Central Systolic Blood Pressure and Left Ventricular Mass: Findings From the International 24‐Hour Aortic Blood Pressure Consortium

Background Central systolic blood pressure (cSBP) reflects the pressure experienced by vital organs and may be more closely related to hypertensive cardiac damage than brachial SBP. Twenty‐four–hour ambulatory blood pressure monitoring provides additional insight into cardiovascular load beyond office readings. This study investigated the association of 24‐hour cSBP, measured noninvasively with a validated device, with left ventricular mass index (LVMi) and LV hypertrophy. Methods We analyzed data from 21 centers worldwide (n=2367; 45.5% women; mean age 49.5 years) participating in the International 24‐Hour Aortic Blood Pressure Consortium. Brachial and central 24‐hour SBPs were recorded using the Mobil‐O‐Graph device, calibrated by either systolic/diastolic (cSBP C1) or mean/diastolic (cSBP C2) pressure; LVMi was derived echocardiographically. BP phenotypes (normotension, isolated diastolic and systolic hypertension, and systolic‐diastolic hypertension) were based on 24‐hour brachial BPs, subdivided by cSBP. Results LVMi correlated most strongly with 24‐hour cSBP C2 ( P <0.001) consistently, across sex, body mass index (BMI), age, and treatment strata. Receiver operating characteristic analysis showed superior prediction of LV hypertrophy for 24‐hour cSBP C2 (area under the curve=0.68). Both brachial BP phenotype and central SBP status were independently associated with LVMi ( P =0.0045 and <0.001, respectively), without interaction. Discordant classification occurred in 14.4% of participants and was linked to higher LVMi in normotension and lower LVMi in systolic‐diastolic hypertension. Conclusions Twenty‐four–hour central SBP calibrated with oscillometric mean/diastolic pressure (cSBP C2), is more closely associated with LVMi and LV hypertrophy than brachial SBP. These findings highlight the potential clinical value of incorporating central pressure monitoring into risk assessment and hypertension management.