Prognostic significance of invasive central and peripheral blood pressures for cardiovascular events and mortality

BACKGROUND: High blood pressure (BP) is the leading modifiable risk factor for cardiovascular disease (CVD) and mortality. The prognostic relevance of invasive central versus peripheral BP for predicting major adverse CVD events (MACEs) remains unexplored. This exploratory study examined the prognostic associations of invasive central and peripheral BP measurement in a cohort of older patients with higher CVD risk. METHODS: In 238 patients undergoing elective coronary angiography (mean age 69 ± 11 years, 72% males), invasive aortic and brachial BP were measured sequentially. Patients were followed for 37 ± 23 months for MACEs, defined as a composite of CVD death, nonfatal myocardial infarction or stroke, hospitalization for unstable angina or heart failure. RESULTS: Both aortic and brachial invasive pulse pressures (PP) were independently associated with MACEs [adjusted hazard ratio (aHR) per 10 mmHg increase 1.11, 95% CI 1.01-1.22, P = 0.03, and 1.10, 95% CI 1.01-1.21, P = 0.04, respectively]. Associations of aortic [aHR 1.08, 95% CI 0.99-1.17, P = 0.07] and brachial (aHR 1.07, 95% CI 0.98-1.17, P = 0.13] systolic BPs were borderline. Differences in receiver operating characteristic performance between aortic and brachial PPs (area under the curve difference = 0.02) were not significant. Optimal thresholds for brachial PP to predict MACEs were 10 mmHg higher than aortic PP. CONCLUSIONS: In this exploratory cohort of older, higher-risk patients, invasive aortic and brachial PPs showed broadly similar associations with MACEs. Although numerically different, aortic PP appears to offer negligible incremental prognostic value beyond brachial PP, suggesting that measurement at either site would be clinically valuable. These findings warrant confirmation in adequately powered studies.