Abstract
Blood pressure variability (BPV) is an established cardiovascular risk factor associated with target organ damage beyond mean blood pressure levels. Arterial stiffness, assessed by carotid-femoral pulse wave velocity (cfPWV), represents an early manifestation of hypertension and an independent predictor of cardiovascular events. Among short-term BPV indices, Average Real Variability (ARV) is considered a robust marker of blood pressure fluctuations. This study evaluated the relationship between ARV and arterial stiffness and identified clinically relevant ARV thresholds associated with increased cfPWV. A total of 315 adults underwent 24-h ambulatory blood pressure monitoring and cfPWV assessment. Receiver operating characteristic (ROC) analysis was performed to determine optimal systolic and diastolic ARV cut-off values for detecting increased arterial stiffness (cfPWV ≥10 m/s). Multivariable logistic regression models assessed independent associations between ARV indices and cfPWV. ROC analysis identified daytime systolic ARV ≥11.4 mmHg as the optimal threshold for predicting cfPWV ≥10 m/s (AUC 0.68; 95% CI 0.61-0.76; p < 0.001). Other significant ARV cut-offs ranged between 11.4 and 12.0 mmHg for systolic and diastolic measures. After adjustment for age, sex, and mean systolic blood pressure, daytime systolic ARV remained independently associated with cfPWV ≥10 m/s (OR 5.36 95% CI 1.70-17.04; p < 0.01). All diastolic ARV indices also retained statistical significance, with lower effect sizes (OR 2.45-3.25).Daytime systolic ARV ≥11.4 mmHg shows the strongest independent association with increased arterial stiffness, while diastolic ARV ijch70355ndices remain significant but weaker predictors. Trial Registration: The study received approval from the institutional bioethics committee. As it does not meet the criteria for a clinical trial, registration was not applicable.