The aortic-femoral arterial stiffness gradient is blood pressure independent in older adults: the atherosclerosis risk in communities (ARIC) study

Keeron Stone, Simon Fryer, James Faulkner, Michelle L. Meyer, Kevin Heffernan, Anna Kucharska-Newton, Gabriel Zieff, Craig Paterson, Kunihiro Matsushita, Timothy M. Hughes, Hirofumi Tanaka, Lee Stoner

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Background:Aortic arterial stiffness is a strong independent predictor of cardiovascular disease (CVD); however, its dependence on mean arterial pressure (MAP) limits its clinical utility. The aortic-femoral arterial stiffness gradient (af-SG), a novel marker of CVD risk, may be a promising alternative, but its dependence on MAP is not known. The aim of this study was to determine the relationship between MAP and the af-SG in healthy older adults and those with established disease, including hypertension and diabetes.Method:We evaluated the dependency of the af-SG on MAP in healthy older adults (n = 694, aged 74 ± 5 years), and adults with hypertension (n = 2040, aged 76 ± 5 years), and diabetes (n = 1405, aged 75 ± 5 years) as part of the community-based Atherosclerosis Risk in Communities (ARIC) Study. Carotid-femoral pulse-wave velocity (cfPWV), femoral-ankle PWV (faPWV) and blood pressure were measured using standardized protocols. The af-SG was calculated as faPWV divided by cfPWV. Multivariable regression analysis was performed to test the independent association of MAP with af-SG, with adjustments for known confounders, including age, sex, BMI, blood glucose and heart rate.Results:There was no significant relationship between the af-SG and MAP in healthy (β = 0.002, P = 0.301), hypertension (β = -0.001, P = 0.298) or diabetes (β = -0.001, P = 0.063) population groups, with MAP explaining less than 0.1, less than 0.1 and 0.2% of the variance in the af-SG, respectively.Conclusion:These findings suggest that the af-SG may be regarded as a MAP independent index of arterial health and CVD risk in older adults.

Original languageEnglish
Pages (from-to)2361-2369
Number of pages9
JournalJournal of Hypertension
Issue number12
StatePublished - Dec 1 2021

Bibliographical note

Funding Information:
The authors thank the staff and participants of the ARIC study for their important contributions. The ARIC study has been funded in whole or in part with Federal funds from the National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, under Contract nos. (HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700005I, HHSN268201700004I). The study was also supported by R01AG053938.

Publisher Copyright:
© 2021 Lippincott Williams and Wilkins. All rights reserved.


  • arterial stiffness
  • cardiovascular disease
  • mean arterial pressure
  • pulse wave velocity
  • pulse wave velocity ratio

ASJC Scopus subject areas

  • Internal Medicine
  • Physiology
  • Cardiology and Cardiovascular Medicine


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