Prediction of Cardiovascular Events by Type I Central Systolic Blood Pressure

Abstract

Compared with brachial blood pressure (BP), central systolic BP (SBP) can provide a better indication of the hemodynamic strain inflicted on target organs, but it is unclear whether this translates into improved cardiovascular risk stratification. We aimed to assess which of central or brachial BP best predicts cardiovascular risk and to identify the central SBP threshold associated with increased risk of future cardiovascular events. This study included 13 461 participants of CARTaGENE with available central BP and follow-up data from administrative databases but without cardiovascular disease or antihypertensive medication. Central BP was estimated by radial artery tonometry, calibrated for brachial SBP and diastolic BP (type I), and a generalized transfer function (SphygmoCor). The outcome was major adverse cardiovascular events. Cox proportional-hazards models, differences in areas under the curves, net reclassification indices, and integrated discrimination indices were calculated. Youden index was used to identify SBP thresholds. Over a median follow-up of 8.75 years, 1327 major adverse cardiovascular events occurred. The differences in areas under the curves, net reclassification indices, and integrated discrimination indices were of 0.2% ([95% CI, 0.1–0.3] P <0.01), 0.11 ([95% CI, 0.03–0.20] P =0.01), and 0.0004 ([95% CI, −0.0001 to 0.0014] P =0.3), all likely not clinically significant. Central and brachial SBPs of 112 mm Hg (95% CI, 111.2–114.1) and 121 mm Hg (95% CI, 120.2–121.9) were identified as optimal BP thresholds. In conclusion, central BP measured with a type I device is statistically but likely not clinically superior to brachial BP in a general population without prior cardiovascular disease. Based on the risk of major adverse cardiovascular events, the optimal type I central SBP appears to be 112 mm Hg.

Central Over Peripheral Blood Pressure: An Emerging Issue in Hypertension Research

“…aiming at a relatively accurate pressure difference between central and peripheral sites) and Type II (the device purports to estimate the intra-arterial central BP, aiming at a relatively accurate absolute central BP value despite inaccuracy at the peripheral site). This nomenclature has started to be used in more recent literature [36] while the new strict validation criteria have shown the strengths but also some limitations of certain commercial devices [37]. Further progress on the validation of the techniques and devices used for assessment of central blood pressures is the main goal of the Working Group 3 of the Vascular Ageing (VascAgeNet) COoperation in Science and Technology (COST) Action [38].…”

Central systolic blood pressure (cSBP) to brachial systolic blood pressure (brachSBP) ratio reproducibility during antihypertensive therapy

“…American working group (in 2013) suggested the cut-off value of cSBP for hypertension ≥ 130 /90 mmHg; the reference value for optimal ˂ 110/80 and prehypertension 110-129/80-89 mmHg (22). Similar cut-off value (112 mmHg) for optimal central blood pressure was suggested on the basis of major adverse cardiovascular events occurrence during almost 9-year follow-up (23).…”

Aortic haemodynamics: the effects of habitual endurance exercise, age and muscle sympathetic vasomotor outflow in healthy men

“…However, this discrepancy is likely related to the study of only normotensive men in both age groups here, unlike the previous study. Therefore, in terms of cardiovascular risk as determined by aSBP (Stamatelopoulos et al 2006 ; Vlachopoulos et al 2010 ; Lamarche et al 2020 ), the benefit of habitual endurance exercise is apparent in young but not middle-aged normotensive men.…”

“…aortic pulse wave velocity, aPWV), and aortic reservoir pressure (O'Rourke and Mancia 1999 ; Mynard et al 2020 ). Notably, AP and aPWV increase with age (McEniery et al 2005 ) and contribute to the increase aortic systolic blood pressure (aSBP), which is predictive of future cardiovascular events in the general population (Lamarche et al 2020 ). Whether lifestyle factors, such as habitual endurance exercise, influence AP, aPWV, and aSBP similarly is currently unclear.…”