Central pulse pressure predicted fatal or nonfatal cardiovascular events more strongly than brachial pulse pressure (HR 1.15 vs 1.10 per 10 mm Hg; P<0.001 vs P=0.008).
Cohort (n=3,520)
Does central pulse pressure predict vascular disease and cardiovascular events more strongly than brachial pulse pressure?
Noninvasively-determined central pulse pressure is a stronger predictor of vascular hypertrophy, atherosclerosis, and cardiovascular events than brachial blood pressure.
Effect estimate: HR 1.15 per 10 mm Hg
p-value: p=<0.001
Brachial blood pressure is predictive of cardiovascular outcome; however central pressure may better represent the load imposed on the coronary and cerebral arteries and thereby bear a stronger relationship to vascular damage and prognosis. Relations of brachial and central pressures to carotid artery hypertrophy (intimal-medial thickness and vascular mass), extent of atherosclerosis (plaque score), and incident cardiovascular events were examined in the Strong Heart Study. Central pressures were calculated using radial applanation tonometry. Among 3520 participants, central and brachial pulse pressures were more strongly related to vascular hypertrophy and extent of atherosclerosis than were systolic pressures. Central pulse pressure was more strongly related to all 3 arterial measures than was brachial pulse pressure (r=0.364 versus 0.309 for plaque score; P<0.001 for comparison of Spearman correlation coefficient; r=0.293 versus 0.249 for intimal-medial thickness; P<0.002; r=0.320 versus 0.289 for vascular mass; P<0.05). Among the 2403 participants free of clinical cardiovascular disease at baseline, 319 suffered fatal or nonfatal cardiovascular events during mean follow-up of 4.8+/-1.3 years. After adjustment for age, gender, current smoking, body mass index, cholesterol:HDL ratio, creatinine, fibrinogen, diabetes, and heart rate, central pulse pressure predicted cardiovascular events more strongly than brachial pulse pressure (hazards ratio=1.15 per 10 mm Hg, chi(2)=13.4, P<0.001 versus hazards ratio=1.10, chi(2)=6.9, P=0.008). In conclusion, noninvasively-determined central pulse pressure is more strongly related to vascular hypertrophy, extent of atherosclerosis, and cardiovascular events than is brachial blood pressure. These findings support prospective examination of use of central blood pressure as a treatment target in future trials.
Roman et al. (2007) conducted a cohort in Cardiovascular disease (n=3,520). Central pulse pressure vs. Brachial pulse pressure was evaluated on Fatal or nonfatal cardiovascular events (HR 1.15 per 10 mm Hg, p=<0.001). Central pulse pressure predicted fatal or nonfatal cardiovascular events more strongly than brachial pulse pressure (HR 1.15 vs 1.10 per 10 mm Hg; P<0.001 vs P=0.008).