Multidomain Arterial Afterload and Left Atrial-Left Ventricular Coupling in Hypertensive Phenotypes.

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.