Twenty-four hour central systolic blood pressure calibrated with mean/diastolic BP (C2) was an independent predictor of cardiovascular events, whereas brachial SBP and C1-calibrated cSBP were not.
Cohort (n=839)
Does 24-hour central systolic blood pressure predict cardiovascular events better than 24-hour brachial systolic blood pressure in patients undergoing ambulatory blood pressure monitoring?
Twenty-four hour central systolic blood pressure calibrated with mean/diastolic BP is superior to brachial systolic blood pressure in predicting cardiovascular events.
Objective: Twenty-four hour central systolic blood pressure (cSBP) is the blood pressure seen by vital organs, and is closer associated with hypertensive organ damage than its brachial counterpart (bSBP). Their relationship with cardiovascular events is currently unknown. Design and method: We measured bSBP during ambulatory 24-hour blood pressure monitoring (24h-ABPM), using a validated brachial-cuff based device (Mobil-O-Graph, IEM), in patients undergoing clinically indicated ABPM. Brachial arterial waveforms were acquired during diastole and processed with an invasively validated transfer function (ARCSolver algorithm) to estimate central SBP, using C1 (systolic/diastolic BP) or C2 (mean/diastolic BP) for waveform calibration. Primary endpoint was a combination of death, myocardial infarction, stroke, coronary and peripheral revascularization and heart failure hospitalization. Results: We included 839 patients (mean age 60.7 years, 42.6% women, 71.3% hypertension, 12.8% diabetes, 6.6% current smoking, 22.1% coronary artery disease) with a mean 24-hour brachial BP of 130/81 mmHg. During an average follow up of 6.6 years, 235 patients reached the combined cardiovascular endpoint. In multiple-adjusted Cox proportional hazards models, only C2 cSBP, but neither bSBP nor C1 cSBP was an independent predictor of the combined endpoint (Table). The results were unchanged in the subgroups with available renal function/estimated glomerular filtration rate (n=694, 209 events), nt-proBNP (n=542, 166 events), or both (n=525, 157 events). Conclusions: Twenty-four hour cSBP is superior to bSBP in predicting cardiovascular events, but the method of waveform calibration is crucial.
Wassertheurer et al. (Fri,) conducted a cohort in Patients undergoing clinically indicated ABPM (n=839). Twenty-four hour central systolic blood pressure (cSBP) vs. Twenty-four hour brachial systolic blood pressure (bSBP) was evaluated on Combination of death, myocardial infarction, stroke, coronary and peripheral revascularization and heart failure hospitalization. Twenty-four hour central systolic blood pressure calibrated with mean/diastolic BP (C2) was an independent predictor of cardiovascular events, whereas brachial SBP and C1-calibrated cSBP were not.