High Central Pulse Pressure Is Independently Associated With Adverse Cardiovascular Outcome

Abstract

Objective To facilitate clinical use of central PP, we sought to determine a value that might predict adverse outcome and thereby provide a target for assessment of intervention strategies. Background We previously documented that central pulse pressure (PP) more strongly relates to carotid hypertrophy and extent of atherosclerosis and, more importantly, better predicts incident cardiovascular disease (CVD) than brachial PP. Methods Radial applanation tonometry was performed in the 3rd Strong Heart Study exam to determine central blood pressure. Cox regression analyses were performed using pre-specified covariates and quartiles of central and brachial PP. Results Among 2,405 participants without prevalent CVD, 344 suffered CVD events during 5.6±1.7 years. Quartiles of central PP (p<0.001) predicted outcome more strongly than quartiles of brachial PP (p=0.052). With adjustment for covariates, only the event rate in the 4th quartile of central PP (≥50 mmHg) was significantly higher than that in the first quartile (HR 1.69, 95% CI: 1.20–2.39, p=0.003). Central PP ≥50 mmHg was related to outcome in both men (HR 2.06, 95% CI: 1.39–3.04, p<0.001) and women (HR 2.03, 95% CI: 1.55–2.65, p<0.001); in participants with (HR 1.84, 95% CI: 1.41–2.39, p<0.001) and without diabetes (HR 1.91, 95% CI: 1.29–2.83, p=0.001); and in individuals below (HR 2.51, 95% CI: 1.59–3.95, p<0.001) and above (HR 1.53, 95% CI: 1.19–1.97, p=0.001) the age of 60. Conclusions Central PP ≥50 mmHg predicts adverse CVD outcome and may serve as a target in intervention strategies, if confirmed in other populations and in prospective studies.

Comparison of arterial stiffness indices measured by the Colins and SphygmoCor systems

“…16,17 The arterial pulse wave is generated by the sum of the forward pressure wave, timing of the reflected wave and the magnitude of the reflected wave along the arterial tree. 18 Arterial wave reflection occurs in the peripheral arteries due to changes in the arterial properties or in the architecture of the arterial tree.…”

Can arterial stiffness parameters be measured in the sitting position?

“…15,16 Therefore, measurement of central blood pressure is increasingly used in epidemiological studies. Another important aspect of central blood pressure measurement is that antihypertensive drugs have differential effects on central pressure despite similar effects on brachial pressure.…”

Aortic size index enlargement is associated with central hemodynamics in essential hypertension

“…2 Recent studies have suggested that central aortic BP may be better associated with target organ damage and clinical outcomes in people with hypertension. [3][4][5][6][7] Moreover, in Marfan's disease, it has been previously shown that central blood pressure (cBP) has a key role in the pathogenesis of aortic aneurysms. 8 In hypertensive patients, the ARD, and in particular dilatation of the sinus of Valsalva, is associated with more pronounced alterations in cardiac structure and geometry than in normotensive subjects; 2 however, the relationship between aortic root size and both the central and the peripheral BP levels has not yet been fully investigated in patients with hypertension and aortic dilatation.…”