Cardiovascular End Points and Mortality Are Not Closer Associated With Central Than Peripheral Pulsatile Blood Pressure Components
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Published:2020-08
Issue:2
Volume:76
Page:350-358
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ISSN:0194-911X
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Container-title:Hypertension
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language:en
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Short-container-title:Hypertension
Author:
Huang Qi-Fang1, Aparicio Lucas S.2, Thijs Lutgarde3, Wei Fang-Fei3, Melgarejo Jesus D.3, Cheng Yi-Bang1, Sheng Chang-Sheng1, Yang Wen-Yi4, Gilis-Malinowska Natasza5, Boggia José2, Niiranen Teemu J.67, Wojciechowska Wiktoria8, Stolarz-Skrzypek Katarzyna8, Barochiner Jessica9, Ackermann Daniel10, Tikhonoff Valérie11, Ponte Belen1213, Pruijm Menno14, Casiglia Edoardo11, Narkiewicz Krzysztof5, Filipovský Jan15, Czarnecka Danuta8, Kawecka-Jaszcz Kalina8, Jula Antti M.6, Bochud Murielle16, Vanassche Thomas17, Verhamme Peter17, Struijker-Boudier Harry A.J.18, Wang Ji-Guang1, Zhang Zhen-Yu3, Li Yan1, Staessen Jan A.319ORCID, Aparicio LS, Barochiner J, Thijs L, Staessen JA, Wei FF, Yang WY, Zhang ZY, Cheng YB, Guo QH, Huang JF, Huang QF, Li Y, Sheng CS, Wang JG, Filipovský J, Seidlerová J, Juhanoja EP, Jula AM, Lindroos AS, Niiranen TJ, Sivén SS, Casiglia E, Pizzioli A, Tikhonoff V, Chori BS, Danladi B, Odili AN, Oshaju H, Kucharska W, Kunicka K, Gilis-Malinowska N, Narkiewicz K, Sakiewicz W, Swierblewska E, Kawecka-Jaszcz K, Stolarz-Skrzypek K, Schutte AE, Norton GR, Woodiwiss AJ, Ackermann D, Bochud M, Ponte B, Pruijm M, Álvarez-Vaz R, Américo C, Baccino C, Borgarello L, Florio L, Moliterno P, Noboa A, Noboa O, Olascoaga A, Parnizari P, Pécora M
Affiliation:
1. From the Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital (Q.-F.H., Y.-B.C., C.-S.S., J.-G.W., Y.L.) 2. Shanghai Jiao Tong University School of Medicine, China; Servicio de Clínica Médica, Sección Hipertensión Arterial, Hospital Italiano de Buenos Aires, Argentina (L.S.A., J.B.) 3. Research Unit Hypertension and Cardiovascular Epidemiology (L.T., F.-F.W., J.D.M., Z.-Y.Z., J.A.S.), KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium 4. Department of Cardiology, Shanghai General Hospital (W.-Y.Y.) 5. Hypertension Unit, Department of Hypertension and Diabetology, Medical University of Gdańsk, Poland (N.G.-M., K.N.) 6. Population Studies Unit, Department of Chronic Disease Prevention, National Institute for Health and Welfare, Turku, Finland (T.J.N., A.M.J.) 7. Department of Medicine, Turku University Hospital and University of Turku, Finland (T.J.N.) 8. First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland (W.W., K.S.-S., D.C., K.K.-J.) 9. Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (J.B.) 10. Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Switzerland (D.A.) 11. Department of Medicine, University of Padua, Italy (V.T., E.C.) 12. Division of Nephrology, University Hospital of Geneva, Geneva, Switzerland (B.P.) 13. Center for Primary Care and Public Health (B.P.), Unisanté, University of Lausanne, Switzerland 14. Service of Nephrology and Hypertension, Lausanne University Hospital and University of Lausanne, Switzerland (M.P.) 15. Faculty of Medicine, Charles University, Pilsen, Czech Republic (J.F.) 16. Center for Primary Care and Public Health (M.B.), Unisanté, University of Lausanne, Switzerland 17. Centre for Molecular and Vascular Biology (T.V., P.V.), KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium 18. Department of Pharmacology and Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, the Netherlands (H.A.J.S.-B.) 19. NPA Alliance for the Promotion of Preventive Medicine, Mechelen, Belgium (J.A.S.).
Abstract
Pulsatile blood pressure (BP) confers cardiovascular risk. Whether associations of cardiovascular end points are tighter for central systolic BP (cSBP) than peripheral systolic BP (pSBP) or central pulse pressure (cPP) than peripheral pulse pressure (pPP) is uncertain. Among 5608 participants (54.1% women; mean age, 54.2 years) enrolled in nine studies, median follow-up was 4.1 years. cSBP and cPP, estimated tonometrically from the radial waveform, averaged 123.7 and 42.5 mm Hg, and pSBP and pPP 134.1 and 53.9 mm Hg. The primary composite cardiovascular end point occurred in 255 participants (4.5%). Across fourths of the cPP distribution, rates increased exponentially (4.1, 5.0, 7.3, and 22.0 per 1000 person-years) with comparable estimates for cSBP, pSBP, and pPP. The multivariable-adjusted hazard ratios, expressing the risk per 1-SD increment in BP, were 1.50 (95% CI, 1.33–1.70) for cSBP, 1.36 (95% CI, 1.19–1.54) for cPP, 1.49 (95% CI, 1.33–1.67) for pSBP, and 1.34 (95% CI, 1.19–1.51) for pPP (
P
<0.001). Further adjustment of cSBP and cPP, respectively, for pSBP and pPP, and vice versa, removed the significance of all hazard ratios. Adding cSBP, cPP, pSBP, pPP to a base model including covariables increased the model fit (
P
<0.001) with generalized
R
2
increments ranging from 0.37% to 0.74% but adding a second BP to a model including already one did not. Analyses of the secondary end points, including total mortality (204 deaths), coronary end points (109) and strokes (89), and various sensitivity analyses produced consistent results. In conclusion, associations of the primary and secondary end points with SBP and pulse pressure were not stronger if BP was measured centrally compared with peripherally.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Internal Medicine
Cited by
30 articles.
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