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

Abstract

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.

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Acknowledgements

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.

Funding

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.

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Correspondence to Kazuo Eguchi.

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Appendices

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.

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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

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