Invasive aortic pulse pressure is not superior to cuff pulse pressure in cardiovascular risk prediction

Abstract

Objective: Aortic pulse pressure (PP) represents the hemodynamic cardiac and cerebral burden more directly than cuff PP. The objective of this study was to investigate whether invasively measured aortic PP confers additional prognostic value beyond cuff PP for cardiovascular events and death. With increasing age, cuff PP progressively underestimates aortic PP. Whether the prognostic association between cuff PP and outcomes is age-dependent remains to be elucidated. Methods: Cuff PP and invasively measured aortic PP were recorded in 21 908 patients (mean age 63 years, 58% men, 14% with diabetes) with stable angina pectoris undergoing elective coronary angiography during January 2001--December 2012. Multivariate Cox models were used to assess the association with incident myocardial infarction, stroke, and death. Discrimination was assessed using Harrell's C-index. Results: During a median follow-up period of 3.7 years (range 0.1–10.8 years), 422 strokes, 511 myocardial infarctions, and 1530 deaths occurred. Both cuff and aortic PP were associated with stroke, myocardial infarction, and death in crude analyses. However, only cuff PP remained associated with stroke (hazard ratio per 10 mmHg, 1.06 (95% confidence interval (CI) 1.01--1.12)] and myocardial infarction [hazard ratio per 10 mmHg 1.05 (95% CI 1.01--1.11)] in multivariate Cox models. Both cuff and aortic PP lost significance as predictors of death in multivariate models. Age did not modify the prognostic association between cuff PP and stroke, myocardial infarction, and death. Conclusion: Invasively measured aortic PP did not add prognostic information about cardiovascular outcomes and death beyond cuff PP in patients with stable angina pectoris.

Estimated Pulse Wave Velocity Is Associated With All‐Cause Mortality During 8.5 Years Follow‐up in Patients Undergoing Elective Coronary Angiography

“…We have previously demonstrated that invasively measured systolic BP and PP did not add predictive information beyond cuff systolic BP and cuff PP in mortality prediction. 30 , 31 However, the current data suggest that the interaction terms and quadratic terms in the ePWV may reflect information from the invasive BP not captured by cuff BP. These findings warrant further investigations in future studies.…”

“…The association between ePWV and stroke became significant with adjustment for invasive systolic BP or PP instead of cuff BP, which is in line with our previous studies where no added prediction from invasive systolic BP was observed, and cuff PP, but not invasively measured PP, remained significantly associated with stroke in multivariate analyses. 30 , 31 …”

Central hypertension is a non‐negligible cardiovascular risk factor

“… 7 The comparisons involving 4574 subjects from 5 studies revealed that central pulse pressure was associated with a marginally but non‐significantly higher relative ratio of clinical outcome than brachial pulse pressure (1.318 versus 1.188, P = .057), whereas the risk estimates for central and brachial systolic BPs were similar (1.236 versus 1.204, P = .62). 7 Subsequent comparison studies 15 , 16 , 17 , 18 reported negative results by including both central and brachial BP variables in a single model, which might complicate the interpretation due to collinearity. In the Framingham Heart Study involving around 2200 participants followed up for a median of 7.8 years, central pulsatile pressures, either calibrated from carotid pressure waveforms 15 or derived using radial artery tonometry and a generalized transfer function, 16 were not related to cardiovascular events after adjustment for common risk factors including brachial systolic BP.…”

New Method to Estimate Central Systolic Blood Pressure From Peripheral Pressure: A Proof of Concept and Validation Study

“…The DCBP formula may help to easily estimate cSBP in clinics or help to assess the cardiovascular risk in patients from large clinical databases, both retrospectively and prospectively, provided measurement errors of MBP and DBP are minimized. The evidence supporting a tighter association of cardiovascular end points with central than peripheral BP remains controversial (3)(4)(5)(6)(7)(8)(9). This is a major issue because cardiovascular disease is the global number one cause of mortality.…”

“…It is the central BP which loads the heart, and there is an anatomic proximity of the aorta to the brain and kidneys. Thus, end-organ damages due to pressure overload and cardiovascular complications may be more closely related to central than peripheral BP (3)(4)(5)(6), although this point remains debated (7)(8)(9). The peripheral systolic BP (SBP) is most often higher than central systolic BP (cSBP,) and this pressure amplification is mainly explained by the narrowing of arterial caliber and by arterial properties, especially arterial stiffness which affects the speed of the pressure pulse wave traveling down from the heart to periphery and back to the heart, thus impacting the amount of both pressure wave amplification and reflection (1,2,(10)(11)(12)(13)(14)(15)(16)(17)(18)(19).…”