Estimated Pulse Wave Velocity Is Associated with Early Renal Impairment in Non-Diabetic Hypertensive Patients

Hypertension is a major modifiable risk factor for chronic kidney disease (CKD), accelerating renal injury by promoting arterial stiffness. Estimated pulse wave velocity (ePWV), an indicator of arterial stiffness, is associated with CKD progression, but its relationship with urinary albumin-to-creatinine ratio (UACR) in non-diabetic hypertensive patients remains unclear. This retrospective study included 509 non-diabetic adults with essential hypertension. Participants were classified as having early renal impairment (UACR ≥30 mg/g, n = 167) or not (UACR <30 mg/g, n = 342). ePWV was calculated from age and mean blood pressure (MBP). The impairment group showed significantly higher ePWV (P < 0.001). Restricted cubic splines revealed a positive linear correlation between ePWV and UACR (P for nonlinear = 0.938). Multivariable logistic regression identified that ePWV was an independent risk factor for early renal impairment. Each 1 m/s increase in ePWV was associated with a 43.9% elevated risk of early renal impairment (OR = 1.439, 95% CI: 1.176–1.761), with the highest ePWV quartile (>9.70 m/s) showing an OR of 4.894 (95% CI: 2.019–11.86). ROC analysis showed that ePWV had the highest AUC at 0.710, higher than age (0.585) and MBP (0.693), and it provided greater incremental value for identifying early renal impairment than age and MBP when incorporated into the base model. Subgroup analyses by sex, age, BMI, and eGFR consistently supported these associations. In conclusion, ePWV is an independent risk marker for early renal impairment in non-diabetic hypertensive patients, supporting its potential use in early risk stratification.