4.1. Study Patients

The current retrospective observational study included patients (n = 858) with some risk of metabolic abnormalities (hypertension, diabetes, and dyslipidemia) who had visited the department of cardiology division of Toho University Sakura Medical Center (Chiba, Japan) and undergone echocardiography between 2015 and 2018. Among them, we retrospectively studied 165 consecutive hypertensive patients with preserved LVEF who had echocardiography performed on the same day as their CAVI. The exclusion criteria were as follows: LVEF <50%, acute myocardial infarction, old myocardial infarction, cardiomyopathy, open-heart surgery, non-sinus rhythm, atherosclerosis obliterans (ankle-brachial index, <0.9), pulmonary hypertensive disease, moderate or severe valvular disease, and strain analysis not available (Figure 4).

Flow chart showing patient selection. CAVI, cardio-ankle vascular index; LVEF, left ventricular ejection fraction.

Patients were defined as having hypertension if they had systolic blood pressure (SBP) ≥140 mmHg and/or diastolic blood pressure (DBP) ≥90 mmHg or were taking antihypertensive agents. SBP and DBP were measured simultaneously during CAVI measurements using Vasela 1500. We used SBP and DBP values determined from measurements at the right side in this study. According to the American College of Cardiology/American Heart Association, the detail of hypertension was classified as follows and the results are shown in Table 1.

The presence of the following concomitant diseases was recorded: diabetes mellitus (defined as glycated hemoglobin ≥6.5% (NGSP-standardized value) or requiring antidiabetic treatment) and dyslipidemia (defined as low-density lipoprotein cholesterol concentration ≥140 mg/dL, high-density lipoprotein cholesterol concentration <40 mg/dL, triglyceride concentration ≥150 mg/dL, or requiring antihyperlipidemic treatment).