Cuff-Based Oscillometric Central and Brachial Blood Pressures Obtained Through ABPM are Similarly Associated with Renal Organ Damage in Arterial Hypertension

Abstract

Background/Aims: Central blood pressure (BP) has been suggested to be a better estimator of hypertension-associated risks. We aimed to evaluate the association of 24-hour central BP, in comparison with 24-hour peripheral BP, with the presence of renal organ damage in hypertensive patients. Methods: Brachial and central (calculated by an oscillometric system through brachial pulse wave analysis) office BP and ambulatory BP monitoring (ABPM) data and aortic pulse wave velocity (PWV) were measured in 208 hypertensive patients. Renal organ damage was evaluated by means of the albumin to creatinine ratio and the estimated glomerular filtration rate. Results: Fifty-four patients (25.9%) were affected by renal organ damage, displaying either microalbuminuria (urinary albumin excretion ≥30 mg/g creatinine) or an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m². Compared to those without renal abnormalities, hypertensive patients with kidney damage had higher values of office brachial systolic BP (SBP) and pulse pressure (PP), and 24-h, daytime, and nighttime central and brachial SBP and PP. They also had a blunted nocturnal decrease in both central and brachial BP, and higher values of aortic PWV. After adjustment for age, gender, and antihypertensive treatment, only ABPM-derived BP estimates (both central and brachial) showed significant associations with the presence of renal damage. Odds ratios for central BP estimates were not significantly higher than those obtained for brachial BP. Conclusion: Compared with peripheral ABPM, cuff-based oscillometric central ABPM does not show a closer association with presence of renal organ damage in hypertensive patients. More studies, however, need to be done to better identify the role of central BP in clinical practice.

Pharmacological treatment of hypertension guided by peripheral or central blood pressure: a comparison between the two strategies

“…In our study, central BP had no better association with renal impairment than peripheral BP, a finding that corroborates with those of previous outpatient studies ( 42 , 43 ). This may be justified by the fact that central BP is associated with macrovascular damage, but is not so closely related to microvascular injury, typical of renal injury ( 9 ).…”

“…Another study reported the better predictive value of central BP compared to peripheral BP for cardiac damage such as LVH (38). A possible explanation is that arterial stiffness increases systolic BP, causing an early return of pulse waves during the systolic period and increased left ventricle afterload that causes cardiac hypertrophy and consequent LVH (39)(40)(41).…”

Different Relevance of Peripheral, Central or Nighttime Blood Pressure Measurements in the Prediction of Chronic Kidney Disease Progression in Patients with Mild or No-Proteinuria

“…Indeed, in a recent study in which the central blood pressure in patients with CKD stage 3 and albuminuria were compared with matched patients with no CKD, there were no significant differences found regarding the central blood pressure parameters between these two groups of patients [27], suggesting that the impact of kidney function on central BP may only be present in more advanced CKD [28]. This also raises a question concerning the importance of targeting these parameters in early stages of CKD.…”

Association of brachial and central hemodynamic parameters to eGFR and proteinuria in Gujarati diabetics with mild-to-moderate nephropathy

“…[24] One recent study, central BP in patients with CKD stage 3 and albuminuria were compared with matched patients without CKD, and there were no significant differences of central BP parameters between these two groups of patients[25] like us and suggested that the kidney function has impact of on central BP, may be only in more advanced CKD. [26] This also raises a question concerning the importance of targeting these parameters in early stages of CKD.…”