Multidomain Arterial Afterload and Left Atrial–Left Ventricular Coupling in Hypertensive Phenotypes

ABSTRACT

Brachial blood pressure may not fully reflect the multidimensional arterial load associated with left atrial–left ventricular (LA–LV) coupling. In this cross‐sectional study, we examined local carotid pulse wave velocity (PWV), cuff‐derived arterial pressure–volume index (API), and arterial velocity–pulse index (AVI), separately and as a composite afterload index (ACI), in 336 inpatients (71 controls, 183 with hypertension, and 82 with hypertension and type 2 diabetes). Covariate‐adjusted linear models related standardized exposures to the left atrial stiffness index (LASI) and LA–LV coupling index (LACI). Greater ACI was associated with higher LACI ( β = 0.0142 per 1‐SD, 95% CI 0.0011–0.0273; p = 0.033). The LASI estimate was directionally similar but less precise ( β = 0.0232, 95% CI −0.0024–0.0488; p = 0.076), and all single‐domain CIs included zero. These findings support further evaluation of accessible multidomain vascular assessment as a complement to brachial blood pressure. External calibration and longitudinal validation are needed to establish the clinical value of ACI.