Key result
Invasive central aortic systolic BP fails to improve major event prediction over conventional brachial BP.
Why the study?
Central aortic blood pressure could be a better risk predictor than brachial blood pressure, but whether invasively measured aortic systolic blood pressure improves outcome prediction beyond conventional cuff-based office systolic blood pressure in patients with and without CKD was unclear.
Does invasively measured central aortic systolic BP improve cardiovascular risk prediction compared to conventional office systolic BP in patients with and without CKD?
Cohort (n=39,866)
Does invasively measured central aortic systolic BP improve cardiovascular risk prediction compared to conventional office systolic BP in patients with and without CKD?
Invasively measured central aortic systolic BP does not improve cardiovascular outcome prediction beyond conventional brachial office BP, regardless of CKD status.
Introduction: Central aortic blood pressure (BP) could be a better risk predictor than brachial BP. This study examined whether invasively measured aortic systolic BP improved outcome prediction beyond risk prediction by conventional cuff-based office systolic BP in patients with and without chronic kidney disease (CKD). Methods: . Multivariable Cox models were used to determine the association with incident myocardial infarction (MI), stroke, and death. Results: Aortic and office systolic BPs were available in 39,866 patients (mean age: 64 years; 58% males; 64% with hypertension) out of which 6605 (17%) had CKD. During a median follow-up of 7.2 years (interquartile range: 4.6-10.1 years), 1367 strokes (CKD: 353), 1858 MIs (CKD: 446), and 7551 deaths (CKD: 2515) occurred. CKD increased the risk of stroke, MI, and death significantly. Office and aortic systolic BP were both associated with stroke in non-CKD patients (adjusted hazard ratios with 95% confidence interval per 10 mm Hg: 1.08 [1.05-1.12] and 1.06 [1.03-1.09], respectively) and with MI in patients with CKD (adjusted hazard ratios: 1.08 [1.03-1.13] and 1.08 [1.04-1.12], respectively). There was no significant difference between prediction of outcome with office or aortic systolic BP when adjusted models were compared with C-statistics. Conclusion: Regardless of CKD status, invasively measured central aortic systolic BP does not improve the ability to predict outcome compared with brachial office BP measurement.
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Peters et al. (2023) conducted a cohort in Cardiovascular risk in patients with and without chronic kidney disease (n=39,866). Invasively measured central aortic systolic BP vs. Conventional cuff-based office systolic BP was evaluated on Incident myocardial infarction, stroke, and death. Invasively measured central aortic systolic BP did not improve the prediction of incident MI, stroke, or death compared with conventional brachial office BP, regardless of CKD status.
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