Clinical implications of central blood pressure measured by radial tonometry and automated office blood pressure measured using automatic devices in cardiovascular diseases

Abstract

ObjectiveCentral aortic systolic blood pressure (CBP) measured by carotid-femoral pulse wave analysis (cfPWA) is a gold standard method to estimate true arterial pressure. However, the impact of the CBP level measured by radial PWA on cardiovascular (CV) risk assessment is unclear. This study aimed to determine the impact on CV outcome assessment and the association between the optimal levels of non-invasively measured CBP and automated office blood pressure (OBP) in clinical practice.Materials and methodsA total of 2,115 patients underwent non-invasive semiautomated radial artery applanation tonometry (Omron HEM-9000AI) in the Department of Internal Medicine, St. Vincent’s Hospital, from July 2011 to December 2015. The patients were followed for at least 5 years, and atherosclerotic cardiovascular (ASCVD) outcomes were collected.ResultsAmong 2,115 patients (mean age 58 ± 14 years, 50.4% men) who were followed up, the median follow-up period was 52 months (range: 1–104 months). The total number of patients with ASCVD events was 163 (7.70%). In multivariate Cox regression analysis, a CBP of more than 125 mmHg and an automated OBP of more than 131 mmHg were independently associated with a significant increase in ASCVD outcomes. After adjusting for confounding factors, the hazard ratio for ASCVD events increased by 12.5, 11.7, and 12.7%, for every 10 mmHg increase in automated OBP, CBP, and central pulse pressure (PP), respectively.ConclusionThis study demonstrated that the automated OBP measured using the method used in real clinical practice and CBP measured by radial tonometry were associated with an increased risk for adverse ASCVD outcomes.

The prediction of cardiovascular events by phenotype of central and peripheral blood pressure in subjects without hypertension

“…In Figure 2, using a categorical approach, CBP at 120mmHg and SBP at 140mmHg might be divided into normotensive and hypertensive levels based on our previous study and Korea guideline [3,[13][14][15]. Group 1 (isolated central hypertension group, consisting of high CBP and normal SBP) had a total of 162 patients, with average values for age, BMI, CBP, SBP, DBP, PP, and CPP of 57.2 ± 10.8 years, 24.2 ± 3.1 kg/m 2 , 126.4 ± 4.5 mmHg, 132.1 ± 4.8 mmHg, 81.0 ± 7.9 mmHg, 51.0 ± 8.0 mmHg, and 45.5 ± 8.6 mmHg, respectively.…”

“…In addition, it is thought that CBP may be more advantageous than brachial BP, which is mainly measured at the office, in evaluating target organ damage in normotensive patients [17, 18]. Therefore, our previous study showed that CV risk increased rapidly at a CBP of 120 mmHg or higher through previously studied CBP data, irrespective of the brachial BP status [13-15]. In a recent meta-analysis, optimal CBP and central hypertension were defined as less than 110 mmHg and 120 mmHg, respectively, based on the primary CV endpoint with a 5-year probability of cohort data [10].…”

Influence of acute dietary nitrate supplementation timing on nitrate metabolism, central and peripheral blood pressure and exercise tolerance in young men

“…The clinical relevance of the observed reductions in central SBP in healthy young men is currently unknown and warrants additional investigation. However, central SBP readings > 125 mmHg are associated with a significant increase in atherosclerotic cardiovascular outcomes, and for every 10 mmHg increase in central SBP the risk of an adverse cardiovascular outcomes increases by 11.7% (Kwon et al 2022 ). This is important since resolving the time of day that administration of antihypertensive interventions elicits the optimal effects on cardiovascular health and cardioprotection remains unclear and an active area or research in cardiovascular medicine (Mackenzie et al 2022 ; Hermida et al 2010 ).…”