Predictive value of estimated pulse wave velocity with all-cause and cause-specific mortality in the hypertensive population: the National Health and Nutrition Examination Surveys 1999–2014

Background: Estimated pulse wave velocity (ePWV) has been proposed as a potential approach to assess carotid–femoral pulse wave velocity (cfPWV). However, the potential ability of ePWV to predict all-cause and cause-specific mortality in the population group with hypertension remains unresolved. Methods: We conducted a prospective cohort study using the data of 14 044 adults (age ≥18 years) from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2014, and followed this cohort until the end of December 2019. ePWV was calculated by using a regression equation for age and mean blood pressure (MBP), derived by the Arterial Stiffness Collaborative Group. Results: The weighted mean age of the 14 044 adults included was 54.79 years; 49.42% of all participants were men. During the median follow-up period of 11 years, 3795 deaths were recorded. In the fully adjusted cox regression model, each 1 m/s increase in ePWV was associated with an increased risk of 56% [hazard ratio 1.61; 95% confidence interval (CI) 1.49–1.64] risk for all-cause mortality. Every 1 m/s increase in ePWV resulted in an increased risk of mortality from cardiovascular disease, cerebrovascular disease, respiratory disease, Alzheimer's disease, accidents, cancer, influenza and pneumonia by 60, 70, 47, 118, 73, 41 and 103%, respectively. ePWV has a robust predictive value for 5- and 10-year all-cause mortality in the hypertensive population with AUCs of 0.749 and 0.741, respectively. Conclusion: Elevated ePWV is positively correlated with all-cause mortality and most cause-specific mortalities, independent of traditional risk factors. Moreover, ePWV demonstrates high accuracy in predicting 5-year and 10-year all-cause mortality, outperforming Framingham Risk Score.