Clinical and Cardiometabolic Characteristics Associated with Elevated Office Central Systolic Blood Pressure in Individuals with Normal Brachial Systolic Blood Pressure

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Adults with normal office brachial systolic blood pressure (<140 mmHg) undergoing cardiovascular risk assessment (n=3395). Intervention: Elevated office central systolic blood pressure (≥ 130 mmHg) vs. Central systolic blood pressure < 130 mmHg. Primary outcome: Carotid plaque presence (fully adjusted for conventional cardiovascular risk factors and brachial SBP) (OR 0.86, 95% CI 0.61-1.22, p=0.403).

Q: What does this research mean for the field?

In individuals with normal office brachial systolic blood pressure, elevated office central systolic blood pressure is associated with a less favorable cardiometabolic and hemodynamic profile but is not independently associated with carotid atherosclerosis after adjusting for conventional cardiovascular risk factors. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To determine whether elevated office central systolic blood pressure in individuals with normal office brachial systolic blood pressure is associated with an adverse cardiometabolic and vascular profile.

Sebastián Obregon; Rocío Martínez Vivot; Ana Di Leva; Martín Koretzky; Fernando O. Botto; Sergio Baratta; Carol Kotliar

doi:10.1007/s44200-026-00142-x

November 9, 2026Artery ResearchOpen Access

Clinical and Cardiometabolic Characteristics Associated with Elevated Office Central Systolic Blood Pressure in Individuals with Normal Brachial Systolic Blood Pressure

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Key result

Elevated office central SBP (≥130 mmHg) despite normal brachial SBP was not independently associated with carotid plaque after full adjustment (OR 0.86, 95% CI 0.61–1.22; p=0.403).

Why the study?

Residual cardiovascular risk may persist despite normal office brachial systolic blood pressure (b-SBP), and central systolic blood pressure (c-SBP) may provide complementary haemodynamic information. This study investigated whether elevated office c-SBP despite normal b-SBP identifies individuals with a less favorable cardiometabolic and vascular profile.

Does elevated office central systolic blood pressure (≥130 mmHg) despite normal office brachial systolic blood pressure (<140 mmHg) identify individuals with greater carotid plaque burden and an adverse cardiometabolic profile?

Key Points

To determine whether elevated office central systolic blood pressure in individuals with normal office brachial systolic blood pressure is associated with an adverse cardiometabolic and vascular profile.
Cross-sectional analysis of 3,395 adults with normal office brachial systolic blood pressure (< 140 mmHg).
Elevated central systolic blood pressure was defined as ≥ 130 mmHg and compared across cardiovascular risk factors, Mobil-O-Graph-derived estimated pulse wave velocity, carotid plaque prevalence, and total carotid plaque area.
Elevated office central systolic blood pressure occurred in 271 participants (8.0%), who had higher estimated pulse wave velocity (8.20 ± 1.40 vs. 7.40 ± 1.43 m/s; p < 0.001) and greater median total carotid plaque area (21.1 vs. 14.0 mm²; p = 0.014).

Study Design

Type

Cross-Sectional (n=3,395)

Multicenter

No

Structured PICO

Does elevated office central systolic blood pressure (≥130 mmHg) despite normal office brachial systolic blood pressure (<140 mmHg) identify individuals with greater carotid plaque burden and an adverse cardiometabolic profile?

P

Population

3,395 adults (mean age 51.1 years, 35.4% female) in Argentina with office brachial systolic blood pressure <140 mmHg evaluated in a cross-sectional cardiovascular risk registry.

E

Exposure

Elevated office central aortic systolic blood pressure (c-SBP ≥ 130 mmHg, n=271 [8.0%]), measured via oscillometric Mobil-O-Graph device under standardized office conditions.

C

Comparator

Normal office central aortic systolic blood pressure (c-SBP < 130 mmHg, n=3,124 [92.0%]) measured under the same standardized office conditions.

O

Outcome

Presence of carotid atherosclerotic plaque (defined as focal wall thickening >1.0 mm and ≥50% greater than surrounding intima-media thickness on 2D ultrasound), evaluated in unadjusted and multivariable logistic regression models adjusting for conventional cardiovascular risk factors and brachial SBP.surrogate

Main Result

Odds Ratio: 0.86 (95% CI 0.61–1.22)

Absolute Event Rate: 68.3% vs 62.1%

p-value: p=0.403

Elevated office central SBP (≥130 mmHg) is present in 8% of adults with normal office brachial SBP (<140 mmHg) and clusters with adverse cardiometabolic risk factors, though its association with carotid plaque is not independent of conventional risk factors and brachial SBP.

Limitations

Cross-sectional design precludes temporal or causal inference and does not establish prognostic significance
Single specialized cardiovascular referral center may limit generalizability to community-based populations
Central SBP classification was based on a single standardized office assessment without 24-hour ambulatory BP monitoring
Mobil-O-Graph-derived ePWV is algorithmically estimated and strongly influenced by age and systolic BP rather than a direct measurement of arterial stiffness
Smaller sample size of the elevated central SBP subgroup (n=271) may reduce statistical precision
Subclinical carotid atherosclerosis measures were used rather than clinical cardiovascular outcomes, and residual confounding cannot be excluded
Participants were evaluated at a specialized cardiovascular referral center, limiting generalizability
Estimated PWV (ePWV) is algorithm-derived and strongly influenced by age and systolic BP rather than directly measured carotid-femoral PWV
Relatively small subgroup with elevated office central SBP (n=271) may reduce statistical precision after multivariable adjustment
Outcomes were subclinical carotid atherosclerosis measures rather than clinical cardiovascular events, and residual confounding by unmeasured variables cannot be excluded

Ask about this paper

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Implication

Does not support central SBP for carotid plaque risk stratification beyond standard factors; leaves open its prognostic value in longitudinal cohorts.

Abstract

Background Residual cardiovascular risk may persist despite normal or controlled office brachial systolic blood pressure (b-SBP). Central systolic blood pressure (c-SBP) may provide complementary information on haemodynamic load not fully captured by b-SBP. We investigated whether elevated office c-SBP despite normal b-SBP identifies individuals with a less favorable cardiometabolic and vascular profile. Methods We performed a cross-sectional analysis of 3,395 adults with office b-SBP < 140. Elevated c-SBP was defined ≥ 130 mmHg.Clinical characteristics, cardiovascular risk factors, Mobil-O-Graph-derived estimated pulse wave velocity (ePWV), carotid plaque prevalence and total carotid plaque area (TCPA) were compared. Results Elevated office central SBP was present in 271 participants (8.0%). Compared with participants with central SBP < 130 mmHg, those with elevated central SBP were older, had higher body mass index, and more frequently had diagnosis of hypertension and diabetes. They also had higher e-cfPWV (8.20 ± 1.40 vs. 7.40 ± 1.43 m/s; p < 0.001), a modestly higher prevalence of carotid plaque (68.3% vs. 62.1%; p = 0.050), and larger median TCPA (21.1 vs. 14.0 mm²; p = 0.014). Elevated office c-SBP despite normal b-SBP was associated with carotid plaque in the unadjusted model (OR 1.31, 95% CI 1.01–1.72; p = 0.044), but not after adjustment for conventional cardiovascular risk factors (OR 1.13, 95% CI 0.82–1.56; p = 0.462) or after further adjustment for brachial SBP (OR 0.86, 95% CI 0.61–1.22; p = 0.403). Conclusion Elevated office c-SBP despite normal b-SBP identifies individuals with a less favorable cardiometabolic and haemodynamic profile. Although its association with carotid atherosclerosis was not independent of conventional cardiovascular risk factors and b-SBP, these findings, together with previous longitudinal evidence, raise the possibility that c-SBP may provide clinically relevant information not fully captured by office b-SBP alone. Prospective studies are warranted to determine its incremental prognostic value for cardiovascular and cerebrovascular outcomes.

Discussion

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Cite This Study

Obregon et al. (2026) conducted a cross-sectional in Adults with normal office brachial systolic blood pressure (<140 mmHg) undergoing cardiovascular risk assessment (n=3,395). Elevated office central systolic blood pressure (≥ 130 mmHg) vs. Central systolic blood pressure < 130 mmHg was evaluated on Carotid plaque presence (fully adjusted for conventional cardiovascular risk factors and brachial SBP) (OR 0.86, 95% CI 0.61-1.22, p=0.403). Elevated office central SBP (≥130 mmHg) despite normal brachial SBP was not independently associated with carotid plaque after full adjustment (OR 0.86, 95% CI 0.61–1.22; p=0.403).

synapsesocial.com/papers/6af354495b67d29976ea07a8 https://doi.org/10.1007/s44200-026-00142-x

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Clinical and Cardiometabolic Characteristics Associated with Elevated Office Central Systolic Blood Pressure in Individuals with Normal Brachial Systolic Blood Pressure

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Clinical and Cardiometabolic Characteristics Associated with Elevated Office Central Systolic Blood Pressure in Individuals with Normal Brachial Systolic Blood Pressure

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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