Average Real Variability Is an Independent Predictor of Increased Arterial Stiffness Assessed by Pulse Wave Velocity

Blood pressure variability (BPV) is an established cardiovascular risk factor associated with target organ damage beyond mean blood pressure levels. Arterial stiffness, assessed by carotid-femoral pulse wave velocity (cfPWV), represents an early manifestation of hypertension and an independent predictor of cardiovascular events. Among short-term BPV indices, Average Real Variability (ARV) is considered a robust marker of blood pressure fluctuations. This study evaluated the relationship between ARV and arterial stiffness and identified clinically relevant ARV thresholds associated with increased cfPWV. A total of 315 adults underwent 24-h ambulatory blood pressure monitoring and cfPWV assessment. Receiver operating characteristic (ROC) analysis was performed to determine optimal systolic and diastolic ARV cut-off values for detecting increased arterial stiffness (cfPWV ≥10 m/s). Multivariable logistic regression models assessed independent associations between ARV indices and cfPWV. ROC analysis identified daytime systolic ARV ≥11.4 mmHg as the optimal threshold for predicting cfPWV ≥10 m/s (AUC 0.68; 95% CI 0.61-0.76; p < 0.001). Other significant ARV cut-offs ranged between 11.4 and 12.0 mmHg for systolic and diastolic measures. After adjustment for age, sex, and mean systolic blood pressure, daytime systolic ARV remained independently associated with cfPWV ≥10 m/s (OR 5.36 95% CI 1.70-17.04; p < 0.01). All diastolic ARV indices also retained statistical significance, with lower effect sizes (OR 2.45-3.25).Daytime systolic ARV ≥11.4 mmHg shows the strongest independent association with increased arterial stiffness, while diastolic ARV ijch70355ndices remain significant but weaker predictors. Trial Registration: The study received approval from the institutional bioethics committee. As it does not meet the criteria for a clinical trial, registration was not applicable.