Limitation of Brachial-Ankle Pulse Wave Velocity in Assessing the Risk of Stroke: Importance of Instantaneous Blood Pressure

Background and Objective: The carotid-femoral pulse wave velocity is a well-established index of aortic stiffness, and the brachial-ankle pulse wave velocity (baPWV) has recently been developed as a new method for evaluating arterial stiffness. However, whether the baPWV is also useful in evaluating the risk of stroke is currently controversial. Moreover, it is also unknown which types of stroke and neuroradiological findings are associated with increased arterial stiffness. We investigated the association between the baPWV and risk of stroke using a case-control design. Methods: This study enrolled 223 stroke patients (aged 65.6 ± 10.3 years, mean ± SD) and the same number of age- and sex-matched controls. All of the subjects in this study underwent a structured interview and had their vascular risk factors assessed. We reviewed brain magnetic resonance imaging and magnetic resonance angiography data of stroke patients to assessthe severity of white-matter hyperintensity lesions, number of cerebral microbleeds, and the stenosis of both intracranial and extracranial arteries. The baPWV was measured noninvasively by an oscillometric method. Results: The baPWV was most affected by the instantaneous systolic blood pressure, and was significantly higher in stroke patients than control subjects (1,721 ± 395 cm/s vs. 1,657 ± 366 cm/s, p = 0.03). However, the baPWV did not differ significantly with a specific type of stroke or subtype of ischemic stroke. Multiple regression analysis revealed that the baPWV was not independently associated with increased risk of stroke, or the severity of white-matter hyperintensity lesions or cerebral microbleeds. Conclusion: Although the baPWV was significantly higher in stroke patients than control subjects, it was not independently associated with increased risk of stroke or specific subtypes of ischemic stroke or neuroradiological findings.