S-04-6: Cardiovascular End Points and Mortality Are Not Closer Associated With Central Than Peripheral Pulsatile Blood Pressure Components

Huang, Qi-Fang

doi:10.1097/01.hjh.0000912884.68946.a2

Cited by 4 publications

(18 citation statements)

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“…The adjusted standardized hazard ratios of the primary cardiovascular endpoint were 1.50 (95% CI, 1.33–1.70) for central systolic BP, 1.49 (95% CI, 1.33–1.67) for peripheral systolic BP, 1.36 (95% CI, 1.19–1.54) for central pulse pressure, and 1.34 (95% CI, 1.19–1.51) for brachial pulse pressure. Adding central BPs to a model with brachial BPs did not increase the model fit (generalized R 2 increments ≤.003%) 8 . Once again, it showed that, at least in adult populations, central and brachial BPs were associated with cardiovascular complications at a similar strength.…”

Section: Central Versus Brachial Bp As a Risk Factormentioning

confidence: 77%

“…The anatomic proximity of the aorta to heart, brain, and kidney gives rise to the hypothesis that central BP might be a better reflection of pulsatile pressure load of the target organs and a better predictor of outcomes than peripheral BP. However, up to now the evidence supporting the hypothesis remains inconsistent 7,8 …”

Section: Ntroductionmentioning

confidence: 99%

“…Nevertheless, up to now, almost all the non‐invasive estimations of central BP relied on the calibration with brachial BP 9,10 . Given the very close correlation between central and brachial BPs, it might not be surprising that at the population level central BPs were not more strongly associated with outcomes than their brachial counterparts 7,8 . Nevertheless, elevated central BP remains a consistent and significant risk factor for cardiovascular morbidity and mortality across studies.…”

Section: Ntroductionmentioning

confidence: 99%

“…To further clarify whether central arterial properties could contribute to risk stratification using a powerful meta‐analysis of individual rather than aggregate data, the International Database of Central Arterial Properties for Risk Stratification (IDCARS) was constructed 19 . Of the 5608 subjects from 9 studies in Europe, Africa, Asia, and South America, 255 experienced a cardiovascular endpoint and 204 died during the follow up for a median of 4.1 years 8 . The Pearson correlation coefficient between central and brachial BPs was .97 for systolic and .95 for pulse pressure.…”

Section: Central Versus Brachial Bp As a Risk Factormentioning

confidence: 99%

“…9,10 Given the very close correlation between central and brachial BPs, it might not be surprising that at the population level central BPs were not more strongly associated with outcomes than their brachial counterparts. 7,8 Nevertheless, elevated central BP remains a consistent and significant risk factor for cardiovascular morbidity and mortality across studies. Based on the central and brachial BP status, patients could be cross-classified as concordant or discordant normotensive or hypertensive.…”

Section: Ntroductionmentioning

confidence: 99%

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Central hypertension is a non‐negligible cardiovascular risk factor

Cheng

et al. 2022

J of Clinical Hypertension

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High blood pressure (BP) confers cardiovascular risk. However, the clinical value of central BP remains debatable. In this article, we aim to briefly review the prognosis, diagnosis, and treatment of central hypertension. Central and brachial BPs are closely correlated. In most prospective investigations, elevated central and peripheral BPs were similarly associated with adverse outcomes. Outcome-driven thresholds of the central systolic BP estimated by the type I device were on average 10 mmHg lower than their brachial counterparts. Cross-classification based on the central and brachial BPs identified that nearly 10% of patients had discrepancy in their status of central and brachial hypertension. Irrespective of the brachial BP status, central hypertension was associated with increased cardiovascular risk, highlighting the importance of central BP assessment in the management of hypertensive patients. Newer antihypertensive agents, such as renin-angiotensin-aldosterone system inhibitors and calcium channel blockers, were more efficacious than older agents in central BP reduction. Clinical trials are warranted to demonstrate whether controlling central hypertension with an optimized antihypertensive drug treatment will be beneficial beyond the control of brachial hypertension.

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Section: Central Versus Brachial Bp As a Risk Factormentioning

confidence: 77%

Section: Ntroductionmentioning

confidence: 99%

Section: Ntroductionmentioning

confidence: 99%

Section: Central Versus Brachial Bp As a Risk Factormentioning

confidence: 99%

Section: Ntroductionmentioning

confidence: 99%

See 3 more Smart Citations

Central hypertension is a non‐negligible cardiovascular risk factor

Cheng

et al. 2022

J of Clinical Hypertension

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Central blood pressure estimation in type 1 diabetes: impact and implications of peripheral calibration method.

Helleputte

Spronck

Sharman

et al. 2022

Journal of Hypertension

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Objective:Peripheral blood pressure (BP) waveforms are used for noninvasive central BP estimation. Central BP could assist in cardiovascular risk assessment in patients with type 1 diabetes mellitus (T1DM). However, correct calibration of peripheral BP waveforms is important to accurately estimate central BP. We examined differences in central BP estimated by radial artery tonometry depending on which brachial BP (SBP/DBP vs. MAP/DBP) is used for calibration of the radial waveforms, for the first time in T1DM.Methods:A cross-sectional study in T1DM patients without known cardiovascular disease. Radial artery BP waveforms were acquired using applanation tonometry (SphygmoCor) for the estimation of central SBP, central pulse pressure (PP) and central augmentation pressure, using either brachial SBP/DBP or MAP/DBP for the calibration of the radial pressure waveforms.Results:Fifty-four patients (age: 46 ± 9.5 years; T1DM duration: 27 ± 8.8 years) were evaluated. Central BP parameters were significantly higher when brachial MAP/DBP-calibration was used compared with brachial SBP/DBP-calibration (7.5 ± 5.04, 7.5 ± 5.04 and 1.5 ± 1.36 mmHg higher central SBP, central PP and central augmentation pressure, respectively, P < 0.001).Conclusion:In patients with T1DM, there are significant differences in central BP values estimated with radial artery tonometry, depending on the method used for calibration of the radial waveforms. Brachial MAP/DBP-calibration resulted in consistently higher central BP as compared to using brachial SBP/DBP, leading to patient re-stratification. Hence, the accuracy of noninvasive estimation of central BP by radial tonometry is dependent on calibration approach, and this problem must be resolved in validation studies using an invasive reference standard to determine which method best estimates true central BP.

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Brachial and central hypertension in relation to coronary stenosis in patients with coronary angiography

Chen,

Li,

Wang

et al. 2023

J of Clinical Hypertension

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The clinical significance of central beyond brachial blood pressure (BP) remains unclear. In patients who underwent coronary angiography, the authors explored whether elevated central BP would be associated with coronary arterial disease (CAD) irrespective of the status of brachial hypertension. From March 2021 to April 2022, 335 patients (mean age 64.9 years, 69.9% men) hospitalized for suspected CAD or unstable angina were screened in an ongoing trial. CAD was defined if a coronary stenosis of ≥50%. According to the presence of brachial (non‐invasive cuff systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg) and central (invasive systolic BP ≥130 mmHg) hypertension, patients were cross‐classified as isolated brachial hypertension (n = 23), isolated central hypertension (n = 93), and concordant normotension (n = 100) or hypertension (n = 119). In continuous analyses, both brachial and central systolic BPs were significantly related to CAD with similar standardized odds ratios (OR, 1.47 and 1.45, p < .05). While categorical analyses showed that patients with isolated central hypertension or concordant hypertension had a significantly higher prevalence of CAD and the Gensini score than those with concordant normotension. Multivariate‐adjusted OR (95% confidence interval [CI]) for CAD was 2.24 (1.16 to 4.33, p = .009) for isolated central hypertension and 3.02 (1.58 to 5.78, p < .001) for concordant hypertension relative to concordant normotension. The corresponding OR (95% CI) of a high Gensini score was 2.40 (1.26–4.58) and 2.17 (1.19–3.96), respectively. In conclusion, regardless of the presence of brachial hypertension, elevated central BP was associated with the presence and severity of CAD, indicating that central hypertension is an important risk factor for coronary atherosclerosis.

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S-04-6: Cardiovascular End Points and Mortality Are Not Closer Associated With Central Than Peripheral Pulsatile Blood Pressure Components

Cited by 4 publications

References 0 publications

Central hypertension is a non‐negligible cardiovascular risk factor

Central hypertension is a non‐negligible cardiovascular risk factor

Central blood pressure estimation in type 1 diabetes: impact and implications of peripheral calibration method.

Brachial and central hypertension in relation to coronary stenosis in patients with coronary angiography

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