Cardiovascular disease (CVD) is the leading global cause of death, with elevated blood pressure (BP) in young adults being linked to CVD in adulthood. Pulse wave velocity (PWV) is a noninvasive measure of arterial stiffness, a predictor of CVD, and can be influenced by exercise. Exercise, like stair climbing, improves vascular health and reduces BP. The primary aims of this study were to examine whether the change in BP after a single stair climb is associated with PWV and whether it is associated with 24-h BP averages. Fifty-four young adults (23.8 ± 3.56 years) underwent back-to-back sessions of vascular health assessment, a 24-h ambulatory BP (ABP) monitoring, and a single stair climb exercise consisting of 42 steps. Pre- to post-climb BP response was calculated. Our population was normotensive (119.4/73.7 mmHg) and had an increase in SBP (126.4-138.5 mmHg, P < 0.05) and heart rate (HR) (85.6-94.2 bpm, P < 0.05) with climb. We found an inverse relationship between PWV (5.4 ± 0.85 m/s) and change in SBP with climb ( r = -0.340, P = 0.012). We found no relationship between 24-h BP averages and post-stair climb response. The first to report an inverse relationship between SBP response to exercise and PWV in young adults emphasizes subtle differences in vascular compliance. While the stair climb elicited a significant vascular response, there was no association with 24-h ABP averages. The potential of stair climbing as a practical exercise for assessing vascular health underscores the need for future research.

Arterial stiffness, as measured by carotid-femoral pulse wave velocity (cfPWV), is an independent cardiovascular risk factor. Arterial stiffness measurement requires the acquisition of pulse waveforms at two arterial sites. This technique is often constrained to clinical or laboratory settings. Estimated PWV (ePWV) addresses these limitations by only requiring the measurement of a single pulse, or no pulse at all, providing a wider application for cardiovascular health monitoring. The aim of this systematic literature review is to investigate the various approaches and clinical utility of ePWV as a surrogate measure of arterial stiffness. The literature search followed the PRISMA guidelines and was conducted in the following databases: Embase, MEDLINE, PubMed, and Scopus. The initial search identified 409 papers: Embase (n = 38), MEDLINE (n = 98), PubMed (n = 93), and Scopus (n = 180). After screening and applying the exclusion criteria, 131 eligible papers remained. Peak topic publication occurred in 2024 (30%). Most papers (69%) used regression-based approaches in ePWV while 34% used a pulse wave analysis (PWA)-based approach. Most PWA approaches (57%) used an oscillometric cuff. There were few validation studies (12%). Validation studies presented correlations (r) from 0.35 to 0.92 and standard deviations reaching ±2.54 m/s. The use of ePWV as a surrogate for arterial stiffness is positively observed across the literature. However, validation studies reveal substantial individual differences hidden within acceptable population averages, underscoring the need to refine estimation algorithms for greater precision.NEW & NOTEWORTHY This structured literature review provides a collective overview of the various indirect approaches that have been used for noninvasive estimation of pulse wave velocity (PWV), along with the various clinical applications they have been used in. It focuses on the vast use of simple regression-based approaches, the individual differences hidden in the population averages, and how the inclusion of pulse wave analysis (PWA), currently underutilized, may enhance the assessment of arterial stiffness.

Arterial stiffness is a significant predictor of cardiovascular disease, commonly assessed using pulse wave velocity (PWV). Traditional PWV measurement methods, such as time-of-flight, become unreliable in highly reflective systems due to the presence of standing waves and measurement noise, complicating accurate determination of wave arrival times. To address these limitations, we developed and validated a spatial wavelength-based PWV measurement approach. Our objective was to evaluate the capability of this method in nonbiological systems and compare its performance directly to standard methods. Experimental measurements were conducted using latex tubes in a benchtop pulsatile flow system across multiple frequencies (20-47 Hz). High-speed video analysis tracked spatial diameter changes, allowing identification of the spatial wavelength. Computational fluid-structure interaction (FSI) simulations, replicating experimental conditions, provided validation. Measuring PWV via spatial wavelength showed consistent accuracy when compared to traditional methods (phase-slope, peak-slope, and pressure arrival time), remaining within 12% error relative to theoretical predictions derived from the Moens-Korteweg equation. Spatial wavelength-based calculation has practical limitations, including reduced reliability near resonant frequencies and the requirement for at least one full wavelength within the length of measured region, constraining clinical usability. This method can be used in laboratory conditions at higher frequencies, potentially allowing quantification of how vascular implants and prosthetics could alter arterial wall dynamics.

Vascular Age: A narrative review of assessment methods, clinical applications, and future directions.

Aged-related analysis of pressure pulse wave in the time and frequency domains

Association of the cholesterol, high-density lipoprotein, and glucose index with stroke risk in individuals with cardiovascular-kidney-metabolic syndrome stages 0-3: a national prospective cohort study.

Cardiovascular disease burden in children with obesity: A narrative review.

Pulse wave analysis of the radial artery waveform: a proof-of-concept for noninvasive anemia detection

To evaluate the effects of tiotropium/olodaterol (T/O) on phase-resolved functional lung (PREFUL) MRI parameters in hyperinflated chronic obstructive pulmonary disease (COPD) patients and examine correlations with conventional cardiopulmonary and hyperpolarized 129Xe MRI measures. Retrospective subanalysis of a prospective, randomized, placebo-controlled, crossover trial with open-label extension. Thirty-two patients with moderate-to-severe COPD (61.5 ± 7.7 years; 17 men); 30 completed the MRI extension at 1.5 T. PREFUL analysis yielded regional ventilation (RVent), flow-volume loop correlation metric (FVL-CM), normalized perfusion (QN), ventilation defect percentage (VDP), perfusion defect percentage (QDP), V/Q match metrics (VQM), and pulmonary pulse wave velocity (PWV; post-hoc parameter). Linear mixed-effects models tested treatment effects; correlations were evaluated with Spearman's rank and bootstrap 95% confidence intervals (95% CIs). PREFUL parameters improved after T/O single dose (SD) versus placebo, including improvements in FVL-CM by 4.1 percentage points (pp; 95% CI: 1.0 to 7.3 pp) and QN by 0.4 pp (95% CI: 0.2 to 0.6 pp) and reductions in VDP and QDP, with parallel gains in VQM(Non-Defect) (p < 0.05). PWV decreased after multiple doses (-0.87 m/s, 95% CI: -1.26 to -0.48 m/s). PREFUL MRI baseline values showed significant correlations with pulmonary function tests, cardiac, dynamic contrast-enhanced and 129Xe MRI. SD treatment-induced absolute changes in VDP(FVL-CM) correlated with reductions in residual volume (ρ = 0.41, 95% CI: 0.02 to 0.64). Further correlations were observed between PREFUL MRI and ¹²⁹Xe-derived VDP, apparent diffusion coefficient, and compartment ratios. PREFUL MRI sensitively captured immediate SD T/O-induced improvements in V/Q parameters and dose-dependent PWV responses after sustained bronchodilation. Question Can phase-resolved functional lung (PREFUL) MRI sensitively capture immediate single-dose and sustain multi-dose effects of tiotropium/olodaterol on ventilation-perfusion and vascular function in COPD patients? Findings Tiotropium/olodaterol improved PREFUL MRI-derived ventilation, perfusion, and V/Q matching parameters after a single dose, with sustained pulmonary vascular improvements after repeated dosing. Clinical relevance PREFUL MRI detected immediate and sustained functional improvements after tiotropium/olodaterol and showed significant correlations with cardiopulmonary tests and hyperpolarized ¹²⁹Xe MRI, supporting its role as a sensitive, radiation-free tool for monitoring COPD treatment response.

The long-term health impacts of dietary nitrate may depend on its food source, since coingested components differ between plant-based (eg, polyphenols) and animal-based (eg, heme iron) foods, likely directing nitrate toward distinct metabolic pathways and divergent vascular effects. We investigated whether plant- and animal-sourced nitrate intake showed different associations with 5-year blood pressure (BP) changes and whether these associations were modified by key coingested nutrients. In a cohort of 2942 Chinese adults, dietary intake was assessed using a validated food frequency questionnaire. Systolic BP and diastolic BP were measured at baseline and after 5 years. Brachial-ankle pulse wave velocity was assessed at follow-up to define arterial stiffness. Linear and logistic regression models were used to estimate β-coefficients and odds ratios, respectively. Higher plant-sourced nitrate was associated with a greater 5-year SBP decline (β, -3.51 [95% CI, -5.89 to -1.13]) and lower arterial stiffness (odds ratio, 0.59 [95% CI, 0.35-0.98]). Conversely, higher animal-sourced nitrate was associated with diastolic BP increase (β, 1.95 [95% CI, 0.54-3.37]). In joint analyses using a 2×2 approach based on median intakes of each component, high intakes of both plant-sourced nitrate and polyphenols or vitamin C showed the strongest inverse associations with systolic BP change, whereas high intakes of both animal-sourced nitrate and heme iron showed the strongest positive associations with DBP change. The association between dietary nitrate and BP is determined by its food source and might be affected by accompanying nutrients, highlighting the importance of considering the complete dietary context in nutritional epidemiology.

Non-dipper hypertension is associated with increased cardiovascular risk and target organ damage. Although endothelial dysfunction and arterial stiffness contribute to impaired nocturnal blood pressure decline, their relationship with the Endothelial Activation and Stress Index (EASIX) remains unclear. This study aimed to evaluate the association between nocturnal dipping status, EASIX score, and arterial stiffness. This retrospective study included 163 newly diagnosed hypertensive patients who underwent 24-hour ambulatory blood pressure monitoring and were classified as dipper or non-dipper based on nocturnal systolic blood pressure decline. Arterial stiffness was assessed using pulse wave velocity (PWV), and EASIX was calculated from lactate dehydrogenase, creatinine, and platelet count. Logistic regression analysis was performed to identify independent predictors of non-dipper status, while receiver operating characteristic analysis evaluated the diagnostic performance of EASIX, PWV, and their combination. Seventy-two patients were classified as non-dippers and 91 as dippers. Non-dipper patients had significantly higher EASIX scores (0.73 vs. 0.52, p < 0.001) and PWV values (7.92 vs. 7.05 m/s, p = 0.003). In multivariable analysis, EASIX (OR: 2.553, 95% CI: 1.568-4.156, p < 0.001) and PWV (OR: 1.358, 95% CI: 1.090-1.691, p = 0.006) remained independently associated with non-dipper status. The combined model demonstrated better discrimination (AUC: 0.755) than EASIX (0.723) or PWV (0.625) alone. Higher EASIX scores and increased arterial stiffness were independently associated with non-dipper status, and the combined use of EASIX and PWV improved predictive performance. EASIX may serve as a simple marker for early risk stratification; however, larger prospective studies are needed.

The aim of this systematic review and meta-analysis was to investigate the changes in aortic stiffness before (pre) and after endovascular aortic repair (ER) for thoracic and abdominal aortic disease, along with the associated changes in left ventricular function. PubMed, Web of Science, EMBASE, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov were searched. Two independent reviewers screened and selected eligible studies, and RevMan 5.4 was used for the statistical analysis. A total of 28 studies (including 2227 participants) were included. Abdominal aortic aneurysms (AAA) patients had higher pulse wave velocity (PWV) than volunteer participants (Mean difference [MD]:2.08; 95% confidence interval (CI): 0.54-3.62, I2 = 94%, p = 0.008). The PWV increased after ER (MD 1.22; 95%CI: 0.54-1.91, I2 = 86%, p < 0.001) and subgroup analysis of thoracic endovascular aortic repair (TEVAR, MD: 1.51; 95%CI: 0.83-2.19, I2 = 9%, p < 0.001) and endovascular aneurysm repair (EVAR, MD:1.29; 95%CI: 0.39-2.20, I2 = 90%, p = 0.005) showed similar results. Pooled analysis also showed that the left ventricular mass index (LVMI) increased after ER (MD:5.35; 95%CI: 1.16-9.54, I2 = 24%, p = 0.01), while no significant change was observed in left ventricular ejection fraction (MD:0.08; 95%CI: -0.63-0.79, I2 = 0%, p = 0.82). Patients with AAA have significantly higher PWV than age-matched controls. Endovascular repair may be associated with left ventricular structural remodeling, as reflected by changes in LVMI, while no significant effect on LVEF was observed. These adverse remodeling processes may merit consideration during follow-up. Further high-quality studies are needed to confirm these findings and to clarify strategies for reducing aortic stiffness.

African American women experience disproportionate cardiovascular disease risk, and altered central hemodynamics signal early vascular aging. For African American mothers, concern about their children's exposure to racism represents a salient psychosocial stressor, but its vascular consequences are unclear. We examined whether greater racism‑related Concern for Children (CFC) was associated with adverse longitudinal changes in central hemodynamics. African American mothers aged 30-46 years (n=236) underwent assessments of central systolic blood pressure (cSBP), augmentation index (AIx), pulse pressure amplification (PPA), and pulse wave velocity (PWV; n=205) at baseline and 4±1 years later. CFC was measured continuously (range 0-24) and categorically (high vs. low). Multivariable linear regression models examined associations between CFC and changes in central hemodynamics, adjusting for baseline values and sociodemographic, clinical, and psychosocial covariates. Logistic regression evaluated CFC and odds of newly developed high‑risk PPA (PPA<1.3). In fully adjusted models, greater CFC was associated with larger increases in AIx (b=0.30, 95% CI [0.11, 0.48]; P=0.002). At follow‑up, women with high CFC had AIx values 3.9 percentage points higher than those with low CFC (P=0.005). CFC was also associated with declining PPA (b=‑0.003, 95% CI [‑0.005, ‑0.001]; P=0.024) and greater odds of newly developed high‑risk PPA (OR=1.08, 95% CI [1.01, 1.15]; P=0.033). No associations were observed for cSBP or PWV. Greater racism‑related concern for children is associated with signs of early vascular aging in African American mothers, highlighting the cardiovascular consequences of racism‑related maternal stress.

Inconsistent links between arterial stiffness and cognition may reflect limited cognitive tests and unaccounted diurnal pulse wave velocity variation. To bridge this knowledge gap, we investigated 24-hour ambulatory estimated pulse wave velocity (ePWV) and its association with dementia-related neuroimaging and cognitive function in hypertension. We assessed 893 patients with hypertension aged ≥50 years (mean age, 67.2 years; 52.3% women), including brain magnetic resonance imaging (n=545), global cognitive testing (n=623), and ambulatory ePWV measurements. White matter hyperintensity and hippocampus were quantified via Computational Anatomy Toolbox12 and Statistical Parametric Maps 12. Cognition was assessed via the Mini-Mental State Examination and Montreal Cognitive Assessment. Among 623 tested participants, the prevalence of mild cognitive impairment was 10% (Mini-Mental State Examination, n=62) and 18.5% (Montreal Cognitive Assessment, n=115). Cognitive scores decline with higher white matter hyperintensity burden and lower hippocampal volume (P≤0.024). Higher 24-hour ePWV quartiles showed graded associations with higher white matter hyperintensity volume and lower hippocampal volume (both P<0.001) and lower cognitive scores (P≤0.037). Multivariable models showed each 1-SD (+1.2 m/s) increment in 24-hour ePWV were associated with 2.00±1.74 mL greater white matter hyperintensity volume (P=0.004), and 0.54±0.14 mL smaller hippocampal volume (P<0.001), independent of age, systolic blood pressure, and other confounders. These associations persisted after further adjustment for carotid-femoral PWV, which itself showed no independent association (P≥0.18). Results were consistent for daytime and nighttime ePWV and across key subgroups. Ambulatory ePWV is an independent risk factor for dementia-related brain pathology. Targeting arterial stiffness represents a promising strategy for dementia prevention.

This study focuses on a non-invasive blood pressure prediction method based on radial artery pulse wave feature analysis, aiming to achieve rapid and accurate blood pressure measurement, help doctors diagnose diseases more accurately, promote the development of digital pulse diagnosis, and provide a new approach for blood pressure monitoring in wearable devices. By extracting 25 multidimensional features (including time-domain, frequency-domain, and nonlinear features) of the radial artery pulse wave, and after feature correlation analysis and importance assessment, weights were assigned to establish a blood pressure prediction model based on the random forest algorithm. Experimental results show that the mean absolute errors of systolic and diastolic blood pressure prediction are 3.39 mmHg and 2.06 mmHg, respectively, with standard deviations of 4.76 mmHg and 2.78 mmHg, respectively, both meeting the commonly referenced AAMI performance criteria (M AE ≤ 5mmHg and ST D ≤ 8mmHg), which are widely used as benchmarking thresholds in cuffless blood pressure estimation studies. Compared with current mainstream methods, such as Photoplethysmography (PPG) combined with Electrocardiogram (ECG) prediction and pulse wave velocity (PWV) estimation, this model demonstrates higher prediction accuracy and convenience advantages in wearable device applications.

Blood flow restriction training (BFRT) is used to enhance low-load exercise, but vascular effects remain uncertain. We compared BFRT with matched non-BFRT exercise on endothelial function, arterial stiffness, and vascular structure. This PRISMA 2020 review was preregistered (PROSPERO CRD420251118357). PubMed, Web of Science, Cochrane Library, and Chinese National Knowledge Infrastructure were searched on October 2, 2025, with systematic snowballing. Randomized parallel-group, crossover, or within-subject controlled trials were pooled using random-effects models (three-level or conventional) to estimate Hedges' g; subgroup/meta-regression examined moderators; RoB2, PEDro, and GRADE assessed study quality. Thirty-five trials (n = 764) were included. Overall, BFRT showed no advantage for flow-mediated dilation (FMD; k = 30; g = -0.10) or pulse wave velocity (PWV; k = 32; g = -0.04); pooled effects were also non-significant for blood flow, AIx, CAVI, arterial diameter, and ankle-brachial index. Effects depended on protocol: resistance BFRT improved FMD (g = 0.56), whereas handgrip (g = -0.85) and some interval/aerobic BFRT reduced FMD; interventions <4 weeks decreased FMD (g = -0.69). Low-load BFRT reduced PWV versus high-load resistance training (g = -0.76). Age positively moderated FMD responses; certainty ranged from very low to moderate. Evidence does not support a generalized vascular benefit of BFRT. Low-load resistance BFR may be most favorable, while small-muscle and moderate-to-high-intensity protocols warrant caution. Larger trials, especially in women and clinical populations, are needed.

This study evaluated whether the 3-minute Step Test, a submaximal measure of cardiorespiratory fitness, can predict cardiometabolic and arterial health in youth with atherosclerosis-promoting cardiometabolic risk factors. Children and adolescents attended a paediatric preventive cardiology clinic for management of cardiometabolic risk factors. Cardiorespiratory fitness was assessed using a 3-minute Step Test, where an individual steps up/down on a 6-inch step at 24 steps/min for 3 minutes. The percentage of age-predicted maximum heart rate that was attained at the end of the Step Test was recorded as a measure of physiological work (cardiorespiratory fitness). Lifestyle-influenced cardiometabolic risk factors included: body anthropometrics [body mass index z-score, waist-to-height ratio z-score], systolic blood pressure, and serum markers [triglycerides, high-density lipoprotein cholesterol, haemoglobin A1C, alanine aminotransferase, vitamin D]. Arterial function was assessed by measuring pulse wave velocity and was normalised to sex and height-specific z-score. The sample included 482 patients [age 14.31 ± 2.38 years, 261 (53%) male]. A higher percent predicted peak heart rate strongly correlated with worse lifestyle-influenced cardiometabolic risk factors and with higher pulse wave velocity, suggesting increased arterial stiffness. Percent predicted peak heart rate from the 3-minute Step Test was associated with cardiometabolic and arterial health. The 3-minute Step Test is an inexpensive, quick, and low-resource-intensive method to estimate cardiorespiratory fitness, cardiometabolic and arterial health in an outpatient clinical setting.

Atherosclerotic cardiovascular disease is the leading cause of mortality worldwide, with arterial stiffness being an important predictor of cardiovascular mortality. This study aimed to examine in the Swedish longitudinal cohort of males and females (SPAF-1958) whether aerobic capacity measured at early- (34years) and mid-adulthood (52years) can predict arterial stiffness assessed by pulse wave velocity later in life (63years). Further, we determined whether this association is modified by traditional cardiovascular risk factors such as obesity, smoking, blood pressure, advanced lipoprotein profiles and high-density lipoprotein (HDL) function determined as cholesterol efflux capacity. Multiple regression analysis revealed that a higher aerobic capacity at ages 34 (B = -0.04, P = 0.002) and 52 (B = -0.04, P = 0.005) significantly predicted lower arterial stiffness at age 63, independent of obesity, smoking, blood pressure, HDL, and HDL-cholesterol efflux capacity. In contrast, lipoprotein profiles and HDL-mediated cholesterol efflux at age 52 were not associated with arterial stiffness at age 63 (P > 0.05). These findings suggest that maintaining aerobic capacity from early adulthood can reduce arterial stiffness and cardiovascular risk in later life, independently of traditional and contemporary cardiovascular factors. This study emphasizes the need for further research on lifestyle modifications to enhance cardiovascular health.

Individuals with high pulse wave velocity (PWV) may suffer from early vascular ageing (EVA) and face increased cardiovascular risk. Nonetheless, some individuals with EVA survive until old age, some even escaping cardiovascular complications entirely. The aim of this study was to explore characteristics of such individuals in population-based cohorts. We used data from the Metabolic syndrome and Artery REsearch (MARE) Consortium and a MARE sub-cohort; the Malmö Diet Cancer Study - Cardiovascular (MDCS-CV) arm for analyses, both covering cardiovascular risk factors, PWV, and carotid intima-media thickness (cIMT). EVA survivors (individuals 75+ years; PWV ≥ 90th percentile for age strata), were compared to age-matched and sex-matched controls (PWV 0 to 75th percentile). Additionally, in MDCS-CV, prospective EVA escapers [without major adverse cardiovascular events (MACE) or death during 10-year follow-up], were compared to EVA nonescapers. EVA Elderly survivors in the MARE Consortium had a higher risk factor burden, including cIMT levels, compared to controls. In MDCS-CV, similar patterns were found; however, cIMT did not differ between EVA Elderly survivors and controls, despite higher mean PWV (17 vs. 11 m/s). Finally, in MDCS-CV, EVA Elderly escapers ( n = 34) compared to nonescapers ( n = 56) had lower mean cIMT (0.92 vs. 1.01 mm; P = 0.009), despite comparable PWV (17 vs. 16 m/s). No other group differences were observed. EVA elderly survivors and escapers exist even among the very elderly. The latter are characterized by lower cIMT than EVA Elderly nonescapers. This could indicate discordant (differentiated) arterial ageing to be further explored.

Background:In this study, we evaluated the effects of a combined exercise program incorporating a postural balance apparatus on the fall-related physical fitness and blood vessel elasticity of older women.Methods:The participants were 36 women aged 65 years or older who did not engage in regular exercise. They were randomly divided into an exercise group (n = 18) and a control group (n = 18). The exercise group underwent a combined exercise program for 12 weeks (60 minutes a day for 5 days a week), whereas the control group engaged in no physical activity or exercise during the 12 weeks. The combined exercise program consisted of aerobic exercise (such as step-ups and the short foot exercise), resistance exercises (such as heel raises, semi-squats, and weight-bearing closed-chain exercises), and joint mobility exercises (such as step-ups with pelvic floor muscle engagement, lower body stretching, and back stretching) to be performed on a postural balance apparatus, which provided an inclined and elastic surface to facilitate ankle dorsiflexion, joint mobility, and proprioceptive stimulation. The exercises were performed at a moderate intensity, maintaining a perceived exertion rating between 11 and 14, for 12 weeks. The outcome variables were measured through experimental procedures. The collected data were analyzed using means, standard deviations, and 2-way repeated measures analysis of variance.Results:We found a significant improvement in the range of motion for left ankle dorsiflexion in the lying and seated positions, as well as right ankle dorsiflexion in the lying, seated, and prone positions, in the exercise group compared to the control group (P < .05). Furthermore, the atherosclerosis left brachial–ankle pulse wave velocity, atherosclerosis right brachial–ankle pulse wave velocity, diastolic blood pressure, and heart rate significantly decreased in the exercise group compared to the control group (P < .05).Conclusions:These results confirmed that the 12-week apparatus-assisted combined exercise program, unlike conventional programs, effectively improves ankle dorsiflexion, vascular elasticity, and cardiovascular health in older women.