Association between Heart Rate Variability and Pulse Wave Velocity: A Scoping Review

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Objectives : A physiological association between pulse wave velocity (PWV), an indicator of arterial stiffness used to assess residual cardiovascular risk, and heart rate variability (HRV), which reflects autonomic nervous system function, has been suggested; however, previous findings remain inconsistent.This scoping review aims to summarize the association between HRV and PWV and analyze how these associations change after adjusting for hemodynamic (heart rate [HR], blood pressure [BP]) and demographic (age, sex) variables, thereby providing foundational data for future research designs.Methods : We searched PubMed (from inception to December 1, 2025) for human studies that simultaneously measured HRV and PWV and reported a quantitative association between the two indices.A total of 31 studies were included.The proportions of results showing discordance with the expected direction or non-significance (null) were compared across different adjustment models incorporating HR, BP, age, and sex.Results : In unadjusted analyses, time-domain and vagal tone indices generally exhibited an inverse correlation with PWV, whereas the ratio index predominantly showed a positive correlation.In the adjusted models, the proportion of null results varied depending on the model; 4 out of 10 models (40.0%) in the HR-adjusted analyses and 3 out of 7 models (42.9%) in the fully adjusted analyses reported null findings.Furthermore, an imbalance in the evidence from multivariate adjustments was observed across HRV domains, with a notable lack of fully adjusted evidence for the ratio index.Conclusions : The significance of the HRV-PWV association can either be lost or newly emerge depending on the adjustment for major covariates such as HR, BP, age, and sex.Future studies need to verify the independence and clinical applicability of the HRV-PWV association by employing standardized measurement and adjustment protocols, alongside research designs based on autonomic reactivity.

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