Cardiovascular End Points and Mortality Are Not Closer Associated With Central Than Peripheral Pulsatile Blood Pressure Components
Qi‐Fang Huang, Lucas S. Aparicio, Lutgarde Thijs, Fang‐Fei Wei, Jesús D. Melgarejo, Yi‐Bang Cheng, Chang‐Sheng Sheng, Wen‐Yi Yang, Natasza Gilis‐Malinowska, José Boggia, Teemu Niiranen, Wiktoria Wojciechowska, Katarzyna Stolarz‐Skrzypek, Jessica Barochiner, Daniel Ackermann, Valérie Tikhonoff, Belén Ponte, Menno Pruijm, Edoardo Casiglia, Krzysztof Narkiewicz, Jan Filipovský, Danuta Czarnecka, Kalina Kawecka−Jaszcz, Antti Jula, Murielle Bochud, Thomas Vanassche, Peter Verhamme, Harry A.J. Struijker-Boudier, Ji‐Guang Wang, Zhen‐Yu Zhang, Yan Li, Jan A. Staessen, LS Aparicio, Jessica Barochiner, Lutgarde Thijs, Jan A. Staessen, FF Wei, WY Yang, Z-Y. Zhang, Y.B. Cheng, QH Guo, Huang Jf, Q. F. Huang, Y Li, CS Sheng, JG Wang, Jan Filipovský, Jitka Seidlerová, E. Juhanoja, AM Jula, AS Lindroos, TJ Niiranen, SS Sivén, Edoardo Casiglia, A Pizzioli, Valérie Tikhonoff, B S Chori, Benjamin Danladi, Augustine N. Odili, Henry Oshaju, W. Kucharska, Katarzyna Kunicka, Natasza Gilis‐Malinowska, Krzysztof Narkiewicz, Wojciech Sakiewicz, Ewa Świerblewska, Kalina Kawecka−Jaszcz, Katarzyna Stolarz‐Skrzypek, Aletta E. Schutte, GR Norton, A. Woodiwiss, Daniel Ackermann, Murielle Bochud, Belén Ponte, Menno Pruijm, Ramón Álvarez-Vaz, C. Americo, Cecilia Baccino, Luciana Borgarello, Lucía Florio, Paula Moliterno, Agustín Noboa, Óscar Noboa, Alicia Olascoaga, Paula Parnizari, M Pécora
Abstract
Pulsatile blood pressure (BP) confers cardiovascular risk. Whether associations of cardiovascular end points are tighter for central systolic BP (cSBP) than peripheral systolic BP (pSBP) or central pulse pressure (cPP) than peripheral pulse pressure (pPP) is uncertain. Among 5608 participants (54.1% women; mean age, 54.2 years) enrolled in nine studies, median follow-up was 4.1 years. cSBP and cPP, estimated tonometrically from the radial waveform, averaged 123.7 and 42.5 mm Hg, and pSBP and pPP 134.1 and 53.9 mm Hg. The primary composite cardiovascular end point occurred in 255 participants (4.5%). Across fourths of the cPP distribution, rates increased exponentially (4.1, 5.0, 7.3, and 22.0 per 1000 person-years) with comparable estimates for cSBP, pSBP, and pPP. The multivariable-adjusted hazard ratios, expressing the risk per 1-SD increment in BP, were 1.50 (95% CI, 1.33–1.70) for cSBP, 1.36 (95% CI, 1.19–1.54) for cPP, 1.49 (95% CI, 1.33–1.67) for pSBP, and 1.34 (95% CI, 1.19–1.51) for pPP ( P <0.001). Further adjustment of cSBP and cPP, respectively, for pSBP and pPP, and vice versa, removed the significance of all hazard ratios. Adding cSBP, cPP, pSBP, pPP to a base model including covariables increased the model fit ( P <0.001) with generalized R 2 increments ranging from 0.37% to 0.74% but adding a second BP to a model including already one did not. Analyses of the secondary end points, including total mortality (204 deaths), coronary end points (109) and strokes (89), and various sensitivity analyses produced consistent results. In conclusion, associations of the primary and secondary end points with SBP and pulse pressure were not stronger if BP was measured centrally compared with peripherally.