Brachial Blood Pressure But Not Carotid Arterial Waveforms Predict Cardiovascular Events in Elderly Female Hypertensives

Dart, Anthony M.; Gatzka, Christoph D.; Kingwell, Bronwyn A.; Willson, Kristyn; Cameron, James D.; Liang, Yu-Lu; Berry, Karen L; Wing, L. M. H.; Reid, Christopher M.; Ryan, Philip; Beilin, Lawrence J.; Jennings, Garry; Johnston, Colin I.; McNeil, John J; Macdonald, Graham; Morgan, Trefor; West, Malcolm

doi:10.1161/01.hyp.0000209340.33592.50

Cited by 171 publications

(139 citation statements)

References 57 publications

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“…12,13 McEniery et al 22 suggested that pressure wave analysis might be a more sensitive marker of CV risk in younger subjects than in older subjects, and the ANBP2 study reported that central BP is not an independent variable to predict future CV events in elderly women. 23 The results of the present study were consistent with the previous findings, indicating that SBP2 is useful in identifying not only high CV risk state but also low CV risk state in younger subjects. Table 3 Results of logistic regression analysis without and with adjustments to assess the significance of the second peak of the radial systolic pressure waveform for the identification of subjects with high and low CHD risk and high and low CVDgen risk Abbreviations: brSBP, brachial systolic blood pressure in the left upper arm determined using an oscillometric method; CHD, coronary heart disease; CI, confidence interval; CVDgen, general cardiovascular disease;Model 1 adOdds, odds ratio adjusted of the covariates in model 1 (the details are described in the footnote of Table 2); Model 2 adOdds, odds ratio obtained by the second peak of the radial systolic pressure waveform, the brachial systolic blood pressure and the covariates in model 1 were entered simultaneously into the model; SBP2, second peak of the radial systolic pressure waveform.…”

Section: Discussionsupporting

confidence: 92%

Significance of the second peak of systolic blood pressure for identifying both high and low cardiovascular risk states

et al. 2010

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This study was conducted to clarify whether the second peak of the systolic blood pressure (SBP2) has significant information about cardiovascular (CV) risk state, independent of the brachial BP. SBP2 was measured by radial pressure wave analysis in 7847 Japanese subjects (50 ± 10 years old), and the Framingham risk score (FRS) and general cardiovascular disease risk score were calculated (FRSgen). The results of multivariate analysis revealed that the SBP2 showed a significant correlation with the FRS (b¼0.04, t-value¼3.92, Po0.01) and FRSgen (b¼0.05, Po0.01), independent of the brachial SBP. The non-standardization coefficient of SBP2 was smaller than that of brachial SBP. The logistic regression analysis showed that SBP2 (2 mm Hg per increase) had a significant odds ratio to identify not only subjects with a high risk for coronary heart disease (CHD) and general CV disease (CVDgen), but also subjects with a low risk for CHD and CVDgen, independent of the brachial SBP. However, when the analysis was limited to subjects of X49 years of age, SBP2 could not identify either high or low CV risk subjects. Thus, in middle-aged Japanese subjects, SBP2 may provide little, yet significant, information reflecting both high and low CV risk states, independent of the brachial BP. SBP2 seems to be more applicable for CV risk stratification in younger subjects than in older subjects. INTRODUCTIONPressure wave reflection in the aorta is an independent marker of cardiovascular (CV) risk, 1,2 and the blood pressure measured in the aorta by non-invasive pressure wave analysis, the so-called central blood pressure (central BP), has been proposed to be a predictor of future CV events, independent of brachial blood pressure (brachial BP). [3][4][5][6] The second peak of radial systolic blood pressure (SBP2) is a non-invasive surrogate marker of central BP, and this value is closely correlated with the aortic systolic BP values obtained by invasive methods in both high-and low-aortic systolic BP ranges. 7 Brachial BP is a continuous variable reflecting the CV risk state, with CV risk increasing with increasing brachial BP. 8,9 Furthermore, even in normal brachial BP ranges, low brachial BP reflects a low CV risk state. 10 However, it is not yet clear whether low SBP2 would provide a significant additive predictive value of a low CV risk state, independent of brachial BP.We have recently succeeded in measuring SBP2 in a large number of Japanese subjects undergoing health screenings. 11 This cross-sectional study was conducted to clarify whether SBP2 might provide significant information for CV risk stratification not only for high CV risk state,

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Section: Discussionsupporting

confidence: 92%

Significance of the second peak of systolic blood pressure for identifying both high and low cardiovascular risk states

et al. 2010

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“…In contrast, in the ANBP2, central BP was estimated by carotid applanation tonometry. 10,15 Interestingly, in the current study by Dart et al, 10 brachial pulse pressure tended to be equal or even lower than central pulse pressure, which may raise concern and certainly fuels debate on the reliability of those measurements. On the other hand, on a theoretical basis, it may be argued that the radial applanation tonometry detects a difference between central and peripheral BP, because it extrapolates central BP by the transfer function 13 in which a difference between the 2 BPs is built in.…”

contrasting

confidence: 50%

“…10 Furthermore, the study by Dart et al 10 is based on a pairwise design, whereas the CAFE Study 6 included patients who reached end points. Previously, Dart et al 15 showed that brachial, and not central, BP was related to total fatal and nonfatal cardiovascular events in the ANBP2; therefore, the authors commented that the pairwise design did not introduce significant survival effects in the present ANBP2 substudy. 10 Notwithstanding, in the present ANBP2 substudy, 10 the lack of difference in outcome by study design between the treatment arms might have selected negatively those at higher risk of fatal cardiovascular events because of higher central BP.…”

mentioning

confidence: 66%

Pulsology Reloaded

2007

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T he Losartan Intervention For Endpoint reduction in hypertension (LIFE) Study, 1 the Second Australian National Blood Pressure Trial (ANBP2), 2 and the Anglo-Scandinavian Cardiovascular Outcome Trials 3 have shown that different antihypertensive treatments may have different impacts on the rate of events in hypertension while achieving comparable brachial blood pressure (BP) reduction. Thus, although brachial BP estimation by classic Riva-Rocci cuff sphygmomanometer and the Korotkoff auscultatory technique have provided almost all of our knowledge on epidemiology, prognosis, and treatment of hypertension, 4,5 recent trials 1-3 are revealing intrinsic limitations of the conventional approach, because the real goal of treatment in hypertension is the reduction in the number and the rate of untoward events.More recently, the Conduit Artery Function Evaluation (CAFE) Study 6 described higher central BP as a key factor explaining the greater number and rate of events with atenolol than with amlodipine plus perindopril. Central pressure waveform and BP values can be estimated by applanation tonometry, a method supported by solid theoretical principles and modeling studies in experimental settings. 7 Analysis of the systolic portion of the carotid pressure waveform allows for obtaining indices of the arterial viscous-elastic properties that correlate with end-organ damage and clinical outcomes in hypertension. 8 Therefore, the indices of arterial waveform reflection and mechanics and central BP assessed by applanation tonometry have the potential to add significant information for risk stratification beyond and above brachial BP. In fact, the conclusions of the CAFE Study were well received. 9 In addition, applanation tonometry has also been associated with 2D-guided M-mode vascular ultrasonography to assess simultaneously the viscous-elastic properties of the carotid artery, the intima-media thickness, and quantification of atherosclerosis. 8 Assessment of cardiovascular target organ damage is curial for a global risk assessment integrating the staging of hypertension by measures of BP. 5

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“…Another limitation of this study is that brachial SBP and DBP were used to calculate the carotid CSDC and stiffness β instead of carotid SBP and DBP, respectively. Physiologically, mean blood pressure and DBP are nearly identical in the carotid and brachial arteries, whereas SBP and pulse pressure are significantly higher in the brachial arteries than the carotid arteries, although the differences are minimized with aging (31). This may be a reason that CAVI was associated with stiffness β and CSDC, although these associations were relative weak.…”

Section: Discussionmentioning

confidence: 99%

Relationship between Cardio-Ankle Vascular Index (CAVI) and Carotid Atherosclerosis in Patients with Essential Hypertension

et al. 2007

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Brachial Blood Pressure But Not Carotid Arterial Waveforms Predict Cardiovascular Events in Elderly Female Hypertensives

Cited by 171 publications

References 57 publications

Significance of the second peak of systolic blood pressure for identifying both high and low cardiovascular risk states

Significance of the second peak of systolic blood pressure for identifying both high and low cardiovascular risk states

Pulsology Reloaded

Relationship between Cardio-Ankle Vascular Index (CAVI) and Carotid Atherosclerosis in Patients with Essential Hypertension

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