Left-ventricular hypertrophy is associated better with 24-h aortic pressure than 24-h brachial pressure in hypertensive patients

Protogerou, Athanase D.; Argyris, Antonis; Παπαϊωάννου, Θεόδωρος; Kollias, George; Konstantonis, George; Nasothimiou, Efthimia; Achimastos, Apostolos; Blacher, Jacques; Safar, Michel E.; Sfikakis, Petros P.

doi:10.1097/hjh.0000000000000263

Cited by 108 publications

(77 citation statements)

References 48 publications

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“…cSBP calibrated with peripheral SBP and DBP did not significantly predict mortality. A similar finding was obtained by Protogerou et al [48] who showed that 24-hour cSBP had a significantly stronger association with left ventricular mass index when the calibration was done with mean and diastolic BP than when calibrated with systolic and diastolic pressure values. However, the use of SBP and DBP, or MAP and DBP, is likely device specific because, for example, the WatchBP Office Central might produce a large error in cSBP when using MAP and DBP for calibration [49].…”

Section: Issues Related To Calibrationsupporting

confidence: 74%

Practical Suitability of a Stand-Alone Oscillometric Central Blood Pressure Monitor: A Review of the Microlife WatchBP Office Central

Verberk

Cheng

Huang³

et al. 2015

Pulse

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Accumulating evidence indicates that central blood pressure (CBP) is a better cardiovascular risk predictor than brachial blood pressure (BP). Although more additional benefits of CBP-based treatment above usual hypertension treatment are to be demonstrated, the demand for implementing CBP assessment in general clinical practice is increasing. For this, the measurement procedure must be noninvasive, easy to perform, and cost- and time-efficient. Therefore, oscillometric devices with the possibility to assess CBP seem the best option. Recently, such an oscillometric BP monitor, the Microlife WatchBP Office Central, was developed, which demonstrated its high accuracy in a validation study against invasive BP measurement. Calibration errors of this device are limited because the procedure is automated, standardized, and performed at the same place of and within 30 s from pulse wave assessment. The transformation from the peripheral pulse wave to CBP is done by means of an individual-based pulse wave analysis according to a theory of arterial compliance and wave reflections. In addition, the device has demonstrated to enable a more reliable diagnosis of hypertension by CBP than by peripheral BP, with a lower frequency of over- and underdiagnosis. Altogether, the available clinical evidence suggests that the Microlife WatchBP Office Central fulfills the criteria for general clinical use.

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Section: Issues Related To Calibrationsupporting

confidence: 74%

Practical Suitability of a Stand-Alone Oscillometric Central Blood Pressure Monitor: A Review of the Microlife WatchBP Office Central

Verberk

Cheng

Huang³

et al. 2015

Pulse

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“…Ease of use: Assessment of wave reflections/central BPs with peripheral tonometry can be made by validated, non-invasive devices. Cuff-based techniques are more easy to use and offer simultaneous assessment of both brachial and aortic BP, as well as the opportunity of 24-h recordings; they predict left ventricular hypertrophy more accurately than peripheral ambulatory blood pressure monitoring [138]. Nevertheless, the technical validation of these latter devices is ongoing and needs to be done at rest and with exercise [139,140].…”

Section: Clinical Utilitymentioning

confidence: 97%

The role of vascular biomarkers for primary and secondary prevention. A position paper from the European Society of Cardiology Working Group on peripheral circulation

Vlachopoulos¹,

Xaplanteris²,

Aboyans³

et al. 2015

Atherosclerosis

634

482

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While risk scores are invaluable tools for adapted preventive strategies, a significant gap exists between predicted and actual event rates. Additional tools to further stratify the risk of patients at an individual level are biomarkers. A surrogate endpoint is a biomarker that is intended as a substitute for a clinical endpoint. In order to be considered as a surrogate endpoint of cardiovascular events, a biomarker should satisfy several criteria, such as proof of concept, prospective validation, incremental value, clinical utility, clinical outcomes, cost-effectiveness, ease of use, methodological consensus, and reference values. We scrutinized the role of peripheral (i.e. not related to coronary circulation) noninvasive vascular biomarkers for primary and secondary cardiovascular disease prevention. Most of the biomarkers examined fit within the concept of early vascular aging. Biomarkers that fulfill most of the criteria and, therefore, are close to being considered a clinical surrogate endpoint are carotid ultrasonography, ankle-brachial index and carotid-femoral pulse wave velocity; biomarkers that fulfill some, but not all of the criteria are brachial ankle pulse wave velocity, central haemodynamics/wave reflections and C-reactive protein; biomarkers that do no not at present fulfill essential criteria are flow-mediated dilation, endothelial peripheral arterial tonometry, oxidized LDL and dysfunctional HDL. Nevertheless, it is still unclear whether a specific vascular biomarker is overly superior. A prospective study in which all vascular biomarkers are measured is still lacking. In selected cases, the combined assessment of more than one biomarker may be required.

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“…41 The univariable pearson r correlations with LV mass index were 0.511, 0.399 and 0.332 respectively, with the slope of the relationship with MAP/DBP calibrated waveforms being significantly greater than for the other calibration methods. Whether this may be a device-specific phenomenon related to the algorithm to determine MAP is unknown and will need to be tested using other techniques.…”

Section: Calibration Of Arterial Pressure Waveforms To Derive Central Bpmentioning

confidence: 96%

“…This appearance is only an artefact of the non-invasive brachial SBP being lower than the true brachial SBP, together with the synthesised central SBP being closer to the true (higher) central SBP. 38,41 In the end it may be simpler to focus acceptance on only using BP methods that are validated to measure a representation of central aortic BP, as originally intended in the 19th century, 1 rather than dissecting central from peripheral BP, which continues to fuel uncertainty in the field. This concept would require international cooperation to harmonise and validation of central BP-focussed thresholds, but may be preferred to lessen confusion and because central-to-peripheral BP amplification delivers no added (or little) prognostic power separate from central BP indices.…”

Section: Calibration Of Arterial Pressure Waveforms To Derive Central Bpmentioning

confidence: 99%

Central pressure should be used in clinical practice

Sharman

2014

ARTRES

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The original purpose for recording brachial blood pressure (BP) more than 100 years ago was to estimate central (aortic) BP. While high brachial BP is an important cardiovascular risk factor, it is clear that major differences in central systolic BP (SBP; e.g. >30 mmHg) can occur among people with similar brachial SBP. It is also proven that central SBP responses to antihypertensive therapy can differ substantially from brachial SBP responses, such that true treatment effects cannot be gauged from conventional brachial BP. Importantly, assessment of central BP results in: 1) improved predictive accuracy of future cardiovascular events beyond brachial BP and other cardiovascular risk factors; 2) superior diagnostic accuracy over brachial BP and; 3) different patient management than usual care guided by brachial BP. Collectively, the above illustrates that central BP is a better cardiovascular risk biomarker than brachial BP. As with all medical advances there are areas of research need and international consensus is required on issues such as standardization of techniques. However, central BP can now be accurately estimated (with appropriate waveform calibration) using brachial cuff methods in an approach that is familiar to clinicians, acceptable to patients and amenable to widespread use. In other words, this modern BP technique can finally satisfy the original purpose for measuring central aortic BP as intended more than 100 years ago. Although the tipping point towards routine use is yet to be reached, the body of evidence continues to favour the view that central BP should be used in clinical practice.

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Left-ventricular hypertrophy is associated better with 24-h aortic pressure than 24-h brachial pressure in hypertensive patients

Abstract: These data suggest that aortic ABPM, when compared to brachial ABPM, improves the individualized assessment of the BP-associated heart damage.

Cited by 108 publications

References 48 publications

Practical Suitability of a Stand-Alone Oscillometric Central Blood Pressure Monitor: A Review of the Microlife WatchBP Office Central

Practical Suitability of a Stand-Alone Oscillometric Central Blood Pressure Monitor: A Review of the Microlife WatchBP Office Central

The role of vascular biomarkers for primary and secondary prevention. A position paper from the European Society of Cardiology Working Group on peripheral circulation

Central pressure should be used in clinical practice

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