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Distinct Mediating Roles of Hypertension in Arterial Stiffness Mechanisms Associated with Cardiovascular Disease
Jing Li1,2,3,4, Shuohua Chen5, Xiaoli Zhang1,2,3
1Department of Epidemiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
American Journal of Hypertension
|July 2, 2026
Summary
Arterial stiffness (AS) components increase cardiovascular disease (CVD) risk. Load-dependent stiffness primarily acts through hypertension, while structural stiffness may indicate independent vascular damage, suggesting combined BP control and vascular protection for CVD prevention.
Area of Science:
- Cardiovascular Medicine
- Vascular Biology
- Epidemiology
Background:
- Arterial stiffness (AS) is a key risk factor for cardiovascular disease (CVD).
- AS arises from structural and load-dependent stiffening, but their distinct contributions to CVD risk and hypertension's role are unclear.
- This study quantifies AS component associations with incident CVD and assesses hypertension's mediating effects.
Purpose of the Study:
- To quantify the associations of different arterial stiffness components with incident cardiovascular disease (CVD).
- To evaluate the mediating role of hypertension in the relationship between arterial stiffness and CVD risk.
Main Methods:
- 12,684 participants from the Kailuan cohort were assessed for arterial stiffness (AS) via brachial-ankle pulse wave velocity (baPWV) and hypertension.
- Four AS components (measured, total, structural, load-dependent) were analyzed using Cox models and mediation analysis.
- Follow-up was conducted for a median of 11.35 years to ascertain incident CVD events.
Main Results:
- Increased arterial stiffness components were associated with higher CVD risk (HRs ranging from 1.17 to 1.21 per 1-SD increase).
- Hypertension mediated a significant proportion of these associations, ranging from 24.0% for structural stiffness to 75.9% for load-dependent stiffness.
- Load-dependent stiffness showed higher mediation by hypertension compared to structural stiffness.
Conclusions:
- Load-dependent arterial stiffness primarily contributes to CVD risk through hypertension.
- Structural stiffness may represent blood pressure-independent vascular damage.
- Combined strategies of blood pressure control and vascular protection are recommended for CVD prevention.
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