Pulsatile but Not Steady Component of Blood Pressure Predicts Cardiovascular Events in Coronary Patients

Abstract

Abstract-Although the differences between central and peripheral blood pressure (BP) values have been known for decades, the consequences of decision making based on peripheral rather than central BP have only recently been recognized. There are only a few studies assessing the relationship between intraaortic BP and cardiovascular risk. In addition, the relationship between central BP and the risk of cardiovascular events in a large group of coronary patients has not yet been evaluated. Therefore, the aim of the study was to determine the prognostic significance of central BP-derived indices in patients undergoing coronary angiography. Invasive central BPs were taken at baseline, and study end points were ascertained during over a 4. Key Words: blood pressure Ⅲ central pulse pressure Ⅲ pulsatility Ⅲ cardiovascular risk Ⅲ atherosclerosis Ⅲ coronary artery disease D iastolic blood pressure (DBP) was previously believed to be the only meaningful predictor of cardiovascular events; however, systolic blood pressure (SBP) is now being considered an even more important cardiovascular risk factor. 1 Recently, the prospective and retrospective epidemiological studies have demonstrated that elevated pulse pressure (PP, the difference between systolic and diastolic pressure) is independently related to the risk of cardiovascular events, especially in the elderly. 1,2 Furthermore, new parameters (pulsatility and pulsatility index) of the pulsatile component of blood pressure (BP) have been developed. 3,4 Pulsatility is calculated as PP divided by mean blood pressure (MBP). 3 Unlike SBP, DBP, and PP, this new parameter is not correlated with MBP, and thus it may be very useful in research on atherosclerosis pathogenesis and its complications development. 5,6 Pulsatility may be seen as indicator of the relative changes of blood pressure in opposition to pulse pressure which is an index of absolute blood pressure changes.Although the differences between central and peripheral BP values have been known for decades, the consequences of decision making based on peripheral rather than central BP have only recently been recognized. 6 -9 As central BP directly affects heart and coronary as well as carotid arteries and is directly related to the incidence of major cardiovascular complications, more and more attention is being given to the ascending aortic BP measurements. 6,7 There are only a few studies assessing the relationship between central BP and cardiovascular risk. The relationship between pulsatility (as measured invasively in the ascending aorta) and the risk of cardiovascular events has not yet been evaluated. Therefore, the present study was designed for the assessment of the relationship between prognosis and the steady and pulsatile components of central BP. Methods Study PopulationConsecutive patients suspected of having coronary artery disease (CAD) who were undergoing nonemergency coronary angiography from

Estimation of central systolic blood pressure using an oscillometric blood pressure monitor

“…14,26,30 Although all current noninvasive methods for the estimation of aortic pressure are affected by the limited accuracy of the oscillometric blood pressure monitors, 31,32 the clinical values of the central blood pressure estimates remain evident. 5,7,8 Because brachial SBP2 represents a very significant weight in both the invasive and noninvasive prediction models, the accurate identification of SBP2 on a peripheral pulse without visible late systolic peak may deserve concerns. The identification of SBP2 on a radial pressure waveform may be difficult when it is close to the end-systolic pressure as with nitroglycerin, in youth, with tachycardia, and in systolic heart failure.…”

“…1,2 The discrepancy between the central and peripheral blood pressures is mainly caused by the central-to-peripheral amplification of the pressure pulse and may magnify with administration of vasoactive agents. [2][3][4] Furthermore, recent evidence from epidemiological studies, 5,6 clinical observation, 7 and a large clinical trial 8 suggest that central blood pressure is more relevant than peripheral blood pressure in predicting target organ damage and cardiovascular outcomes. However, the implementation of central blood pressure in the daily practice of hypertension management may require the availability of its reliable measurements to both medical care providers in the clinics and patients at home.…”

Aortic pulse pressure and atherosclerotic structural alterations of coronary arteries

“…Heart rate and b-blocking agents (yes/no) were used as conventional factors potentially acting independently on PP. [1][2][3][4][5] According to the degree of significance (Po0.15), the variables were either added or not added in the model.…”

“…Brachial non-invasive SBP, DBP or PP levels gave even less indications on the predictive value of coronary alterations. Interestingly, Jankowski et al 2 have recently demonstrated that aortic PP was the most important predictor of CV events in coronary patients with preserved as well as in those with reduced EF. Because, in the present population of old hypertensive and atherosclerotic subjects, the increased PP is due to a low DBP with SBP close to normal values, the corresponding patients are often clinically classified as 'adequately controlled' (SBP o140 mm Hg and DBP o90 mm Hg) by antihypertensive drug treatment.…”

“…[1][2][3][4] More specifically, it has been shown that increased brachial and aortic PP are significant and independent predictors of cardiac and mainly coronary events, whereas mean arterial pressure (MAP) should be a stronger predictor of cerebral, cardiac (heart failure) and renal events. [1][2][3][4][5] However, in some of the published reports, brachial systolic blood pressure (SBP) was found to be a better predictor of coronary events than brachial PP, even in the elderly population. [6][7][8] On the other hand, it has been shown that increased PP is predictor of CV risk, even when PP involves low diastolic blood pressure (DBP) without any increase of SBP.…”