Superiority of 24-Hour Aortic Over 24-Hour Brachial Pressure to Associate With Carotid Arterial Damage on the Basis of Pressure Amplification Variability: the SAFAR Study

Author:

Argyris Antonios A.1ORCID,Mouziouras Dimitrios1,Samara Stamatia1ORCID,Zhang Yi2,Georgakis Marios K.3ORCID,Blacher Jacques4,Safar Michel4,Sfikakis Petros P.5,Protogerou Athanase D.1

Affiliation:

1. Cardiovascular Prevention and Research Unit, Clinic/Laboratory of Pathophysiology, Laiko Hospital, Medical School, National and Kapodistrian University of Athens, Greece (A.A.A., D.M., S.S., A.D.P.).

2. Department of Cardiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China (Y.Z.).

3. Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Germany (M.K.G.).

4. Université de Paris; AP-HP; Diagnosis and Therapeutic Center, Hôtel-Dieu, Paris, France (J.B., M.S.).

5. 1st Department of Propaedeutic Medicine, Laiko Hospital, Medical School, National and Kapodistrian University of Athens, Greece (P.P.S.).

Abstract

Background: Evidence suggests marginal superiority of static aortic systolic blood pressure (aSBP) compared with brachial SBP (bSBP) regarding the association with organ damage and prognosis of cardiovascular disease (CVD). The noninvasive 24-hour aSBP assessment is feasible and associates better with presence of left ventricular hypertrophy compared with 24-hour bSBP. We aimed at comparing the association of 24-hour aSBP and 24-hour bSBP with indices of arterial damage and examining the role of 24-hour SBP amplification variability (within-subjects’ SD) in this association. Methods: Consecutive subjects referred for CVD risk assessment underwent 24-hour aortic and brachial ambulatory BP monitoring using a validated oscillometric device (Mobil-O-Graph). Arterial damage was assessed by carotid intima-media thickness (IMT) and detection of carotid and femoral atheromatosis (plaque presence). Results: Cross-sectionally 501 individuals (aged 54±13 years, 57% men, 80% hypertensives) were examined. Multivariable analysis revealed superiority of 24-hour aSBP regarding the association with IMT, carotid hypertrophy and carotid—but not femoral—atheromatosis. In receiver operator characteristics analysis, 24-hour aSBP displayed a higher discriminatory ability—compared to 24-hour bSBP—for the detection of both carotid hypertrophy (area under the curve, 0.662 versus 0.624, P <0.05) and carotid atheromatosis (area under the curve, 0.573 versus 0.547, P <0.05). This effect was more prominent in individuals with above-median 24-hour SD of SBP amplification. Conclusions: Our results suggest that 24-hour aSBP assessment may be of significant value in clinical practice to detect site-specific arterial damage on the basis of pressure amplification variability and should be prospectively examined in clinical trials.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Internal Medicine

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