Risk Stratification by Cross-Classification of Central and Brachial Systolic Blood Pressure-Reference-Cited by-同舟云学术

Risk Stratification by Cross-Classification of Central and Brachial Systolic Blood Pressure

Published:2022-05 Issue:5 Volume:79 Page:1101-1111
ISSN:0194-911X
Container-title:Hypertension
language:en
Short-container-title:Hypertension

Author:

Cheng Yi-Bang¹^ORCID,Thijs Lutgarde²^ORCID,Aparicio Lucas S.³,Huang Qi-Fang¹^ORCID,Wei Fang-Fei²⁴^ORCID,Yu Yu-Ling²⁵^ORCID,Barochiner Jessica³^ORCID,Sheng Chang-Sheng¹,Yang Wen-Yi⁶^ORCID,Niiranen Teemu J.⁷⁸^ORCID,Boggia José⁹^ORCID,Zhang Zhen-Yu²^ORCID,Stolarz-Skrzypek Katarzyna¹⁰,Gilis-Malinowska Natasza¹¹,Tikhonoff Valérie¹²^ORCID,Wojciechowska Wiktoria¹⁰^ORCID,Casiglia Edoardo¹²^ORCID,Narkiewicz Krzysztof¹¹^ORCID,Filipovský Jan¹³^ORCID,Kawecka-Jaszcz Kalina¹⁰,Wang Ji-Guang¹^ORCID,Li Yan¹^ORCID,Staessen Jan A.¹⁴¹⁵^ORCID,

Affiliation:

1. Department of Cardiovascular Medicine, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, State Key Laboratory of Medical Genomics, National Research Centre for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (Y.-B.C., Q.-F.H., C.-S.S., J.-G.W., Y.L.).

2. Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.T., F.-F.W., Y.-L.Y., W.-Y.Y., Z.-Y.Z.).

3. Servicio de Clínica Médica, Sección Hipertensión Arterial, Hospital Italiano de Buenos Aires, Argentina (L.S.A., J.Ba.).

4. Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (F.-F.W.).

5. Research Unit Environment and Health, KU Leuven Department of Public Health and Primary Care, University of Leuven, Belgium (Y.-L.Y).

6. Department of Cardiology, Shanghai General Hospital, Shanghai, China (W.-Y.Y.).

7. Department of Chronic Disease Prevention, Finnish Institute for Health and Welfare, Turku, Finland (T.J.N.).

8. Department of Medicine, TurkuUniversity Hospital and University of Turku (T.J.N.).

9. Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (J.Bo.).

10. First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland (K.S.-S., W.W., K.K.-J.).

11. Hypertension Unit, Department of Hypertension and Diabetology, Medical University of Gdańsk, Poland (N.G.-M., K.N.).

12. Department of Medicine, University of Padua, Italy (V.T., E.C.).

13. Faculty of Medicine, Charles University, Pilsen, Czech Republic (J.F.).

14. Research Institute Alliance for the Promotion of Preventive Medicine, Mechelen, Belgium (J.A.S.).

15. Biomedical Sciences Group, Faculty of Medicine, University of Leuven, Belgium (J.A.S.).

Abstract

Background: Whether cardiovascular risk is more tightly associated with central (cSBP) than brachial (bSBP) systolic pressure remains debated, because of their close correlation and uncertain thresholds to differentiate cSBP into normotension versus hypertension. Methods: In a person-level meta-analysis of the International Database of Central Arterial Properties for Risk Stratification (n=5576; 54.1% women; mean age 54.2 years), outcome-driven thresholds for cSBP were determined and whether the cross-classification of cSBP and bSBP improved risk stratification was explored. cSBP was tonometrically estimated from the radial pulse wave using SphygmoCor software. Results: Over 4.1 years (median), 255 composite cardiovascular end points occurred. In multivariable bootstrapped analyses, cSBP thresholds (in mm Hg) of 110.5 (95% CI, 109.1–111.8), 120.2 (119.4–121.0), 130.0 (129.6–130.3), and 149.5 (148.4–150.5) generated 5-year cardiovascular risks equivalent to the American College of Cardiology/American Heart Association bSBP thresholds of 120, 130, 140, and 160. Applying 120/130 mm Hg as cSBP/bSBP thresholds delineated concordant central and brachial normotension (43.1%) and hypertension (48.2%) versus isolated brachial hypertension (5.0%) and isolated central hypertension (3.7%). With concordant normotension as reference, the multivariable hazard ratios for the cardiovascular end point were 1.30 (95% CI, 0.58–2.94) for isolated brachial hypertension, 2.28 (1.21–4.30) for isolated central hypertension, and 2.02 (1.41–2.91) for concordant hypertension. The increased cardiovascular risk associated with isolated central and concordant hypertension was paralleled by cerebrovascular end points with hazard ratios of 3.71 (1.37–10.06) and 2.60 (1.35–5.00), respectively. Conclusions: Irrespective of the brachial blood pressure status, central hypertension increased cardiovascular and cerebrovascular risk indicating the importance of controlling central hypertension.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Internal Medicine

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