) and complications (16.0% versus 6.5%; aOR, 2.56; 95% CI, 1.60–4.10). Specifically, heart failure (2.4% versus 0.1%; aOR, 17.85; 95% CI, 3.36–94.86), gastrointestinal bleeding (1.9% versus 0.1%; aOR, 26.04; 95% CI, 2.83–239.30), and sepsis (3.3% versus 0.5%; aOR, 5.53; 95% CI, 1.84–16.67) were more common in patients with low SBP. Functional outcome at 90 days did not differ (shift towards worse outcome: adjusted common odds ratio, 1.24; 95% CI, 0.95–1.61). Conclusions— Whether it is cause or consequence, low SBP at presentation in patients with AIS was associated with an increased risk of in-hospital mortality and complications, specifically heart failure, gastrointestinal bleeding, and sepsis. Clinicians should be vigilant for potentially treatable complications. Clinical Trial Registration— URL: https://www.controlled-trials.com . Unique identifier: ISRCTN66140176.

Risk from low blood pressure in frail older adults: diastolic pressure and pulse pressure are important

2020 ◽  
Author(s):  
J David Spence
Keyword(s):  
Blood Pressure ◽  
Older Adults ◽  
Blood Flow ◽  
Pulse Pressure ◽  
Coronary Flow ◽  
Older Patients ◽  
Diastolic Pressure ◽  
Blood Pressure Measurement ◽  
J Curve ◽  
Low Blood Pressure

Abstract Blood pressure measurement with a cuff in patients with stiff arteries can be misleading, with false elevation of the diastolic pressure. Coronary flow, and most of the cerebral blood flow occur during diastole. There is a marked diastolic J curve in patients with diastolic pressure &lt;60 mmHg and pulse pressure &gt;60 mmHg. Aiming for a systolic target of 120 mmHg is not safe in some frail older patients.

Short-term prognosis of normalising serum potassium following an episode of hypokalaemia in patients with chronic heart failure

2020 ◽  
pp. 204748732091115
Author(s):  
Mette Aldahl ◽  
Christoffer Polcwiartek ◽  
Line Davidsen ◽  
Kristian Kragholm ◽  
Peter Søgaard ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Confidence Interval ◽  
Mortality Risk ◽  
Cardiovascular Mortality ◽  
Serum Potassium ◽  
Reference Group ◽  
Hazard Ratio ◽  
Increased Risk ◽  
All Cause Mortality

Background/aim It is well known that patients with chronic heart failure and hypokalaemia have increased mortality risk. We investigated the impact of normalising serum potassium following an episode of hypokalaemia on short-term mortality among patients with chronic heart failure. Methods and results We identified 1673 patients diagnosed with chronic heart failure who had a serum potassium measurement under 3.5 mmol/l within 14 days and one year after initiated medical treatment with both loop diuretics and angiotensin-converting enzyme inhibitors or angiotensin-II receptor blockers. A second serum potassium measurement was required 8–30 days after the episode of hypokalaemia. All-cause mortality and cardiovascular mortality was examined within 90 days from the second serum potassium measurement. Mortality was examined according to six predefined potassium groups derived from the second measurement:<3.5 mmol/l ( n = 302), 3.5–3.7 mmol/l ( n = 271), 3.8–4.1 mmol/l ( n = 464), 4.2–4.4 mmol/l ( n = 270), 4.5–5.0 mmol/l ( n = 272), and 5.1–8.0 mmol/l ( n = 94). We used Cox regression to estimate both all-cause mortality risk and cardiovascular mortality, with serum potassium at 3.8–4.1 mmol/l as reference. After 90 days, the all-cause mortality in the six groups was 29.5%, 22.1%, 20.3%, 24.8%, 23.5% and 43.6%, respectively. In multivariable adjusted analysis, patients with serum potassium <3.5 mmol/l (hazard ratio: 1.51; 95% confidence interval: 1.13–2.02) and serum potassium 5.1–8.0 mmol/l (hazard ratio: 2.18; 95% confidence interval: 1.50–3.17) had an increased risk of all-cause mortality compared to the reference. After 90 days, the cardiovascular mortality in the six groups was 19.2%, 17.7%, 14.4%, 18.9%, 18.8% and 34.0%, respectively. In multivariable adjusted analysis, patients with serum potassium 5.1–8.0 mmol/l (hazard ratio: 2.32; 95% confidence interval: 1.51–3.56) had an increased risk of cardiovascular mortality compared to the reference, while serum potassium <3.5 mmol/l (hazard ratio: 1.37; 95% confidence interval: 0.97–1.95) had a trend toward increased risk of cardiovascular mortality compared to the reference. Conclusion Patients with chronic heart failure and hypokalaemia, who after 8–30 days remained hypokalaemic, had a significantly higher 90-day all-cause mortality risk compared to patients in the reference group (3.8–4.1 mmol/l). Patients with chronic heart failure and hypokalaemia, who after 8–30 days had the serum potassium level increased to a level within 5.1–8.0 mmol/l, had both a significantly higher 90-day all-cause mortality risk and cardiovascular mortality risk compared to patients in the reference group (3.8–4.1 mmol/l).

scholarly journals Blood Pressure Levels in Young Adulthood and Midlife Stroke Incidence in a Diverse Cohort

Hypertension ◽  
2021 ◽  
Vol 77 (5) ◽  
pp. 1683-1693 ◽  
Author(s):  
Yariv Gerber ◽  
Jamal S. Rana ◽  
David R. Jacobs ◽  
Yuichiro Yano ◽  
Deborah A. Levine ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Young Adults ◽  
Continuous Variable ◽  
Hazard Ratio ◽  
Time Dependent ◽  
Middle Aged ◽  
Cox Models ◽  
Stroke Incidence ◽  
Primordial Prevention ◽  
Middle Aged Adults

We examined the longitudinal association between blood pressure (BP) and stroke incidence in young and middle-aged adults. BP measured during 9 examinations of the CARDIA study (Coronary Artery Risk Development in Young Adults) from 1985-1986 to 2015-2016 was used to classify participants (n=5079) according to the 2017 Hypertension Clinical Practice Guidelines. We used the highest BP obtained through the third examination (1990–1991) to define baseline BP categories; time-dependent categories (accounting for change in BP over time) were determined incorporating follow-up measurements. BP groups at ages 30 and 40 years were also defined. Stroke events were adjudicated until 2018. Mean age at baseline was 29.8 years. Stroke occurred in 100 participants. Stroke incidence (per 100 000 person-years) was higher ( P <0.001) in Black (120 [95% CI, 95–149]) versus White (29 [95% CI, 18–46]) participants. After adjustment with Cox models for sociodemographic and cardiovascular risk factors, stage 2 hypertension was associated with a higher risk of stroke at baseline (hazard ratio, 3.72 [95% CI, 2.12–6.54]), as a time-dependent variable (hazard ratio, 5.84 [95% CI, 3.43–9.95]), at age 30 (hazard ratio, 4.14 [95% CI, 2.19–7.82]) and at age 40 (hazard ratio, 5.59 [95% CI, 3.35–9.31]), compared with normal BP. Elevated BP and stage 1 hypertension showed more modest increases in risk. As a continuous variable, systolic BP ≥90 mm Hg at age 40 was directly associated with stroke risk. These findings call for primordial prevention strategies to reduce population BP levels among young and middle-aged adults, particularly in Black young adults given ≈4-fold higher stroke incidence, including within values traditionally considered to be normal.

Carotid Artery Stiffness Mechanisms Associated With Cardiovascular Disease Events and Incident Hypertension: the MESA

Hypertension ◽  
2022 ◽  
Author(s):  
Ryan J. Pewowaruk ◽  
Claudia Korcarz ◽  
Yacob Tedla ◽  
Gregory Burke ◽  
Philip Greenland ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Elastic Modulus ◽  
Arterial Stiffness ◽  
The United States ◽  
Hazard Ratio ◽  
Structural Stiffness ◽  
Cox Models ◽  
Artery Stiffness ◽  
The Difference

Background: Elastic arteries stiffen via 2 main mechanisms: (1) load-dependent stiffening from higher blood pressure and (2) structural stiffening due to changes in the vessel wall. It is unknown how these different mechanisms contribute to incident cardiovascular disease (CVD) events. Methods: The MESA (Multi-Ethnic Study of Atherosclerosis) is a longitudinal study of 6814 men and women without CVD at enrollment, from 6 communities in the United States. MESA participants with B-mode carotid ultrasound and brachial blood pressure at baseline Exam in (2000–2002) and CVD surveillance (mean follow-up 14.3 years through 2018) were included (n=5873). Peterson’s elastic modulus was calculated to represent total arterial stiffness. Structural stiffness was calculated by adjusting Peterson’s elastic modulus to a standard blood pressure of 120/80 mm Hg with participant-specific models. Load-dependent stiffness was the difference between total and structural stiffness. Results: In Cox models adjusted for traditional risk factors, load-dependent stiffness was significantly associated with higher incidence of CVD events (hazard ratio/100 mm Hg, 1.21 [95% CI, 1.09–1.34] P <0.001) events while higher structural stiffness was not (hazard ratio, 1.03 [95% CI, 0.99–1.07] P =0.10). Analysis of participants who were normotensive (blood pressure <130/80, no antihypertensives) at baseline exam (n=2122) found higher load-dependent stiffness was also associated with significantly higher incidence of hypertension (hazard ratio, 1.53 [95% CI, 1.35–1.75] P <0.001) while higher structural stiffness was not (hazard ratio, 1.03 [95% CI, 0.99–1.07] P =0.16). Conclusions: These results provide valuable new insights into mechanisms underlying the association between arterial stiffness and CVD. Load-dependent stiffness was significantly associated with CVD events but structural stiffness was not.

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