J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website https://www.jocmr.org

Original Article

Volume 14, Number 6, June 2022, pages 229-236

Relationships Between Arterial Pressure-Volume Index and Cardiovascular Disease Biomarkers in Patients With Hypertension

Figure 1. Distribution of API. The API shows a nearly normal distribution, with a mean value of 27 (range: 16 - 42). API: arterial pressure-volume index.

Figure 2. Comparisons of API in patients with CCB and/or RAS inhibitor, showing the comparison of the API in the three groups (CCB alone (n = 66); RAS inhibitor alone (n = 62); combination of CCB and RAS inhibitors (n = 91)). The API was similar between the CCB alone (API: 27 ± 5) and RAS inhibitor alone (API: 28 ± 5) groups. However, patients receiving treatment with a combination of CCB and RAS inhibitors (API: 25 ± 4) had a significantly lower API than those treated with CCB or RAS inhibitors alone. The bars show standard deviation. *P = 0.003 vs. CCB. **P < 0.001 vs. RAS-i. ^#P = 0.047 vs. CCB, ^##P = 0.009 vs. RAS-i. API: arterial pressure-volume index; CCB: calcium channel blocker; RAS-i: renin angiotensin system inhibitor; SBP: systolic blood pressure.

Figure 3. Receiver-operating characteristic curve analysis. The detection of albuminuria (≥ 30 mg/g Cr) (a), high hs-cTnT concentration (≥ 0.014 ng/mL) (b), or high skin AF (≥ 3.0 arbitrary unit) (c) were determined by previous reports. The maximum Youden’s index indicated that an API of >26 was the optimal cut-off point for the determination of albuminuria (AUC = 0.703, P < 0.001), high hs-cTnT concentration (AUC = 0.702, P < 0.001), or high skin AF (AUC = 0.704, P < 0.001). API: arterial pressure-volume index; hs-cTnT: high-sensitivity cardiac troponin T; AF: autofluorescence; AUC area under the curve.

**Table 1.** Characteristics of Patients
Continuous values are mean ± SD or median (25-75th percentile). LDL: low-density lipoprotein; HDL: high-density lipoprotein; eGFR: estimated glomerular filtration rate; hs-CRP: high-sensitivity C-reactive protein; BNP: brain natriuretic peptide; hs-cTnT: high-sensitivity cardiac troponin T; AU: arbitrary unit; API: arterial pressure-volume index; CCB: calcium channel blocker; RAS: renin-angiotensin system.
n (male/female)	288 (115/173)
Age (years)	63 ± 11
Body mass index (kg/m²)	23.0 ± 3.9
Current smoker, n (%)	59 (20)
Systolic blood pressure (mm Hg)	130 ± 18
Diastolic blood pressure (mm Hg)	81 ± 12
Pulse rate (/min)	67 ± 10
Diabetes mellitus, n (%)	132 (46)
Fasting blood glucose (mg/dL)	113 ± 27
Hemoglobin A1c (%)	6.4 ± 0.9
Dyslipidemia, n (%)	189 (66)
Total cholesterol (mg/dL)	216 ± 42
LDL-cholesterol (mg/dL)	139 ± 40
Triglyceride (mg/dL)	146 ± 65
HDL-cholesterol (mg/dL)	49 ± 14
eGFR (mL/min/1.73 m²)	70 ± 20
Urinary albumin (mg/g Cr)	29 (15 - 51)
hs-CRP (mg/dL)	0.073 (0.034 - 0.166)
BNP (pg/mL)	44.6 (20.0 - 74.3)
hs-cTnT (ng/ml)	0.010 (0.007 - 0.014)
Skin autofluorescence (AU)	2.6 ± 0.5
API	27 ± 5
Medication
CCB, n (%)	205 (71)
RAS inhibitor, n (%)	157 (55)
β-blocker, n (%)	58 (20)
Diuretics, n (%)	45 (16)
Statin, n (%)	128 (44)

Table 1. Characteristics of Patients

Continuous values are mean ± SD or median (25-75th percentile). LDL: low-density lipoprotein; HDL: high-density lipoprotein; eGFR: estimated glomerular filtration rate; hs-CRP: high-sensitivity C-reactive protein; BNP: brain natriuretic peptide; hs-cTnT: high-sensitivity cardiac troponin T; AU: arbitrary unit; API: arterial pressure-volume index; CCB: calcium channel blocker; RAS: renin-angiotensin system.

n (male/female)

288 (115/173)

Age (years)

63 ± 11

Body mass index (kg/m²)

23.0 ± 3.9

Current smoker, n (%)

59 (20)

Systolic blood pressure (mm Hg)

130 ± 18

Diastolic blood pressure (mm Hg)

81 ± 12

Pulse rate (/min)

67 ± 10

Diabetes mellitus, n (%)

132 (46)

Fasting blood glucose (mg/dL)

113 ± 27

Hemoglobin A1c (%)

6.4 ± 0.9

Dyslipidemia, n (%)

189 (66)

Total cholesterol (mg/dL)

216 ± 42

LDL-cholesterol (mg/dL)

139 ± 40

Triglyceride (mg/dL)

146 ± 65

HDL-cholesterol (mg/dL)

49 ± 14

eGFR (mL/min/1.73 m²)

70 ± 20

Urinary albumin (mg/g Cr)

29 (15 - 51)

hs-CRP (mg/dL)

0.073 (0.034 - 0.166)

BNP (pg/mL)

44.6 (20.0 - 74.3)

hs-cTnT (ng/ml)

0.010 (0.007 - 0.014)

Skin autofluorescence (AU)

2.6 ± 0.5

API

27 ± 5

Medication

CCB, n (%)

205 (71)

RAS inhibitor, n (%)

157 (55)

β-blocker, n (%)

58 (20)

Diuretics, n (%)

45 (16)

Statin, n (%)

128 (44)

**Table 2.** Relationship Between API and Various Clinical Parameters
	r	P value
r expressed correlation coefficient. API: arterial pressure-volume index; LDL: low-density lipoprotein; HDL: high-density lipoprotein; eGFR: estimated glomerular filtration rate; hs-CRP: high-sensitivity C-reactive protein; BNP: brain natriuretic peptide; hs-cTnT: high-sensitivity cardiac troponin T; CCB: calcium channel blocker; RAS: renin-angiotensin system.
Sex (female = 0, male = 1)	-0.26	< 0.001
Age	0.21	< 0.001
Body mass index	0.10	0.09
Current smoker (no = 0, yes = 1)	0.06	0.28
Systolic blood pressure	0.60	< 0.001
Diastolic blood pressure	0.05	0.45
Pulse rate	-0.10	0.09
Diabetes mellitus (no = 0, yes = 1)	0.11	0.08
Fasting blood glucose	0.03	0.56
Hemoglobin A1c	0.06	0.36
Dyslipidemia (no = 0, yes = 1)	0.05	0.43
Total cholesterol	0.02	0.73
LDL-cholesterol	0.02	0.71
Triglyceride	-0.05	0.43
HDL-cholesterol	-0.07	0.22
eGFR	-0.13	0.03
Log-urinary albumin	0.42	< 0.001
Log-hs-CRP	0.15	0.01
Log-BNP	0.23	< 0.001
Log-hs-cTnT	0.39	< 0.001
Skin autofluorescence	0.41	< 0.001
CCB (no = 0, yes = 1)	-0.16	0.01
RAS inhibitor (no = 0, yes = 1)	-0.15	0.01
β-blocker (no = 0, yes = 1)	0.11	0.08
Diuretics (no = 0, yes = 1)	0.09	0.12
Statin (no = 0, yes = 1)	-0.04	0.47

Table 2. Relationship Between API and Various Clinical Parameters

P value

r expressed correlation coefficient. API: arterial pressure-volume index; LDL: low-density lipoprotein; HDL: high-density lipoprotein; eGFR: estimated glomerular filtration rate; hs-CRP: high-sensitivity C-reactive protein; BNP: brain natriuretic peptide; hs-cTnT: high-sensitivity cardiac troponin T; CCB: calcium channel blocker; RAS: renin-angiotensin system.

Sex (female = 0, male = 1)

-0.26

< 0.001

Age

0.21

< 0.001

Body mass index

0.10

0.09

Current smoker (no = 0, yes = 1)

0.06

0.28

Systolic blood pressure

0.60

< 0.001

Diastolic blood pressure

0.05

0.45

Pulse rate

-0.10

0.09

Diabetes mellitus (no = 0, yes = 1)

0.11

0.08

Fasting blood glucose

0.03

0.56

Hemoglobin A1c

0.06

0.36

Dyslipidemia (no = 0, yes = 1)

0.05

0.43

Total cholesterol

0.02

0.73

LDL-cholesterol

0.02

0.71

Triglyceride

-0.05

0.43

HDL-cholesterol

-0.07

0.22

eGFR

-0.13

0.03

Log-urinary albumin

0.42

< 0.001

Log-hs-CRP

0.15

0.01

Log-BNP

0.23

< 0.001

Log-hs-cTnT

0.39

< 0.001

Skin autofluorescence

0.41

< 0.001

CCB (no = 0, yes = 1)

-0.16

0.01

RAS inhibitor (no = 0, yes = 1)

-0.15

0.01

β-blocker (no = 0, yes = 1)

0.11

0.08

Diuretics (no = 0, yes = 1)

0.09

0.12

Statin (no = 0, yes = 1)

-0.04

0.47

**Table 3.** Multiple Regression Analysis
Explanatory factor	β	P value
Subordinate factor is API. R² = 0.52, P < 0.001. Explanatory factors were selected by examining the multicollinearity among the variables or by conducting a stepwise method. CCB: calcium channel blocker; RAS: renin-angiotensin system; hs-cTnT: high-sensitivity cardiac troponin T; β: standardized regression coefficient; API: arterial pressure-volume index; R²: coefficient of determination.
Systolic blood pressure	0.28	< 0.001
Log-urinary albumin	0.15	< 0.001
CCB + RAS inhibitor	-0.14	< 0.001
Log-hs-cTnT	0.13	0.001
Skin autofluorescence	0.11	0.01
Sex (male)	-0.09	0.06
Age	0.07	0.08

Table 3. Multiple Regression Analysis

Explanatory factor

P value

Subordinate factor is API. R² = 0.52, P < 0.001. Explanatory factors were selected by examining the multicollinearity among the variables or by conducting a stepwise method. CCB: calcium channel blocker; RAS: renin-angiotensin system; hs-cTnT: high-sensitivity cardiac troponin T; β: standardized regression coefficient; API: arterial pressure-volume index; R²: coefficient of determination.

Systolic blood pressure

0.28

< 0.001

Log-urinary albumin

0.15

< 0.001

CCB + RAS inhibitor

-0.14

< 0.001

Log-hs-cTnT

0.13

0.001

Skin autofluorescence

0.11

0.01

Sex (male)

-0.09

0.06

Age

0.07

0.08