Derivation and Validation of Diagnostic Thresholds for Central Blood Pressure Measurements Based on Long-Term Cardiovascular Risks

• Published in: Journal of the American College of Cardiology Vol. 62; no. 19; pp. 1780 - 1787
• Main Authors: Cheng, Hao-Min, Chuang, Shao-Yuan, Sung, Shih-Hsien, Yu, Wen-Chung, Pearson, Alan, Lakatta, Edward G., Pan, Wen-Harn, Chen, Chen-Huan
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 05.11.2013; Elsevier; Elsevier Limited
• Subjects: Atherosclerosis (general aspects, experimental research); Biological and medical sciences; Blood and lymphatic vessels; Blood pressure; Blood Pressure - physiology; Blood Pressure Monitoring, Ambulatory - methods; Cardiology; Cardiology. Vascular system; Cardiovascular; central blood pressure; Cholesterol; Diagnosis, Differential; diagnostic thresholds; Female; Follow-Up Studies; Forecasting; Health risk assessment; Heart; high blood pressure; Humans; hypertension; Hypertension - diagnosis; Hypertension - epidemiology; Hypertension - physiopathology; Male; Medical sciences; Middle Aged; Morbidity - trends; Mortality; Older people; Prospective Studies; Risk Assessment - methods; Taiwan - epidemiology; Taiwan; CBP; cuff BP; PP; SBP; diagnostic thresholds; DBP; central blood pressure; high blood pressure; CI; hypertension; BP; blood pressure; pulse pressure; peripheral blood pressure; systolic blood pressure; diastolic blood pressure; confidence interval; Cardiovascular disease; Long term; Vascular disease; Test validation; Atherosclerosis; Risk factor; Cardiovascular risk; Arterial pressure; Blood pressure; Hemodynamics; Circulatory system; Diagnosis; Pressure measurement; Cardiology; Threshold
• ISSN: 0735-1097; 1558-3597; 1558-3597
• DOI: 10.1016/j.jacc.2013.06.029

This study sought to derive and validate outcome-driven thresholds of central blood pressure (CBP) for diagnosing hypertension. Current guidelines for managing patients with hypertension mainly rely on blood pressure (BP) measured at brachial arteries (cuff BP). However, BP measured at the central aorta (central BP [CBP]) may be a better prognostic factor for predicting future cardiovascular events than cuff BP. In a derivation cohort (1,272 individuals and a median follow-up of 15 years), we determined diagnostic thresholds for CBP by using current guideline-endorsed cutoffs for cuff BP with a bootstrapping (resampling by drawing randomly with replacement) and an approximation method. To evaluate the discriminatory power in predicting cardiovascular outcomes, the derived thresholds were tested in a validation cohort (2,501 individuals with median follow-up of 10 years). The 2 analyses yielded similar diagnostic thresholds for CBP. After rounding, systolic/diastolic threshold was 110/80 mm Hg for optimal BP and 130/90 mm Hg for hypertension. Compared with optimal BP, the risk of cardiovascular mortality increased significantly in subjects with hypertension (hazard ratio: 3.08, 95% confidence interval: 1.05 to 9.05). Of the multivariate Cox proportional hazards model, incorporation of a dichotomous variable by defining hypertension as CBP ≥130/90 mm Hg was associated with the largest contribution to the predictive power. CBP of 130/90 mm Hg was determined to be the cutoff limit for normality and was characterized by a greater discriminatory power for long-term events in our validation cohort. This report represents an important step toward the application of the CBP concept in clinical practice.