Twenty-four-hour central blood pressure is not better associated with hypertensive target organ damage than 24-h peripheral blood pressure

Sierra, Alejandro de la; Pareja, JA; Fernández-Llama, Patricia; Armario, Pedro; Yun, Sergi; Acosta, E.; Calero, Francesca; Vázquez, Susana; Blanch, Pedro; Sierra, Cristina; Oliveras, Anna

doi:10.1097/hjh.0000000000001431

Cited by 24 publications

(14 citation statements)

References 23 publications

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“…The heart ejects blood directly into the central elastic arteries. Compared with conventional brachial pressure, several 5 but not all 6 studies suggest that central pressure is more strongly related to target organ damage and the incidence of cardiovascular complications. 7 , 8 In view of the close anatomical proximity of central arteries to the heart and the strong association of electrocardiogram (ECG) voltages with BP, 9 we considered that relating ECG voltages to peripheral and central BP might generate new insights.…”

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confidence: 99%

ECG Voltage in Relation to Peripheral and Central Ambulatory Blood Pressure

Yang

Mujaj

Efremov

et al. 2017

American Journal of Hypertension

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BACKGROUNDThe heart ejects in the central elastic arteries. No previous study in workers described the diurnal profile of central blood pressure (BP) or addressed the question whether electrocardiogram (ECG) indexes are more closely associated with central than peripheral BP.METHODSIn 177 men (mean age, 29.1 years), we compared the associations of ECG indexes with brachial and central ambulatory BP, measured over 24 hours by the validated oscillometric Mobil-O-Graph 24h PWA monitor.RESULTSFrom wakefulness to sleep, as documented by diaries, systolic/diastolic BP decreased by 11.7/13.1 mm Hg peripherally and 9.3/13.6 mm Hg centrally, whereas central pulse pressure (PP) increased by 4.3 mm Hg (P < 0.0001). Over 24 hours and the awake and asleep periods, the peripheral-minus-central differences in systolic/diastolic BPs averaged 11.8/–1.6, 12.7/–1.8, and 10.3/–1.2 mm Hg, respectively (P < 0.0001). Cornell voltage and index averaged 1.18 mV and 114.8 mV·ms. Per 1-SD increment in systolic/diastolic BP, the Cornell voltages were 0.104/0.086 mV and 0.082/0.105 mV higher in relation to brachial 24-hour and asleep BP and 0.088/0.90 mV and 0.087/0.107 mV higher in relation to central BP. The corresponding estimates for the Cornell indexes were 9.6/8.6 and 8.2/10.5 mV·ms peripherally and 8.6/8.9 and 8.8/10.7 mV·ms centrally. The regression slopes (P ≥ 0.067) and correlation coefficients (P ≥ 0.088) were similar for brachial and central BP. Associations of ECG measurements with awake BP and PP were not significant.CONCLUSIONSPeripheral and central BPs run in parallel throughout the day and are similarly associated with the Cornell voltage and index.

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confidence: 99%

ECG Voltage in Relation to Peripheral and Central Ambulatory Blood Pressure

Yang

Mujaj

Efremov

et al. 2017

American Journal of Hypertension

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“…With respect to 24‐hour estimators of central BP, 1 study found superiority over peripheral BP in the correlation with left ventricular mass index . However, we have previously found that both central and peripheral BP were similarly associated with TOD (cardiac, renal, or vascular), and according to our results, the association of 24‐hour central BP was no longer significant after adjusting for peripheral BP …”

Section: Discussionmentioning

confidence: 97%

“…Target organ damage (TOD) was defined as the presence of renal abnormalities, left ventricular hypertrophy, or arterial stiffness. Details on such assessments have been reported elsewhere . Briefly, renal abnormalities were defined as the presence of a reduced estimated glomerular filtration rate (eGFR), < 60 mL/min/1.73 m 2 was calculated using the chronic kidney disease‐epidemiology collaborative equation (serum creatinine measured by an enzymatic modified Jaffe reaction) or by the presence of an urinary albumin excretion ≥ 30 mg/g of creatinine (measured by turbidimetry in local laboratories according to current recommended standards and calculated as the average of 2 spot first‐morning void urine samples obtained in separate days).…”

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confidence: 99%

Central blood pressure variability is increased in hypertensive patients with target organ damage

Sierra

Pareja

Yun

et al. 2018

J of Clinical Hypertension

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We aimed to evaluate the association of aortic and brachial short-term blood pressure variability (BPV) with the presence of target organ damage (TOD) in hypertensive patients. One-hundred seventy-eight patients, aged 57 ± 12 years, 33% women were studied. TOD was defined by the presence of left ventricular hypertrophy on echocardiogram, microalbuminuria, reduced glomerular filtration rate, or increased aortic pulse wave velocity. Aortic and brachial BPV was assessed by 24-hour ambulatory BP monitoring (Mobil-O-Graph). TOD was present in 92 patients (51.7%). Compared to those without evidence of TOD, they had increased night-to-day ratios of systolic and diastolic BP (both aortic and brachial) and heart rate. They also had significant increased systolic BPV, as measured by both aortic and brachial daytime and 24-hours standard deviations and coefficients of variation, as well as for average real variability.Circadian patterns and short-term variability measures were very similar for aortic and brachial BP. We conclude that BPV is increased in hypertensive-related TOD. Aortic BPV does not add relevant information in comparison to brachial BPV.

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“…For example, antihypertensive therapy can have different effects on central and peripheral systolic pressure, influencing TOD, reducing left ventricular hypertrophy (LVH), cfPWV, carotid IMT and ACR [19,21]. Another study found that central aortic blood pressure, even when monitored for 24 h with an oscillometric device for pulse wave velocity [22], had similar associations with TOD to peripheral blood pressure [23]. However, the aforementioned study did not measure cfPWV but calculated it from a single point measurement of the pulse wave in the brachial cuff [23].…”

Section: Discussionmentioning

confidence: 99%

“…Another study found that central aortic blood pressure, even when monitored for 24 h with an oscillometric device for pulse wave velocity [22], had similar associations with TOD to peripheral blood pressure [23]. However, the aforementioned study did not measure cfPWV but calculated it from a single point measurement of the pulse wave in the brachial cuff [23]. Although this measurement is not yet used to for clinical assessment of TOD, some studies are starting to show significant differences in aortic PWV between groups measured with this technique [24].…”

Section: Discussionmentioning

confidence: 99%

Association of Haemodynamic Indices of Central and Peripheral Pressure with Subclinical Target Organ Damage

Zuo

Chu

Tan

et al. 2017

Pulse

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Background: Central aortic pressure has often been shown to be more closely associated with markers of vascular function and incidence of cardiovascular events compared to peripheral pressure. However, the potential clinical use of central aortic or peripheral haemodynamic indices as markers of target organ damage (TOD) has not been fully established. Methods: We evaluated associations of TOD with central aortic and peripheral haemodynamic indices (central aortic [cPP] and peripheral pulse pressure [pPP], central aortic augmentation index, and central and peripheral waveform factor) in 770 hospital inpatients (age 60 ± 10 years, 473 males) with primary hypertension. TOD was quantified in terms of arterial stiffness as measured by carotid-femoral pulse wave velocity (cfPWV), carotid intima-media thickness (IMT), and urine albumin-to-creatinine ratio (ACR). Subclinical TOD was defined as carotid IMT >0.9 mm, urine ACR >3.5 mg/mmol in females and >2.5 mg/mmol in males and/or cfPWV >12 m/s. Results: Both cPP and pPP showed significant correlation with cfPWV (r = 0.41 vs. 0.40; p < 0.01), ACR (r = 0.24 vs. 0.27; p < 0.01) and carotid IMT (r = 0.14 vs. 0.15; p < 0.01). Each SD increase in pPP and cPP was associated with increased risk of cfPWV >12 m/s (odds ratio [OR] = 2.7 and 2.9 for pPP and cPP, respectively), ACR >2.5 mg/mmol (OR = 1.2 and 1.4, respectively), and carotid IMT >0.9 mm (OR = 1.46 and 1.53, respectively). Compared to pPP, cPP had higher predictive power for TOD for age ≥60 years (OR = 3.07, p < 0.001). Conclusions: Although both pPP and cPP show an association with TOD in a hypertensive population, cPP provides additional information beyond pPP associated with TOD in a hypertensive cohort. Central aortic haemodynamic indices as potential biomarkers of subclinical TOD need to be validated by further prospective studies.

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Twenty-four-hour central blood pressure is not better associated with hypertensive target organ damage than 24-h peripheral blood pressure

Cited by 24 publications

References 23 publications

ECG Voltage in Relation to Peripheral and Central Ambulatory Blood Pressure

ECG Voltage in Relation to Peripheral and Central Ambulatory Blood Pressure

Central blood pressure variability is increased in hypertensive patients with target organ damage

Association of Haemodynamic Indices of Central and Peripheral Pressure with Subclinical Target Organ Damage

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