Pulse pressure amplification (PPA), the brachial-to-aortic pulse pressure ratio, decreases with age and cardiovascular risk factors. This individual-participant meta-analysis (n = 5608) aimed to define an outcome-driven threshold for PPA. Over 4.1 years, 255 and 109 participants experienced cardiovascular or coronary endpoints, respectively. A PPA threshold of <1.3 was identified, with higher hazard ratios for both endpoints (HRs: 1.54 and 2.45, respectively). Findings were replicated in a test dataset. HRs were notably higher in individuals <60 years. A PPA <1.3 was a significant risk factor, particularly underestimated in women aged 30–60 years.

Qi-Fang Huang, De-Wei An, Lucas S. Aparicio, Yi-Bang Cheng, Fang-Fei Wei, Yu-Ling Yu, Chang-Sheng Sheng, Wen-Yi Yang, Teemu J. Niiranen, José Boggia, Katarzyna Stolarz-Skrzypek, Valérie Tikhonoff, Natasza Gilis-Malinowska, Wiktoria Wojciechowska, Edoardo Casiglia, Krzysztof Narkiewicz, Jan Filipovský, Kalina Kawecka-Jaszcz, Tim S. Nawrot, Ji-Guang Wang, Yan Li, Jan A. Staessen