Relation of central and brachial blood pressure to left ventricular hypertrophy. The Czech Post-MONICA Study

Abstract

Central blood pressure (BP) has been shown to be a better predictor of target organ damage and cardiovascular events than brachial BP. Whether central BP is a better predictor of left ventricular hypertrophy (LVH) determined by electrocardiography (ECG) is not known. Radial applanation tonometry and ECG were performed in 728 subjects from the Czech Post-MONICA Study (a randomly selected 1% population sample). LVH was determined using the Sokolow-Lyon index and Cornell product; central pressure was derived from radial pulse. Of 657 subjects included in the analysis, 17 (9.4%) below 45 years and 43 (9%) over 45 years had LVH. In multiple linear regression analysis, the Sokolow-Lyon index in younger individuals was only associated with male sex and low BMI, with no association with BP found. In older individuals, LVH was associated with higher central and brachial BP. In separate binary logistic regression analyses adjusted for covariates, the odds ratio for central systolic pressure was higher than those for brachial systolic and pulse pressure in LVH prediction. Noninvasively determined central pressure in subjects over 45 years is more strongly related to ECG LVH than brachial pressure. This further supports a closer association of central pressure with target organ damage. Voltage criteria of LVH are not independently associated with central or brachial BP in younger individuals.

Relations of Central Hemodynamics and Aortic Stiffness with Left Ventricular Structure and Function: The Framingham Heart Study

“…Whereas the relation between peripheral blood pressure and cardiac structure has been well documented, few studies have assessed relations among cardiac structure, central hemodynamics, and vascular stiffness using detailed tonometry measures. These prior studies were limited by small sample size or an indirect assessment of central hemodynamics, restricted to non‐European ancestry individuals or relied on electrocardiographic LV hypertrophy . In a sample of 1272 Chinese indiviudals, Wang et al reported that central pulse pressure was associated with LV mass .…”

Association of Central and Peripheral Blood Pressures With Intermediate Cardiovascular Phenotypes

“…24 In the Czech Post-MONICA Study, the presence of LVH was assessed by ECG using either Sokolow-Lyon or Cornell voltage criteria rather than echocardiography. 25 Among 657 participants who had both ECG and radial applanation tonometry, the presence of ECG-LVH was not related to any BP variable in those <45 years of age. Among older participants, the odds ratios to predict the presence of ECG-LVH were higher for central SBP and PP than those for brachial pressures.…”

I Luso-Brazilian Positioning on Central Arterial Pressure

“…17,18 Some authors have identified that central pressure, compared with brachial pressure, correlates better with intermediate cardiovascular risk markers such as carotid intima-media thickness and left ventricular hypertrophy. 19,20 Several studies have reported an independent relationship between central pressure and future cardiovascular events, including in elderly patients with coronary disease and chronic kidney disease. 14,21-23 However, other studies have not found a superior predictive value for central pressure over brachial pressure.…”