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Features and implications of higher systolic central than peripheral blood pressure in patients at very high risk of atherosclerotic cardiovascular disease

Journal of Human Hypertension volume 35, pages 994–1002 (2021)Cite this article

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Abstract

Peripheral blood pressure (PBP) is usually higher than central blood pressure (CBP) due to pulse amplification; however, it is not well understood why cuff-measured PBP can be lower than CBP estimated by the late systolic pressure of radial pulse waves. We explored the implications of systolic PBP–CBP (P-CBP) differences for cardiovascular (CV) prognosis. In total, 335 patients at very high risk of atherosclerotic cardiovascular disease (ASCVD) underwent automated applanation tonometry and brachial-ankle pulse wave velocity (baPWV), and they were classified into groups according to positive or negative systolic P-CBP differences. Between-group characteristics and clinical outcomes (the composite of coronary revascularization, stroke, heart failure hospitalization, and CV death) were evaluated. Patients with negative differences had significantly higher frequency of hypertension, coronary artery disease, higher ASCVD risk burden, and elevated N-terminal pro b-type natriuretic peptide. They had higher left atrial volume index (LAVI) and lower systolic mitral septal tissue velocity (TVI-s’) than those with a positive difference. These patients showed higher systolic PBP and CBP, and a higher baPWV. Multivariable analysis indicated that TVI-s’, LAVI, and ASCVD risk burden were independent determinants of such systolic P-CBP differences. During a median follow-up of 12.6 months, clinical outcomes were significantly related to a negative difference (11.5% vs. 3.4%, p = 0.014), and a systolic P-CBP difference ≤ −8 mmHg was associated with a threefold higher likelihood of poor prognosis. In patients at very high risk of ASCVD, systolic P-CBP difference was associated with cardiac dysfunction and ASCVD risk burden, allowing further risk stratification.

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Fig. 1: Study flow chart of patients.
Fig. 2: Association of the differences in systolic P-CBP with cardiovascular disease risk factors.
Fig. 3: Implication of the differences in systolic P-CBP on clinical outcomes.

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Acknowledgements

This research was supported by the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (HI18C0575) in addition to the National Research Foundation of Korea (NRF) by the Korea government (MSIT) (No. 2017R1C1B5017661). The authors would like to also acknowledge J-H Jeon, RN and S-Y Kim, RN for their significant contribution to this study.

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  1. Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea

    Hyungseop Kim, In-Cheol Kim, Jongmin Hwang, Cheol Hyun Lee, Yun-Kyeong Cho, Hyoung-Seob Park, Chang-Wook Nam, Seongwook Han & Seung-Ho Hur

  2. Division of Cardiology, Department of Internal Medicine, Keimyung University Daegu Dongsan Hospital, Daegu, Republic of Korea

    Jin-Wook Chung

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Kim, H., Kim, IC., Hwang, J. et al. Features and implications of higher systolic central than peripheral blood pressure in patients at very high risk of atherosclerotic cardiovascular disease. J Hum Hypertens 35, 994–1002 (2021). https://doi.org/10.1038/s41371-020-00472-6

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