Invasively Measured Aortic Systolic Blood Pressure and Office Systolic Blood Pressure in Cardiovascular Risk Assessment

Abstract

768S troke and myocardial infarction (MI) remain common diseases with massive consequences for patients and healthcare systems.1,2 Improved risk stratification is crucial to optimize patient care and requires development of more sensitive tools to identify high-risk patients. Because blood pressure (BP) in the brachial artery differs from the BP in the aorta, to which the heart and brain are exposed, cardiovascular risk assessment based on aortic BP could potentially be superior to assessment based on office BP measured at the level of the brachial artery. 3 However, the prognostic value of aortic BP remains unresolved, as aortic BP estimated noninvasively has been found to predict cardiovascular events in some, [4][5][6][7] but not all, 8,9 studies. The gold-standard method for assessing aortic BP is by invasive measurements. Only 2 studies of limited size and duration have assessed the association between invasively measured aortic BP and cardiovascular risk yielding conflicting results. 10,11 Although patients with diabetes mellitus are at high risk of cardiovascular events, 12 no previous studies have Abstract-Aortic systolic blood pressure (BP) represents the hemodynamic cardiac and cerebral burden more directly than office systolic BP. Whether invasively measured aortic systolic BP confers additional prognostic value beyond office BP remains debated. In this study, office systolic BP and invasively measured aortic systolic BP were recorded in 21 908 patients (mean age: 63 years; 58% men; 14% with diabetes mellitus) with stable angina pectoris undergoing elective coronary angiography during January 2001 to December 2012. Multivariate Cox models were used to assess the association with incident myocardial infarction, stroke, and death. Discrimination and reclassification were assessed using Harrell's C and the Continuous Net Reclassification Index. Data were analyzed with and without stratification by diabetes mellitus status. During a median follow-up period of 3.7 years (range: 0. MethodsThis study was conducted using medical databases in Denmark. Denmark has free, universal tax-supported health care with unrestrained access to general practitioners and hospitals. Accurate linkage of all medical registries is possible through the unique central personal registry number. 13 In this study, patient data in The Western Denmark Heart Registry covering 3 million inhabitants 14 was linked to outcome data in The Danish National Registry of Patients 15 and The Danish Civil Registration System. 13The Western Denmark Heart Registry collects patient and procedure data from all cardiac intervention centers in Western Denmark.14 The registry was used to identify all elective CAG procedures performed between January 1, 2001, and December 31, 2012. For the present analysis, we considered patients without previous MI, stroke, heart failure, or valvular disease referred for CAG with suspicion of stable angina pectoris. The first CAG during the inclusion period was defined as the index CAG.Office BP and invasively measur...

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.…”

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

“…Central or aortic BP, however, is expected to better reflect the hemodynamic load on target organs. Indeed, clinical studies suggest that central BP shows a closer relationship with target organ damage than does brachial BP [1-3]. Preclinical heart damage assessed by left ventricular mass and large artery damage assessed by intima media thickness and pulse wave velocity (PWV) appear to be closely associated with central systolic BP (SBP) and central pulse pressure (PP).…”