24 Beyond Blood Pressure Control: Bringing Central Pressure to Clinicians' Attention. (November 2017)

• Record Type: Journal Article
• Authors: Ratana, Levina Tri; Setyasari, Arinta; Pujowaskito, Prihati; Widodo, Prihadi Estu
• Is Part Of: Journal of hypertension. Volume 35(2017)Supplement 3
• Publication Date: 2017-11
• Subjects: Hypertension -- Periodicals; Hypertension -- Periodicals; 616.132005
• DOI: 10.1097/01.hjh.0000527408.34977.ab
• Languages: English
• ISSNs: 1473-5598

Abstract

Abstract : Background: Central blood pressure gained considerable attention in research for it is known to be more predictive of major cardiovascular events, but the reverse happened in clinical settings. Objective: This research aims to determine the relationship among invasive central pressure, peripheral pressure, and CAD severity on patients undergoing Diagnostic Coronary Angiography in Dustira Hospital. Methodology: We studied 155 patients (aged 33–86, mean 57.08; 63.2% men). Parameters were central and brachial pressure measures (SBP, DBP, MAP, PP), pressure gradients, and PP ratio. Difference between central and brachial measures, relationship to CAD severity, variability of central pressure in various brachial BP classification groups, and agreement of 3 proposed central aortic systolic pressure (CASP) cut-offs from previous studies were analyzed. Results: Central and peripheral SBP and PP were significantly different (SBP:144.9 ± 29.9vs 158.5 ± 29.9, p < 0.01, PP:66.7 ± 23.5 vs 69.6 ± 22.0, p = 0.04). Patients with severe CAD had higher central and peripheral measures compared to its milder counterparts, but only central PP was significantly associated with CAD severity (p = 0.04). Brachial BP classification using ESC 2013 criteria showed 82% central BP overlap between normal and high-normal peripheral pressure group, and 34% overlap between normal and stage 1 hypertension group. Furthermore, there were strong agreement between proposed CASP cut-off from ASCOT study and Williams et al (Cohen's κ 0.873, p < 0.001). Conclusions: There were significant differences between central and peripheral BP measurement. Central PP were significantly associated with CAD severity. Brachial BP could not accurately infer central pressure. There was strong agreement between proposed central pressure cut-offs.