The prediction of cardiovascular events by phenotype of central and peripheral blood pressure in subjects without hypertension

Abstract

AbstractBackgroundHypertension (HBP) is a common disease associated with aging, but the rate of recognition and control of the condition remains low. Most guidelines related to HBP have consisted of only peripheral blood pressure (BP) measurement. However, according to many studies, central BP (CBP) has a clearer relationship with the prediction of cardiovascular (CV) events than does peripheral BP and can more clearly express an individual’s BP status. Therefore, we aimed to evaluate the effect of CBP on the prediction of CV events and to investigate the prediction of CV events by phenotype of central and peripheral BP in subjects without hypertension.MethodA total of 2,910 patients were enrolled from June 2011 to December 2016 and were followed up through October 2022. CBP was measured using radial tonometry. The primary endpoint was a composite outcome.ResultThe median follow-up period for enrolled patients was 7.5 years. Out of a total of 722 patients (mean age of 52.5 ± 13.7 years) without HBP, 21 patients (2.9%) had events of the primary endpoint during the follow-up period. Systolic BP averaged 126 mmHg (±15 mmHg) in the event-free group and 136 mmHg (±15 mmHg) in the CV event group, while CBP measured 115 mmHg (±16 mmHg) in the event-free group and 126 mmHg (±16 mmHg) in the CV event group. In a Cox proportional hazards model, every 10 mmHg increase in CBP and systolic BP showed an increase in risk of 30% and 40%, respectively. Isolated central systolic hypertension and dual central and peripheral systolic hypertension showed 4.9% and 6% of the CV event rate, respectively (p=0.897).ConclusionIrrespective of the brachial BP status, isolated central hypertension increased CV events. Therefore, to prevent CV events, it is essential to control not only peripheral BP but also CBP.