Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Comparison of Brachial Blood Pressure and Central Blood Pressure in Attended, Unattended, and Unattended Standing Situations

Hypertension Research volume 44, pages 1283–1290 (2021)Cite this article

Abstract

Central systolic blood pressure (cSBP) is an independent predictor of future cardiovascular disease. Unattended brachial SBP (bSBP) can eliminate the white-coat effect. However, unattended cSBP and unattended standing cSBP have never been reported. We aimed to compare bSBP and cSBP in attended, unattended, and unattended standing situations. We also aimed to compare the white-coat effect and unattended orthostatic BP change between bSBP and cSBP. Altogether, 104 hypertensive outpatients were included (mean age: 66.0 ± 9.8 years, 41.3% male, mean body mass index: 25.0 ± 4.5). Attended bSBP/cSBP values were 127.3 ± 15.7/119.2 ± 15.0, unattended bSBP/cSBP values were 122.7 ± 15.3/114.4 ± 15.1, and unattended standing bSBP/cSBP values were 123.6 ± 15.7/114.1 ± 14.8 mmHg (correlation coefficients/coefficients of determination between bSBP and cSBP: 0.971/0.943, 0.970/0.941, and 0.964/0.929, respectively; all p < 0.001). No significant difference was observed in the white-coat effect between bSBP and cSBP (4.6 ± 5.8 vs. 4.8 ± 5.7 mmHg). Although there was no significant difference between unattended sitting SBP and unattended standing SBP in terms of both bSBP and cSBP, a numerically small but significant difference was observed in the unattended orthostatic BP change between bSBP and cSBP (0.9 ± 8.0 vs. −0.3 ± 9.0 mmHg, p = 0.002). In conclusion, significant and strong correlations were observed between bSBP and cSBP in attended, unattended, and unattended standing BP measurements. The white-coat effect on bSBP was equivalent to that on cSBP. There was a numerically small but significant difference in the unattended orthostatic BP change between bSBP and cSBP.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. 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. Epub 2010/03/04.

    Article  Google Scholar 

  2. Benetos A, Tsoucaris-Kupfer D, Favereau X, Corcos T, Safar M. Carotid artery tonometry: an accurate non-invasive method for central aortic pulse pressure evaluation. J Hypertens Suppl: Off J Int Soc Hypertens. 1991;9:S144–5. Epub 1991/12/01.

    CAS  Google Scholar 

  3. Williams B, Lacy PS, Yan P, Hwee CN, Liang C, Ting CM. Development and validation of a novel method to derive central aortic systolic pressure from the radial pressure waveform using an n-point moving average method. J Am Coll Cardiol. 2011;57:951–61. Epub 2011/02/19.

    Article  Google Scholar 

  4. Weber T, Wassertheurer S, Rammer M, Maurer E, Hametner B, Mayer CC. et al. Validation of a brachial cuff-based method for estimating central systolic blood pressure. Hypertension. 2011;58:825–32. Epub 2011/09/14.

    Article  CAS  Google Scholar 

  5. Hoshide S, Komori T, Ogata Y, Eguchi K, Kario K. Evaluation of central blood pressure in an asian population: comparison between brachial oscillometry and radial tonometry methods. Pulse (Basel). 2018;6:98–102. Epub 2018/10/05.

  6. McEniery CM, Cockcroft JR, Roman MJ, Franklin SS, Wilkinson IB. Central blood pressure: current evidence and clinical importance. Eur Heart J. 2014;35:1719–25. Epub 2014/01/25.

    Article  Google Scholar 

  7. Kollias A, Lagou S, Zeniodi ME, Boubouchairopoulou N, Stergiou GS. Association of central versus brachial blood pressure with target-organ damage: systematic review and meta-analysis. Hypertension. 2016;67:183–90. Epub 2015/11/26.

    Article  CAS  Google Scholar 

  8. Chi C, Yu X, Auckle R, Lu Y, Fan X, Yu S. et al. Hypertensive target organ damage is better associated with central than brachial blood pressure: The Northern Shanghai Study. J Clin Hypertens (Greenwich). 2017;19:1269–75. Epub 2017/10/27.

    Article  CAS  Google Scholar 

  9. Dong Y, Jiang LL, Wang X, Chen Z, Zhang LF, Zhang ZG, et al. Central rather than brachial pressures are stronger predictors of cardiovascular outcomes: a longitudinal prospective study in a Chinese population. J Clin Hypertens. 2020;22:623–30.

    Article  Google Scholar 

  10. Huang QF, Aparicio LS, Thijs L, Wei FF, Melgarejo JD, Cheng YB. et al. Cardiovascular end points and mortality are not closer associated with central than peripheral pulsatile blood pressure components. Hypertension. 2020;76:350–8. Epub 2020/07/09.

    Article  CAS  Google Scholar 

  11. Roman MJ, Devereux RB, Kizer JR, Lee ET, Galloway JM, Ali T. et al. Central pressure more strongly relates to vascular disease and outcome than does brachial pressure: the Strong Heart Study. Hypertension. 2007;50:197–203. Epub 2007/05/09.

    Article  CAS  Google Scholar 

  12. Pini R, Cavallini MC, Palmieri V, Marchionni N, Di Bari M, Devereux RB. et al. Central but not brachial blood pressure predicts cardiovascular events in an unselected geriatric population: the ICARe Dicomano Study. J Am Coll Cardiol. 2008;51:2432–9. Epub 2008/06/21.

    Article  Google Scholar 

  13. Sun P, Yang Y, Cheng G, Fan F, Qi L, Gao L. et al. Noninvasive central systolic blood pressure, not peripheral systolic blood pressure, independently predicts the progression of carotid intima-media thickness in a Chinese community-based population. Hypertens Res: Off J Jpn Soc Hypertens. 2019;42:392–9. Epub 2018/12/28.

    Article  Google Scholar 

  14. Wright JT, Jr, Williamson JD, Whelton PK, Snyder JK, Sink KM, Rocco MV. et al. A randomized trial of intensive versus standard blood-pressure control. N. Engl J Med. 2015;373:2103–16. Epub 2015/11/10.

    Article  CAS  Google Scholar 

  15. Johnson KC, Whelton PK, Cushman WC, Cutler JA, Evans GW, Snyder JK. et al. Blood pressure measurement in SPRINT (systolic blood pressure intervention trial). Hypertension. 2018;71:848–57. Epub 2018/03/14.

    Article  CAS  Google Scholar 

  16. Pappaccogli M, Di Monaco S, Perlo E, Burrello J, D’Ascenzo F, Veglio F. et al. Comparison of automated office blood pressure with office and out-off-office measurement techniques. Hypertension. 2019;73:481–90. Epub 2019/01/10.

    Article  CAS  Google Scholar 

  17. Myers MG, Kaczorowski J, Dolovich L, Tu K, Paterson JM. Cardiovascular risk in hypertension in relation to achieved blood pressure using automated office blood pressure measurement. Hypertension. 2016;68:866–72. Epub 2016/08/17.

    Article  CAS  Google Scholar 

  18. Nerenberg KA, Zarnke KB, Leung AA, Dasgupta K, Butalia S, McBrien K. et al. Hypertension Canada’s 2018 guidelines for diagnosis, risk assessment, prevention, and treatment of hypertension in adults and children. Can J Cardiol. 2018;34:506–25. Epub 2018/05/08.

    Article  Google Scholar 

  19. Tabara Y, Matsumoto T, Murase K, Setoh K, Kawaguchi T, Nagashima S. et al. Day-to-day home blood pressure variability and orthostatic hypotension: the Nagahama Study. Am J Hypertens. 2018;31:1278–85. Epub 2018/09/22.

    Article  CAS  Google Scholar 

  20. Cremer A, Boutouyrie P, Laurent S, Gosse P, Tzourio C. Orthostatic hypotension: a marker of blood pressure variability and arterial stiffness: a cross-sectional study on an elderly population: the 3-City study. J Hypertens. 2020;38:1103–9. Epub 2020/05/07.

    Article  CAS  Google Scholar 

  21. Ricci F, De Caterina R, Fedorowski A. Orthostatic hypotension: epidemiology, prognosis, and treatment. J Am Coll Cardiol. 2015;66:848–60. Epub 2015/08/14.

    Article  Google Scholar 

  22. Townsend RR, Chang TI, Cohen DL, Cushman WC, Evans GW, Glasser SP. et al. Orthostatic changes in systolic blood pressure among SPRINT participants at baseline. J Am Soc Hypertens: JASH. 2016;10:847–56. Epub 2016/09/27.

    Article  Google Scholar 

  23. Li Y, Staessen JA, Sheng CS, Huang QF, O’Rourke M, Wang JG. Age dependency of peripheral and central systolic blood pressures: cross-sectional and longitudinal observations in a Chinese population. Hypertens Res: Off J Jpn Soc Hypertens. 2012;35:115–22. Epub 2011/09/16.

    Article  CAS  Google Scholar 

  24. Faul F, Erdfelder E, Buchner A, Lang AG. Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods. 2009;41:1149–60. Epub 2009/11/10.

    Article  Google Scholar 

  25. O’Rourke MF, Safar ME. Relationship between aortic stiffening and microvascular disease in brain and kidney: cause and logic of therapy. Hypertension. 2005;46:200–4. Epub 2005/05/25.

    Article  Google Scholar 

  26. Cheng HM, Chuang SY, Wang TD, Kario K, Buranakitjaroen P, Chia YC. et al. Central blood pressure for the management of hypertension: is it a practical clinical tool in current practice?. J Clin Hypertens (Greenwich). 2020;22:391–406. Epub 2019/12/17.

    Article  Google Scholar 

  27. Whelton PK, Carey RM, Aronow WS, Casey DE, Jr, Collins KJ, Dennison Himmelfarb C. et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. J Am Coll Cardiol. 2018;71:e127–248. Epub 2017/11/18.

    Article  Google Scholar 

  28. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M. et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018;39:3021–104. Epub 2018/08/31.

    Article  Google Scholar 

  29. Umemura S, Arima H, Arima S, Asayama K, Dohi Y, Hirooka Y. et al. The Japanese society of hypertension guidelines for the management of hypertension (JSH 2019). Hypertens Res: Off J Jpn Soc Hypertens. 2019;42:1235–481. Epub 2019/08/04.

    Article  Google Scholar 

  30. Stergiou GS, Asayama K, Thijs L, Kollias A, Niiranen TJ, Hozawa A. et al. Prognosis of white-coat and masked hypertension: international database of home blood pressure in relation to Cardiovascular Outcome. Hypertension. 2014;63:675–82. Epub 2014/01/15.

    Article  CAS  Google Scholar 

  31. Fujiwara T, Yano Y, Hoshide S, Kanegae H, Kario K. Association of cardiovascular outcomes with masked hypertension defined by home blood pressure monitoring in a Japanese General Practice Population. JAMA Cardiol. 2018;3:583–90. Epub 2018/05/26.

    Article  Google Scholar 

  32. Asayama K, Ohkubo T, Rakugi H, Miyakawa M, Mori H, Katsuya T. et al. Comparison of blood pressure values-self-measured at home, measured at an unattended office, and measured at a conventional attended office. Hypertens Res: Off J Jpn Soc Hypertens. 2019;42:1726–37. Epub 2019/06/22.

    Article  Google Scholar 

  33. Hoshide S, Yano Y, Mizuno H, Kanegae H, Kario K. Day-by-day variability of home blood pressure and incident cardiovascular disease in clinical practice: the J-HOP Study (Japan morning surge-home blood pressure). Hypertension. 2018;71:177–84. Epub 2017/11/15.

    Article  CAS  Google Scholar 

  34. Shimbo D, Newman JD, Aragaki AK, LaMonte MJ, Bavry AA, Allison M. et al. Association between annual visit-to-visit blood pressure variability and stroke in postmenopausal women: data from the Women’s Health Initiative. Hypertension. 2012;60:625–30. Epub 2012/07/04.

    Article  CAS  Google Scholar 

  35. Rothwell PM, Howard SC, Dolan E, O’Brien E, Dobson JE, Dahlof B. et al. Prognostic significance of visit-to-visit variability, maximum systolic blood pressure, and episodic hypertension. Lancet. 2010;375:895–905. Epub 2010/03/17.

    Article  Google Scholar 

  36. Stevens SL, Wood S, Koshiaris C, Law K, Glasziou P, Stevens RJ. et al. Blood pressure variability and cardiovascular disease: systematic review and meta-analysis. BMJ. 2016;354:i4098. Epub 2016/08/12.

    Article  Google Scholar 

  37. Kario K, Schwartz JE, Pickering TG. Ambulatory physical activity as a determinant of diurnal blood pressure variation. Hypertension. 1999;34:685–91. Epub 1999/10/16.

    Article  CAS  Google Scholar 

  38. Verberk WJ, Kroon AA, Kessels AG, Lenders JW, Thien T, van Montfrans GA. et al. The optimal scheme of self blood pressure measurement as determined from ambulatory blood pressure recordings. J Hypertens. 2006;24:1541–8. Epub 2006/08/01.

    Article  CAS  Google Scholar 

  39. Stergiou GS, Parati G, Vlachopoulos C, Achimastos A, Andreadis E, Asmar R. et al. Methodology and technology for peripheral and central blood pressure and blood pressure variability measurement: current status and future directions - Position statement of the European Society of Hypertension Working Group on blood pressure monitoring and cardiovascular variability. J Hypertens. 2016;34:1665–77. Epub 2016/05/24.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

HM analyzed the data from this study and was responsible for writing this article. SH, YY, and KK were advisers for the conception and design of this study. They also assisted in conducting the statistical analyses. We would like to thank all the patients and medical staff who supported this study, including RN (Jichi Medical University) for data management and monitoring. We would also like to thank Healthstats Co. Ltd. for codevelopment of the customized CASPro.

Author information

Author notes

  1. These authors contributed equally: Hiroyuki Mizuno, Satoshi Hoshide.

Authors and Affiliations

  1. Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan

    Hiroyuki Mizuno, Satoshi Hoshide, Ryoko Nozue & Kazuomi Kario

  2. Center for Novel and Exploratory Clinical Trials, Yokohama City University, Yokohama, Japan

    Yuichiro Yano

  3. Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, USA

    Yuichiro Yano

Authors
  1. Hiroyuki Mizuno
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Satoshi Hoshide
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yuichiro Yano
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ryoko Nozue
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kazuomi Kario
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kazuomi Kario.

Ethics declarations

Conflict of interest

In this study, customized CASPro was provided by Healthstats Co. A conflict of interest between Healthstats Co. and the study director and other study-related individuals, including the principal investigators, was disclosed at the meetings of the Ethics and Conflicts of Interest committees. KK received research funding from Omron Healthcare and A&D and honoraria from Omron Healthcare, A&D and Terumo. All other authors report no potential conflicts of interest in relation to this article.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mizuno, H., Hoshide, S., Yano, Y. et al. Comparison of Brachial Blood Pressure and Central Blood Pressure in Attended, Unattended, and Unattended Standing Situations. Hypertens Res 44, 1283–1290 (2021). https://doi.org/10.1038/s41440-021-00694-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41440-021-00694-2

Keywords

This article is cited by

Search

Advanced search

Quick links