Abstract
<title>Abstract</title> <p>Background We investigated whether quantitative arterial stiffness (QAS)-derived functional abnormalities could be detected in adults with high-normal blood pressure without a corresponding increase in quantitative intima–media thickness (QIMT) after covariate adjustment. Methods This retrospective cross-sectional study included adults assessed at Dongzhimen Hospital, Beijing, between November 2021 and December 2022. Four blood pressure groups were defined. Outcomes were maximum QIMT, pulse wave velocity (PWV), distensibility coefficient (DC), compliance coefficient (CC), and a carotid functional stiffness score (CFSS). Models adjusted for age, sex, and body mass index; functional models were further QIMT-adjusted. Results Among 312 participants, 114 had ideal and 91 had high-normal blood pressure. Compared with ideal blood pressure, high-normal blood pressure was not associated with maximum QIMT (standardized adjusted difference, − 0.04; 95% confidence interval [CI], − 0.25 to 0.17; false-discovery-rate-adjusted P = 0.761), but was associated with higher PWV (0.38; 95% CI, 0.21 to 0.56), lower DC (− 0.45; 95% CI, − 0.63 to − 0.27), lower CC (− 0.42; 95% CI, − 0.67 to − 0.17), and higher CFSS (0.43; 95% CI, 0.23 to 0.63). All remained significant after multiple-testing correction and QIMT adjustment. Isolated functional impairment was more frequent with high-normal than ideal blood pressure (37.8% vs 15.2%; adjusted odds ratio, 2.61; 95% CI, 1.27 to 5.36). Conclusions High-normal blood pressure was associated with QAS-derived functional abnormalities without a corresponding increase in QIMT after covariate adjustment. These findings support complementary carotid assessment but do not establish temporal sequence or prognosis.</p>