OUTCOME-DRIVEN THRESHOLDS OF CENTRAL SYSTOLIC BLOOD PRESSURE AND CROSS-CLASSIFICATION OF SYSTOLIC HYPERTENSION AT CENTRAL AND BRACHIAL ARTERIES. (April 2021)

• Record Type: Journal Article
• Authors: Cheng, Yi-Bang; Aparicio, Lucas S.; Thijs, Lutgarde; Melgarejo, Jesus D.; Huang, Qi-Fang; Sheng, Chang -Sheng; Gilis-Malinowska, Natasza; Wei, Fang -Fei; Niiranen, Teemu J.; Yang, Wen -Yi; Boggia, José; Stolarz-Skrzypek, Katarzyna; Barochiner, Jessica; Wojciechowska, Wiktoria; Tikhonoff, Valérie; Casiglia, Edoardo; Narkiewicz, Krzysztof; Filipovský, Jan; Czarnecka, Danuta; Kawecka-Jaszcz, Kalina; Jula, Antti M.; Struijker-Boudier, Harry A.J.; Wang, Ji-Guang; Zhang, Zhen-Yu; Li, Yan; Staessen, Jan A.
• Is Part Of: Journal of hypertension. Volume 39(2021)e-Supplement 1
• Publication Date: 2021-04
• Subjects: Hypertension -- Periodicals; Hypertension -- Periodicals; 616.132005
• DOI: 10.1097/01.hjh.0000745816.83214.2e
• Languages: English
• ISSNs: 1473-5598

Abstract

Abstract : Objective: We aimed to determine the outcome-driven thresholds for central systolic blood pressure (cSBP) based on the new ACC/AHA hypertension classification and to explore the characteristics and prognosis associated with central systolic hypertension (cSHT). Design and method: In 5580 participants enrolled from 9 populations (mean age 54.2 years; 54.1% women), cSBP was estimated tonometrically from the radial waveform (SphygmoCor, Atcor, Australia). We determined the thresholds for cSBP, resulting in 5-year cardiovascular risks similar to those associated with the 2017 ACC/AHA classification of brachial systolic blood pressure (bSBP). Statistical methods included analysis of covariance, the log-rank test and proportional hazards regression. Results: Over 4.1 years (median), 203 persons died (6.4 per 1000 person years) and 252 experienced a composite cardiovascular endpoint (8.2 per 1000 person-years). After rounding to the nearest 5 mm Hg, approximate thresholds for elevated cSBP and stages 1 and 2 and severe cSHT were 110, 120, 130 and 150 mm Hg, respectively. In 3659 untreated subjects, those with isolated cSHT (cSBP > = 120 mmHg, n = 137, 3.7%), compared to the participants with central (cSBP < 120 mmHg) and brachial (bSBP <130 mmHg) normotension (n = 1953, 53.4%), were older, more likely being female, had smaller height, slower heart rate and higher augmentation index. The opposite was true for isolated brachial hypertension (bSHT; bSBP > = 130 mmHg, n = 192, 5.3%). Among 1921 treated patients, the use of b-blockers was more frequent (50% vs. 36.2%, P = 0.027), whereas in isolated cSHT (n = 72, 3.8%) compared with controlled cSBP, RAAS inhibitors less often used (50% vs. 65.3%, P = 0.013). Among all participants, with brachial and central normotension as reference, the multivariable-adjusted hazard ratios (95% confidence interval) of the composite cardiovascular events were 1.29 (0.57–2.90; P = 0.54) for isolated bSHT, 2.30 (1.22–4.33; P = 0.01) for isolated cSHT, and 2.00 (1.39–2.88; P = 0.002) for concordant cSHT and bSHT. Conclusions: Outcome-driven thresholds of central systolic BP were approximately 10 mm Hg lower than their brachial counterparts. cSHT, either isolated (4%) or combined bSHT (90%), was characterised by greater systolic augmentation and was associated with higher cardiovascular risk.