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Ultrasound Assessment of Endothelial-Dependent Flow-Mediated Vasodilation of the Brachial Artery in Clinical Research
Published on: October 22, 2014
Central pressure more strongly relates to vascular disease and outcome than does brachial pressure: the Strong Heart
Mary J Roman1, Richard B Devereux, Jorge R Kizer
1Division of Cardiology, Weill Medical College of Cornell University, New York, NY 10021, USA. mroman@med.cornell.edu
Insights
Central blood pressure, measured noninvasively, better predicts cardiovascular events and arterial damage than brachial blood pressure. This suggests central pressure may be a more effective target for cardiovascular disease prevention strategies.
Area of Science:
- Cardiology
- Vascular Biology
- Hypertension Research
Background:
- Brachial blood pressure is a standard cardiovascular risk predictor.
- Central blood pressure may offer a more direct measure of arterial load, potentially improving risk assessment.
Purpose of the Study:
- To compare the association of central and brachial blood pressure with vascular hypertrophy, atherosclerosis, and cardiovascular events in the Strong Heart Study.
- To evaluate central pulse pressure as a potential therapeutic target for cardiovascular disease.
Main Methods:
- Noninvasive central blood pressure was derived from radial applanation tonometry.
- Associations with carotid artery intimal-medial thickness, vascular mass, plaque score, and incident cardiovascular events were analyzed.
- Statistical models adjusted for multiple cardiovascular risk factors.
Main Results:
- Central and brachial pulse pressures correlated more strongly with vascular hypertrophy and atherosclerosis than systolic pressures.
- Central pulse pressure showed a stronger relationship with plaque score, intimal-medial thickness, and vascular mass compared to brachial pulse pressure.
- Adjusted central pulse pressure was a stronger predictor of cardiovascular events than brachial pulse pressure (HR 1.15 vs. 1.10 per 10 mm Hg).
Conclusions:
- Noninvasively measured central pulse pressure demonstrates a stronger association with vascular damage and cardiovascular events than brachial blood pressure.
- These findings support investigating central blood pressure as a treatment target in future clinical trials for cardiovascular disease prevention.
Abstract:
Brachial blood pressure is predictive of cardiovascular outcome; however central pressure may better represent the load imposed on the coronary and cerebral arteries and thereby bear a stronger relationship to vascular damage and prognosis. Relations of brachial and central pressures to carotid artery hypertrophy (intimal-medial thickness and vascular mass), extent of atherosclerosis (plaque score), and incident cardiovascular events were examined in the Strong Heart Study. Central pressures were calculated using radial applanation tonometry. Among 3520 participants, central and brachial pulse pressures were more strongly related to vascular hypertrophy and extent of atherosclerosis than were systolic pressures. Central pulse pressure was more strongly related to all 3 arterial measures than was brachial pulse pressure (r=0.364 versus 0.309 for plaque score; P<0.001 for comparison of Spearman correlation coefficient; r=0.293 versus 0.249 for intimal-medial thickness; P<0.002; r=0.320 versus 0.289 for vascular mass; P<0.05). Among the 2403 participants free of clinical cardiovascular disease at baseline, 319 suffered fatal or nonfatal cardiovascular events during mean follow-up of 4.8+/-1.3 years. After adjustment for age, gender, current smoking, body mass index, cholesterol:HDL ratio, creatinine, fibrinogen, diabetes, and heart rate, central pulse pressure predicted cardiovascular events more strongly than brachial pulse pressure (hazards ratio=1.15 per 10 mm Hg, chi(2)=13.4, P<0.001 versus hazards ratio=1.10, chi(2)=6.9, P=0.008). In conclusion, noninvasively-determined central pulse pressure is more strongly related to vascular hypertrophy, extent of atherosclerosis, and cardiovascular events than is brachial blood pressure. These findings support prospective examination of use of central blood pressure as a treatment target in future trials.
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