High central blood pressure is associated with incident cardiovascular events in treated hypertensives: the ABC-J II Study


It is not established whether central blood pressure (BP) evaluated by a radial pulse wave analysis is useful to predict cardiovascular prognoses. We tested the hypothesis that central BP predicts future cardiovascular events in treated hypertensive subjects. We conducted a multicenter, observational cohort study of 3566 hypertensives being treated with antihypertensive medications at 27 institutions in Japan. We performed the radial pulse wave analyses using applanation tonometry in all subjects. The primary outcome was the incidence of any of the following: stroke, myocardial infarction (MI), sudden cardiac death, and acute aortic dissection. The mean age of the subjects was 66.0 ± 10.9 years, and 50.6% were male. The mean brachial SBP and central SBP were 138 ± 18 mm Hg and 128 ± 19 mm Hg, respectively. When the central SBP was divided into quintiles, the number of events was least in the 2nd quintile, and we set it as the reference. In the Cox regression analysis adjusting for age, sex, body mass index, creatinine, diabetes, use of β-blocker, and history of MI/stroke, the patients in the 3rd (hazard ratio (HR) 3.55, 95% confidence interval 1.29–9.78, p = 0.014), 4th (HR 4.12, 95% CI 1.53–11.10, p = 0.005), and 5th quintiles (HR 2.87, 95% CI 1.01–8.18, p = 0.048) had a significantly higher incidence of cardiovascular events compared to the 2nd quintile. The results were essentially unchanged when brachial DBP was additionally adjusted. In conclusion, in treated hypertensives, high central SBP was associated with worse cardiovascular outcomes.

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.

Fig. 1
Fig. 2
Fig. 3


  1. 1.

    The CAFE Investigators for the Anglo-Scandinavian Cardiac Outcomes Trial Investigators CAFE Steering Committee and Writing Committee, Williams B, Lacy PS, Thom SM, Cruickshank K, Stanton A, Collier D, et al. Differential impact of blood pressure-lowering drugs on central aortic pressure and clinical outcomes: principal results of the Conduit Artery Function Evaluation (CAFE) study. Circulation. 2006;113:1213–25.

    Article  Google Scholar 

  2. 2.

    Roman MJ, Devereux RB, Kizer JR, Okin PM, Lee ET, Wang W, et al. High central pulse pressure is independently associated with adverse cardiovascular outcome the strong heart study. J Am Coll Cardiol. 2009;54:1730–4.

    Article  Google Scholar 

  3. 3.

    Dart AM, Gatzka CD, Kingwell BA, Willson K, Cameron JD, Liang Y-L, et al. Brachial blood pressure but not carotid arterial waveforms predict cardiovascular events in elderly female hypertensives. Hypertension. 2006;47:785–90.

    CAS  Article  Google Scholar 

  4. 4.

    Mitchell GF, Hwang S-J, Vasan RS, Larson MG, Pencina MJ, Hamburg NM, et al. Arterial stiffness and cardiovascular events: the Framingham Heart Study. Circulation. 2010;121:505–11.

    Article  Google Scholar 

  5. 5.

    Mitchell GF, Hwang SJ, Larson MG, Hamburg NM, Benjamin EJ, Vasan RS, et al. Transfer function-derived central pressure and cardiovascular disease events: the Framingham Heart Study. J Hypertens. 2016;34:1528–34.

    CAS  Article  Google Scholar 

  6. 6.

    Vlachopoulos C, Aznaouridis K, O’Rourke MF, Safar ME, Baou K, Stefanadis C. Prediction of cardiovascular events and all-cause mortality with central haemodynamics: a systematic review and meta-analysis. Eur Heart J. 2010;31:1865–71.

    Article  Google Scholar 

  7. 7.

    Han W, Han X, Sun N, Chen Y, Jiang S, Li M. Relationships between urinary electrolytes excretion and central hemodynamics, and arterial stiffness in hypertensive patients. Hypertens Res. 2017;40:746–51.

    CAS  Article  Google Scholar 

  8. 8.

    Rhee M-Y, Shin S-J, Gu N, Nah D-Y, Kim B-K, Hong K-S, et al. Relationship between 24-h urine sodium/potassium ratio and central aortic systolic blood pressure in hypertensive patients. Hypertens Res. 2016;40:405–10.

    Article  Google Scholar 

  9. 9.

    Wang K-L, Cheng H-M, Chuang S-Y, Spurgeon HA, Ting C-T, Lakatta EG, et al. Central or peripheral systolic or pulse pressure: which best relates to target organs and future mortality? J Hypertens. 2009;27:461–7.

    CAS  Article  Google Scholar 

  10. 10.

    Cheng H-M, Chuang S-Y, Sung S-H, Yu W-C, Pearson A, Lakatta EG, et al. Derivation and validation of diagnostic thresholds for central blood pressure measurements based on long-term cardiovascular risks. J Am Coll Cardiol. 2013;62:1780–7.

    Article  Google Scholar 

  11. 11.

    Miyashita H, Aizawa A, Hashimoto J, Hirooka Y, Imai Y, Kawano Y, et al. Cross-sectional characterization of all classes of antihypertensives in terms of central blood pressure in Japanese hypertensive patients. Am J Hypertens. 2010;23:260–8.

    CAS  Article  Google Scholar 

  12. 12.

    O’Rourke MF, Vlachopoulos C, Graham RM. Spurious systolic hypertension in youth. Vasc Med. 2000;5:141–5.

    Article  Google Scholar 

  13. 13.

    Saladini F, Palatini P. Isolated systolic hypertension in young individuals: pathophysiological mechanisms, prognostic significance, and clinical implications.High Blood Press Cardiovasc Prev. 2017;24:133–9.

    Article  Google Scholar 

  14. 14.

    Shimamoto K, Ando K, Fujita T, Hasebe N, Higaki J, Horiuchi M, et al. The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2014). Hypertens Res. 2014;37:253–390.

    Article  Google Scholar 

  15. 15.

    The Committee of the Japan Diabetes Society on the Diagnostic Criteria of Diabetes Mellitus, Seino Y, Nanjo K, Tajima N, Kadowaki T, Kashiwagi A, Araki E, et al. Report of the committee on the classification and diagnostic criteria of diabetes mellitus. J Diabetes Investig. 2010;1:212–28.

    Article  Google Scholar 

  16. 16.

    American Diabetes Association. Standards of medical care in diabetes—2014. Diabetes Care. 2014;37:S14–80.

    Article  Google Scholar 

  17. 17.

    Teramoto T, Sasaki J, Ishibashi S, Birou S, Daida H, Dohi S, et al. Executive summary of the Japan Atherosclerosis Society (JAS) guidelines for the diagnosis and prevention of atherosclerotic cardiovascular diseases in Japan -2012 version. J Atheroscler Thromb. 2013;20:517–23.

    Article  Google Scholar 

  18. 18.

    McKee PA, Castelli WP, McNamara PM, Kannel WB. The natural history of congestive heart failure: the Framingham Study. N Engl J Med. 1971;285:1441–6.

    CAS  Article  Google Scholar 

  19. 19.

    Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, et al. ACC/AHA 2005 practice guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients with Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; Transatlantic Inter-Society Consensus; and Vascular Disease Foundation. Circulation. 2006;113:e463–5.

    Article  Google Scholar 

  20. 20.

    White WB, Anwar YA. Evaluation of the overall efficacy of the Omron office digital blood pressure HEM-907 monitor in adults. Blood Press Monit. 2001;6:107–10.

    CAS  Article  Google Scholar 

  21. 21.

    El Assaad MA, Topouchian JA, Darné BM, Asmar RG. Validation of the Omron HEM-907 device for blood pressure measurement. Blood Press Monit. 2002;7:237–41.

    Article  Google Scholar 

  22. 22.

    Takazawa K, Kobayashi H, Shindo N, Tanaka N, Yamashina A. Relationship between radial and central arterial pulse wave and evaluation of central aortic pressure using the radial arterial pulse wave. Hypertens Res. 2007;30:219–28.

    Article  Google Scholar 

  23. 23.

    Hirata K, Kojima I, Momomura S. Noninvasive estimation of central blood pressure and the augmentation index in the seated position: a validation study of two commercially available methods. J Hypertens. 2013;31:508–15.

    CAS  Article  Google Scholar 

  24. 24.

    Tomiyama H, Yamazaki M, Sagawa Y, Teraoka K, Shirota T, Miyawaki Y, et al. Synergistic effect of smoking and blood pressure on augmentation index in men, but not in women. Hypertens Res. 2009;32:122–6.

    Article  Google Scholar 

  25. 25.

    Ogihara T, Saruta T, Rakugi H, Shimamoto K, Ito S, Matsuoka H, et al. Rationale, study design and implementation of the COLM study: the combination of OLMesartan and calcium channel blocker or diuretic in high-risk elderly hypertensive patients. Hypertens Res. 2009;32:163–7.

    CAS  Article  Google Scholar 

  26. 26.

    Saruta T, Ogihara T, Saito I, Rakugi H, Shimamoto K, Matsuoka H, et al. Comparison of olmesartan combined with a calcium channel blocker or a diuretic in elderly hypertensive patients (COLM study): safety and tolerability. Hypertens Res. 2015;38:132–6.

    CAS  Article  Google Scholar 

  27. 27.

    Snipes M, Taylor DC. Model selection and Akaike information criteria: an example from wine ratings and prices. Wine Econ Policy. 2014;3:3–9.

    Article  Google Scholar 

  28. 28.

    Mitchell GF, Parise H, Benjamin EJ, Larson MG, Keyes MJ, Vita JA, et al. Changes in arterial stiffness and wave reflection with advancing age in healthy men and women: the Framingham Heart Study. Hypertension. 2004;43:1239–45.

    CAS  Article  Google Scholar 

  29. 29.

    Kips JG, Schutte AE, Vermeersch SJ, Huisman HW, Van Rooyen JM, Glyn MC, et al. Comparison of central pressure estimates obtained from Sphygmocor, Omron HEM-9000AI and carotid applanation tonometry. J Hypertens. 2011;29:1115–20.

    CAS  Article  Google Scholar 

  30. 30.

    Hickson SS, Butlin M, Mir FA, Graggaber J, Cheriyan J, Khan F, et al. The accuracy of central SBP determined from the second systolic peak of the peripheral pressure waveform. J Hypertens. 2009;27:1784–8.

    CAS  Article  Google Scholar 

  31. 31.

    Lin M-M, Cheng H-M, Sung S-H, Liao C-F, Chen Y-H, Huang P-H, et al. Estimation of central aortic systolic pressure from the second systolic peak of the peripheral upper limb pulse depends on central aortic pressure waveform morphology. J Hypertens. 2012;30:581–6.

    CAS  Article  Google Scholar 

  32. 32.

    Millasseau SC, Patel SJ, Redwood SR, Ritter JM, Chowienczyk PJ. Pressure wave reflection assessed from the peripheral pulse. Hypertension. 2003;41:1016.

    CAS  Article  Google Scholar 

  33. 33.

    Takase H, Dohi Y, Kimura G. Distribution of central blood pressure values estimated by Omron HEM-9000AI in the japanese general population. Hypertens Res. 2013;36:50–7.

    Article  Google Scholar 

  34. 34.

    Herbert A, Cruickshank JK, Laurent S, Boutouyrie P. Establishing reference values for central blood pressure and its amplification in a general healthy population and according to cardiovascular risk factors. Eur Heart J. 2014;35:3122–33.

    CAS  Article  Google Scholar 

Download references


We thank the numerous study investigators, fellows, nurses, laboratory technicians, and research coordinators who participated in the ABC-J II study. Especially, we thank Dr. Joseph E. Schwartz and Tetsuo Takeuchi for statistical assistance. Contributors and details of the study investigators of the ABC-J II study are described in the Supplementary file (Appendices). The University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR): the trial number is UMIN000002966.


The study was supported by funding for data collection by Omron Healthcare Inc. (Kyoto, Japan). Omron Healthcare Inc. was not involved in any significant processes of this study such as the design, conduct, monitor, supervision, data analysis, and publication of the study.

Author information




Corresponding author

Correspondence to Kazuo Eguchi.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Electronic supplementary material


Participants and participating centers and Members of the Endpoint Committee

Kazuyuki Shimada: Shin-Oyama City Hospital; Kazuo Eguchi: Jichi Medical University and International University of Health and Welfare Hospital; Hiroshi Miyashita: Jichi Medical University and Ishibashi General Hospital; Tsuneo Takenaka: International University of Health and Welfare and Saitama Medical University Hospital; Yasuharu Tabara: Kyoto University and Ehime University Hospital; Hirofumi Tomiyama: Tokyo Medical University; Yasuaki Dohi: Nagoya Gakuin University and Nagoya City University Hospital; Junichiro Hashimoto: Miyagi University of Education and Tohoku University Graduate School of Medicine; Takayoshi Ohkubo: Teikyo University School of Medicine; Yuko Ohta: Kyushu Dental Univ. Hospital; Yoshitaka Hirooka: Kyushu University; Katsuhiko Kohara: Ehime Medical Center and Ehime University Hospital; Sadayoshi Ito: Tohoku University Graduate School of Medicine; Yuhei Kawano: Teikyo University and National Cerebral and Cardiovascular Center; Kenji Sunagawa: Kyushu University; Hiromichi Suzuki: Musashino Tokushukai Hospital and Saitama Medical University Hospital; Yutaka Imai: Tohoku University Graduate School of Pharmaceutical Science; Kazuomi Kario: Jichi Medical University; Kenji Takazawa: Health Surveillance and Preventive Medicine, Tokyo Medical University Hospital and Tokyo Medical University Hachioji Medical Center; Akira Yamashina:Tokyo Medical University;Mari Odaira:Tokyo Medical University; Motoki Fukutomi: Miwa Municipal Hospital; Takahiro Komori: International University of Health and Welfare Shioya Hospital; Hideaki Takata: National Cerebral and Cardiovascular Center; Ken Oyama: Oyama Medical Clinic; Masaaki Miyakawa: Miyakawa Medical Clinic; Hisao Mori: Yokohama Sotetsu Bldg Clinic; Hiro Yamakawa: Yamakawa Medical Clinic; Hareaki Yamamoto: Yamamoto Clinic; Naoto Yagi: Yagi Clinic; Yoshikazu Aoka: Hitotsubashi Hospital; Toru Awaya: Awaya clinic; Toshiro Iketani: Iketani Medical Clinic; Mitsutoshi Kato: Kato Clinic; Tsuguhisa Hatano: Hatano Clinic; Kiyoshi Uchiba: Nagano City Ooka Clinic; Takeshi Takemi: Jingumae Clinic.

Members of the Endpoint committee

Junichi Yamazaki: Toho University; Shinji Hisatake: Toho University Medical Center Omori Hospital; Uichi Ikeda: Nagano Municipal Hospital; Yasuhisa Kitagawa: Tokai University Hachioji Hospital; Hirohisa Okuma: Tokai University Hachioji Hospital; Kentaro Tokuoka: Tokai University Hachioji Hospital; Koichi Hayashi: Keio University; Shu Wakino: Keio University; Hirobumi Tokuyama: Keio University.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Eguchi, K., Miyashita, H., Takenaka, T. et al. High central blood pressure is associated with incident cardiovascular events in treated hypertensives: the ABC-J II Study. Hypertens Res 41, 947–956 (2018). https://doi.org/10.1038/s41440-018-0075-8

Download citation

Further reading