Prognostic Value of Brachial–Ankle Pulse Wave Velocity in the Prediction of Cardiovascular Events: Comparison with Brachial Pulse Pressure

<b>Background</b>: Although brachial-ankle pulse wave velocity (baPWV) has been used to predict cardiovascular events, studies comparing it with brachial pulse pressure (brPP) for predictive value have been lacking. We investigated how brPP and baPWV differ in their ability to predict future cardiovascular events. <b>Methods</b>: We retrospectively reviewed the clinical data of 11,703 consecutive patients where brPP and baPWV measurements had been made. The primary endpoint was differences in the incidence of major adverse cardiovascular and cerebrovascular events (MACCE). <b>Results</b>: Participants had a median age of 61 years, and men accounted for 57.7% of the cohort. During a median follow-up duration of 3.64 years, 347 (3.0%) MACCE occurred. Using established reference values of baPWV > 1800 cm/s and brPP > 60 mmHg, we, respectively, stratified patients by these values. Kaplan-Meier survival curve analysis revealed that both high baPWV and brPP groups displayed elevated MACCE incidence, all-cause mortality, and cardiovascular mortality. After controlling for potential confounders, multivariate Cox regression analysis showed that individuals with elevated baPWV had higher rates of MACCE, overall mortality, and cardiovascular death, whereas brPP was not significantly associated with these outcomes. Subgroup analysis showed a consistent difference in MACCE incidence across all subgroups when stratified by baPWV; however, the significance disappeared in several subgroups when stratified by brPP. <b>Conclusions</b>: baPWV exhibited a stronger association with MACCE incidence than brPP. Thus, baPWV may be a more effective factor than brPP for cardiovascular risk stratification.