Central Pressure More Strongly Relates to Vascular Disease and Outcome Than Does Brachial Pressure

Hypertension - Tập 50 Số 1 - Trang 197-203 - 2007
Mary J. Roman1, Richard B. Devereux1, Jorge R. Kizer1, Elisa T. Lee1, James M. Galloway1, Tauqeer Ali1, Jason G. Umans1,2, Barbara V. Howard1,2
1From the Division of Cardiology (M.J.R., R.B.D., J.R.K.), Weill Medical College of Cornell University, New York; the Center for American Indian Health Research (E.T.L., T.A.), University of Oklahoma Health Sciences Center, Oklahoma City; the University of Arizona (J.M.G.), Tucson; and Medstar Research Institute (J.G.U., B.V.H.), Washington, DC.
2Union Memorial Hospital

Tóm tắt

Brachial blood pressure is predictive of cardiovascular outcome; however central pressure may better represent the load imposed on the coronary and cerebral arteries and thereby bear a stronger relationship to vascular damage and prognosis. Relations of brachial and central pressures to carotid artery hypertrophy (intimal-medial thickness and vascular mass), extent of atherosclerosis (plaque score), and incident cardiovascular events were examined in the Strong Heart Study. Central pressures were calculated using radial applanation tonometry. Among 3520 participants, central and brachial pulse pressures were more strongly related to vascular hypertrophy and extent of atherosclerosis than were systolic pressures. Central pulse pressure was more strongly related to all 3 arterial measures than was brachial pulse pressure ( r =0.364 versus 0.309 for plaque score; P <0.001 for comparison of Spearman correlation coefficient; r =0.293 versus 0.249 for intimal-medial thickness; P <0.002; r =0.320 versus 0.289 for vascular mass; P <0.05). Among the 2403 participants free of clinical cardiovascular disease at baseline, 319 suffered fatal or nonfatal cardiovascular events during mean follow-up of 4.8±1.3 years. After adjustment for age, gender, current smoking, body mass index, cholesterol:HDL ratio, creatinine, fibrinogen, diabetes, and heart rate, central pulse pressure predicted cardiovascular events more strongly than brachial pulse pressure (hazards ratio=1.15 per 10 mm Hg, χ 2 =13.4, P <0.001 versus hazards ratio=1.10, χ 2 =6.9, P =0.008). In conclusion, noninvasively-determined central pulse pressure is more strongly related to vascular hypertrophy, extent of atherosclerosis, and cardiovascular events than is brachial blood pressure. These findings support prospective examination of use of central blood pressure as a treatment target in future trials.

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Tài liệu tham khảo

10.1016/S0140-6736(03)14739-3

10.1161/01.hyp.0000165020.14745.79

10.7326/0003-4819-138-1-200301070-00006

10.1161/01.hyp.23.3.395

Benetos A, Safar M, Rudnichi A, Smulyan H, Richard J-L, Ducimetière P, Guize L. Pulse pressure: a predictor of long-term cardiovascular mortality in a French male population. Hypertension. 1999; 30: 1410–1415.

10.1161/circ.100.4.354

10.1001/archinte.160.18.2765

10.1016/S0735-1097(00)00687-2

10.1161/hyp.38.4.793

Palmieri V, Devereux RB, Holloywood J, Bella JN, Liu JE, Lee ET, Best LG, Howard BV, Roman MJ. Association of pulse pressure with cardiovascular outcome is independent of left ventricular hypertrophy and systolic dysfunction: The Strong Heart Study. J Hypertens. 2006; 19: 601–607.

10.1161/hyp.32.3.560

10.1161/hyp.36.5.801

10.7326/0003-4819-139-9-200311040-00007

10.1161/circ.103.9.1245

10.1161/hyp.38.4.953

10.1097/00004872-199917080-00004

10.1161/hyp.37.5.1236

10.1161/hyp.39.1.10

10.1161/atvb.21.12.2046

10.1161/circulationaha.104.483628

10.1161/circ.99.18.2434

10.1161/01.hyp.0000159190.71253.c3

10.1161/circulationaha.105.579342

10.1161/circulationaha.105.555235

10.1161/hyp.38.4.932

10.1161/circulationaha.105.595496

10.1152/ajplegacy.1938.125.1.48

10.1161/circ.5.2.257

Nichols WW O’Rourke MF eds. McDonald’s Blood Flow in Arteries: Theoretical Experimental and Clinical Principles. Fifth Edition. Oxford: Hodder Arnold; 2005: 193–213 339–386.

10.1093/oxfordjournals.aje.a115757

North KE, Howard BV, Welty TK, Best LG, Lee ET, Yeh JL, Fabsitz RR, Roman MJ, MacCluer JW. Genetic and environmental contributions to cardiovascular disease risk in American Indians: The Strong Heart Family Study. Am J Epidemiol. 2002; 157: 303–314.

10.2337/diacare.26.11.3160

10.1161/01.HYP.0000107251.49515.c2

10.1161/circ.99.18.2389

10.1093/oxfordjournals.aje.a009406

10.1016/j.echo.2006.04.020

10.1016/0735-1097(96)00225-2

Kelly R, Hayward C, Ganis J, Daley J, Avolio A, O’Rourke M. Noninvasive registration of the arterial pressure waveform using high-fidelity applanation tonometry. J Vasc Med Biol. 1989; 1: 142–149.

10.1161/01.HYP.27.2.168

10.1016/0021-9290(80)90191-8

10.1161/circ.80.1.2610739

10.1161/circ.100.13.1387

10.1161/hyp.38.4.927

10.1097/01.hjh.0000125448.28861.fc

10.1161/hyp.39.3.735

10.1161/01.hyp.0000209340.33592.50

10.1093/eurheartj/ehl254