Risk Stratification by Cross-Classification of Central and Brachial Systolic Blood Pressure

被引：35

作者：

Cheng, Yi-Bang ^{[1
]}

Thijs, Lutgarde ^{[2
]}

Aparicio, Lucas S. ^{[3
]}

Huang, Qi-Fang ^{[1
]}

Wei, Fang-Fei ^{[2
,4
]}

Yu, Yu-Ling ^{[2
,5
]}

Barochiner, Jessica ^{[3
]}

Sheng, Chang-Sheng ^{[1
]}

Yang, Wen-Yi ^{[2
,6
]}

Niiranen, Teemu J. ^{[7
,8
]}

Boggia, Jose ^{[9
,10
]}

Zhang, Zhen-Yu ^{[2
]}

Stolarz-Skrzypek, Katarzyna ^{[11
]}

Gilis-Malinowska, Natasza ^{[12
]}

Tikhonoff, Valerie ^{[13
]}

Wojciechowska, Wiktoria ^{[11
]}

Casiglia, Edoardo ^{[13
]}

Narkiewicz, Krzysztof ^{[12
]}

Filipovsky, Jan ^{[14
]}

Kawecka-Jaszcz, Kalina ^{[11
]}

Wang, Ji-Guang ^{[1
]}

Li, Yan ^{[1
]}

Staessen, Jan A. ^{[15
,16
]}

机构：

[1] Shanghai Jiao Tong Univ, Ruijin Hosp,State Key Lab Med Genom, Sch Med,Dept Cardiovasc Med,Shanghai Key Lab Hype, Natl Res Ctr Translat Med,Shanghai Inst Hypertens, Shanghai, Peoples R China

[2] Univ Leuven, Dept Cardiovasc Sci, Res Unit Hypertens & Cardiovasc Epidemiol, Leuven, Belgium

[3] Hosp Italiano Buenos Aires, Serv Clin Med, Secc Hipertens Arterial, Buenos Aires, DF, Argentina

[4] Sun Yat Sen Univ, Dept Cardiol, Affiliated Hosp 1, Guangzhou, Peoples R China

[5] Univ Leuven, Dept Publ Hlth & Primary Care, Res Unit Environm & Hlth, Leuven, Belgium

[6] Shanghai Gen Hosp, Dept Cardiol, Shanghai, Peoples R China

[7] Finnish Inst Hlth & Welf, Dept Chron Dis Prevent, Turku, Finland

[8] Turku Univ Hosp, Dept Med, Turku, Finland

[9] Univ Republica, Hosp Clin, Ctr Nefrol, Montevideo, Uruguay

[10] Univ Republica, Dept Fisiopatol, Hosp Clin, Montevideo, Uruguay

[11] Jagiellonian Univ Med Coll, Dept Cardiol Intervent Electrocardiol & Hypertens, Krakow, Poland

[12] Med Univ Gdansk, Dept Hypertens & Diabetol, Hypertens Unit, Gdansk, Poland

[13] Univ Padua, Dept Med, Padua, Italy

[14] Charles Univ Prague, Fac Med, Plzen, Czech Republic

[15] Res Inst Alliance Promot Prevent Med, Mechelen, Belgium

[16] Univ Leuven, Fac Med, Biomed Sci Grp, Leuven, Belgium

来源：

HYPERTENSION | 2022年 / 79卷 / 05期

基金：

芬兰科学院; 欧洲研究理事会; 中国国家自然科学基金;

关键词：

brachial blood pressure; central blood pressure; cardiovascular risk; hypertension; mortality; population science; CENTRAL HEMODYNAMICS; AORTIC PRESSURE; HYPERTENSION; PREVALENCE; ASSOCIATION; GUIDELINE; MORTALITY; DEVICE; PULSE;

D O I：

10.1161/HYPERTENSIONAHA.121.18773

中图分类号：

R6 [外科学];

学科分类号：

1002 ; 100210 ;

摘要：

Background: Whether cardiovascular risk is more tightly associated with central (cSBP) than brachial (bSBP) systolic pressure remains debated, because of their close correlation and uncertain thresholds to differentiate cSBP into normotension versus hypertension. Methods: In a person-level meta-analysis of the International Database of Central Arterial Properties for Risk Stratification (n=5576; 54.1% women; mean age 54.2 years), outcome-driven thresholds for cSBP were determined and whether the cross-classification of cSBP and bSBP improved risk stratification was explored. cSBP was tonometrically estimated from the radial pulse wave using SphygmoCor software. Results: Over 4.1 years (median), 255 composite cardiovascular end points occurred. In multivariable bootstrapped analyses, cSBP thresholds (in mm Hg) of 110.5 (95% CI, 109.1-111.8), 120.2 (119.4-121.0), 130.0 (129.6-130.3), and 149.5 (148.4-150.5) generated 5-year cardiovascular risks equivalent to the American College of Cardiology/American Heart Association bSBP thresholds of 120, 130, 140, and 160. Applying 120/130 mm Hg as cSBP/bSBP thresholds delineated concordant central and brachial normotension (43.1%) and hypertension (48.2%) versus isolated brachial hypertension (5.0%) and isolated central hypertension (3.7%). With concordant normotension as reference, the multivariable hazard ratios for the cardiovascular end point were 1.30 (95% CI, 0.58-2.94) for isolated brachial hypertension, 2.28 (1.21-4.30) for isolated central hypertension, and 2.02 (1.41-2.91) for concordant hypertension. The increased cardiovascular risk associated with isolated central and concordant hypertension was paralleled by cerebrovascular end points with hazard ratios of 3.71 (1.37-10.06) and 2.60 (1.35-5.00), respectively. Conclusions: Irrespective of the brachial blood pressure status, central hypertension increased cardiovascular and cerebrovascular risk indicating the importance of controlling central hypertension.

引用

页码：1101 / 1111

页数：11

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