Ambulatory Systolic–Diastolic Pressure Regression Index as a Predictor of Clinical Events: A Meta-Analysis of Longitudinal Studies

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Abstract

Background and Purpose—

Blood pressure variables derived by ambulatory monitoring are important prognostic markers in hypertensive patients. Recent studies showed that ambulatory systolic–diastolic pressure regression index (ASDPRI), also known as ambulatory arterial stiffness index, may correlate with cardiovascular (CV) outcomes.

Methods—

We explored the predictive value of ASDPRI for future CV events, stroke, and all-cause mortality by meta-analyses of 7 longitudinal studies that had evaluated ASDPRI and had followed 20 505 subjects for a mean follow-up of 7.8 years.

Results—

The pooled relative risk of total CV events (including CV mortality), stroke, and all-cause mortality was 1.51 (95% CI, 1.18–1.93; P=0.001; 5 studies), 2.01 (95% CI, 1.60–2.52; P<0.001; 4 studies), and 1.25 (95% CI, 1.10–1.41; P=0.001; 4 studies), respectively, for high ASDPRI versus low ASDPRI subjects. An increase of ASDPRI by 1 standard deviation was associated with an age-adjusted, sex-adjusted, and risk factor-adjusted relative risk increase of total CV events and stroke by 15% and 30%, respectively. ASDPRI predicted stroke better than total CV events, predicted stroke better in normotensive subjects than in hypertensive patients, and also predicted total CV events better in females than in males. There was not significant publication bias.

Conclusions—

ASDPRI is an ambulatory blood pressure-derived biomarker that strongly predicts future CV events, stroke, and all-cause mortality. These findings suggest that this index may be useful for risk stratification purposes.

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