AbstractObjectives This study sought to derive and validate outcome-driven thresholds of central blood pressure (CBP) for diagnosing hypertension. Background 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. Methods In a Derivation Cohort (1272 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 (2501 individuals with median follow-up of 10 years). Results The two analyses yielded similar diagnostic thresholds for CBP. After rounding, systolic/diastolic threshold was 110/80 mmHg for optimal BP and 130/90 mmHg for hypertension. Comparing to optimal BP, the risk of cardiovascular mortality increased significantly in subjects with hypertension (hazard ratio 3.08, 95% confidence interval 1.05-9.05). Of the multivariate Cox proportional-hazards model, incorporation of a dichotomous variable by defining hypertension as CBP ? 130/90 mmHg was associated with the largest contribution to the predictive power. Conclusion CBP of 130/90 mmHg 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.
Date:
2013-07
Relation:
Journal of the American College of Cardiology. 2013 Jul;62(19):1780-1787.
