Derivation and Validation of Diagnostic Thresholds for Central Blood Pressure Measurements Based on Long-Term Cardiovascular Risks

Cheng, Hao Min; Chuang, Shao Yuan; Sung, Shih Hsien; Yu, Wen Chung; Pearson, Alan; Lakatta, Edward G.; Pan, Wen Harn

doi:10.1016/j.jacc.2013.06.029

Cited by 150 publications

(139 citation statements)

References 54 publications

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“…Using an outcome-driven approach to examine the discriminatory ability of central BP for long-term cardiovascular outcomes [13], an operational threshold for central BP, 130/90 mm Hg, has been derived and validated in two independent Taiwanese cohorts [14,15]. This central BP cutoff value has a greater discriminatory power for long-term events [13] and may have a higher sensitivity and a more negative predictive value than peripheral BP in the diagnosis of hypertension [16], subsequently rendering the application of central BP in clinical practice a more cost-effective approach [17]. …”

Section: What Is Unique In the 2015 Tsoc/ths Hypertension Guideline?mentioning

confidence: 99%

The Novelty of the 2015 Guidelines of the Taiwan Society of Cardiology and the Taiwan Hypertension Society for the Management of Hypertension

Cheng

Chiang

2015

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The prevalence rate of hypertension in Asian countries grows faster than in other parts of the world, where stroke exceeds coronary heart disease in causing morbidities and mortalities. The optimal management of hypertension is therefore an especially important task in Asia. In a transparent and rigorous guideline development process, the most updated information available on the management of hypertension was summarized in the 2015 Taiwan Society of Cardiology (TSOC)/Taiwan Hypertension Society (TSH) hypertension guideline. In contradiction with the ESH/ESH joint hypertension guidelines and the 2014 Joint National Committee (JNC) report, this updated guideline suggests some different blood pressure (BP) targets. In brief, the BP target is 150/90 mm Hg for very elderly patients (≥ 80 years), 130/80 mm Hg for patients with diabetes, coronary heart disease, proteinuric chronic kidney disease or those receiving antithrombotics for stroke prevention, and 140/90 mm Hg for all the other hypertension patients with or without the aforementioned comorbidities. To facilitate the adherence to the guideline, the following was proposed: mnemonics for lifestyle modifications: S-ABCDE (Sodium restriction, Alcohol limitation, Body weight reduction, Cigarette smoking cessation, Diet adaptation, and Exercise adoption), treatment algorithm: PROCEED (Previous experience, Risk factors, Organ damage, Contraindications or unfavorable conditions, Expert's or doctor's judgment, Expenses or cost, and Delivery and compliance issue), and medication adjustment algorithm: AT GOALs (Adherence, Timing of administration, Greater doses, Other classes of drugs, Alternative combination or single-pill combination, and Lifestyle modification + Laboratory tests). In particular, the effort of translating the concept of central BP into clinical practice may stand out from all other hypertension guidelines. In summary, our guidelines may deliver useful information and guidance to clinicians in managing hypertensive patients, including the approach to a more accurate diagnosis, treatment and adjustment algorithm, and evidence-based recommendations.

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Section: What Is Unique In the 2015 Tsoc/ths Hypertension Guideline?mentioning

confidence: 99%

The Novelty of the 2015 Guidelines of the Taiwan Society of Cardiology and the Taiwan Hypertension Society for the Management of Hypertension

Cheng

Chiang

2015

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“…For this, a threshold definition is a first requirement. Although still under debate, Cheng et al [63] presented a promising proposal. Based on their study with a derivation cohort of 1,272 individuals and a median follow-up of 15 years using the relationship of CBP and cardiovascular mortality as an outcome, the authors came to systolic/diastolic threshold values of 110/80 mm Hg for optimal BP and 130/90 mm Hg for hypertension, respectively.…”

Section: Use In Clinical Practicementioning

confidence: 99%

“…Subsequently, the derived thresholds were tested in a validation cohort of 2,501 individuals with a median follow-up of 10 years. Compared to optimal BP, the risk of cardiovascular mortality increased signiﬁcantly in subjects with hypertension (hazard ratio: 3.08, 95% conﬁdence interval: 1.05-9.05) [63]. …”

Section: Use In Clinical Practicementioning

confidence: 99%

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

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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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“…Several studies have assessed the prognostic information of noninvasive estimates of aortic BP for cardiovascular events and mortality. Nominally stronger associations were reported for aortic BP than for office BP in a Taiwanese population 7,22 and in selected patient groups such as Native Americans, 6 patients with end-stage renal disease, 4 and community dwelling geriatric individuals.5 On the contrary, office systolic BP had Results are presented for all participants and stratified by diabetes status. Results for stroke and acute myocardial infarction are presented per 10 mm Hg difference.…”

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Invasively Measured Aortic Systolic Blood Pressure and Office Systolic Blood Pressure in Cardiovascular Risk Assessment

et al. 2016

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768S troke and myocardial infarction (MI) remain common diseases with massive consequences for patients and healthcare systems.1,2 Improved risk stratification is crucial to optimize patient care and requires development of more sensitive tools to identify high-risk patients. Because blood pressure (BP) in the brachial artery differs from the BP in the aorta, to which the heart and brain are exposed, cardiovascular risk assessment based on aortic BP could potentially be superior to assessment based on office BP measured at the level of the brachial artery. 3 However, the prognostic value of aortic BP remains unresolved, as aortic BP estimated noninvasively has been found to predict cardiovascular events in some, [4][5][6][7] but not all, 8,9 studies. The gold-standard method for assessing aortic BP is by invasive measurements. Only 2 studies of limited size and duration have assessed the association between invasively measured aortic BP and cardiovascular risk yielding conflicting results. 10,11 Although patients with diabetes mellitus are at high risk of cardiovascular events, 12 no previous studies have Abstract-Aortic systolic blood pressure (BP) represents the hemodynamic cardiac and cerebral burden more directly than office systolic BP. Whether invasively measured aortic systolic BP confers additional prognostic value beyond office BP remains debated. In this study, office systolic BP and invasively measured aortic systolic BP were recorded in 21 908 patients (mean age: 63 years; 58% men; 14% with diabetes mellitus) with stable angina pectoris undergoing elective coronary angiography during January 2001 to December 2012. Multivariate Cox models were used to assess the association with incident myocardial infarction, stroke, and death. Discrimination and reclassification were assessed using Harrell's C and the Continuous Net Reclassification Index. Data were analyzed with and without stratification by diabetes mellitus status. During a median follow-up period of 3.7 years (range: 0. MethodsThis study was conducted using medical databases in Denmark. Denmark has free, universal tax-supported health care with unrestrained access to general practitioners and hospitals. Accurate linkage of all medical registries is possible through the unique central personal registry number. 13 In this study, patient data in The Western Denmark Heart Registry covering 3 million inhabitants 14 was linked to outcome data in The Danish National Registry of Patients 15 and The Danish Civil Registration System. 13The Western Denmark Heart Registry collects patient and procedure data from all cardiac intervention centers in Western Denmark.14 The registry was used to identify all elective CAG procedures performed between January 1, 2001, and December 31, 2012. For the present analysis, we considered patients without previous MI, stroke, heart failure, or valvular disease referred for CAG with suspicion of stable angina pectoris. The first CAG during the inclusion period was defined as the index CAG.Office BP and invasively measur...

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Derivation and Validation of Diagnostic Thresholds for Central Blood Pressure Measurements Based on Long-Term Cardiovascular Risks

Cited by 150 publications

References 54 publications

The Novelty of the 2015 Guidelines of the Taiwan Society of Cardiology and the Taiwan Hypertension Society for the Management of Hypertension

The Novelty of the 2015 Guidelines of the Taiwan Society of Cardiology and the Taiwan Hypertension Society for the Management of Hypertension

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

Invasively Measured Aortic Systolic Blood Pressure and Office Systolic Blood Pressure in Cardiovascular Risk Assessment

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