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Central pressure: variability and impact of cardiovascular risk factors: the Anglo-Cardiff Collaborative Trial II

Carmel M McEniery1, Yasmin, Barry McDonnell

  • 1Clinical Pharmacology Unit, University of Cambridge, Addenbrooke's Hospital Box 110, Cambridge CB2 2QQ, United Kingdom. cmm41@cam.ac.uk

Hypertension (Dallas, Tex. : 1979)
|April 23, 2008
PubMed

Insights

Central aortic pressure is higher than peripheral brachial pressure, especially with cardiovascular risk factors. Peripheral pressure measurements do not reliably estimate central pressure, highlighting the need for direct central pressure assessment.

Area of Science:

  • Cardiovascular Physiology
  • Arterial Hemodynamics
  • Clinical Hypertension Research

Background:

  • Pulse pressure exhibits significant variation across the arterial tree, creating a gradient between central and peripheral pressures.
  • Factors like age, heart rate, and height influence this pressure gradient, but the impact of cardiovascular risk factors on central pressure remains unclear.

Purpose of the Study:

  • To investigate the relative impact of cardiovascular risk factors and disease on central aortic pressure.
  • To determine normal variations in central pressure among healthy individuals.
  • To assess if peripheral pressure reliably predicts central pressure.

Main Methods:

  • Measured seated peripheral (brachial) and central (aortic) blood pressures in 10,613 individuals aged 18-101 years.
  • Calculated the pulse pressure ratio (aortic/brachial pulse pressure) in healthy individuals, patients with cardiovascular disease, diabetes, hypertension, hypercholesterolemia, or smoking.
  • Analyzed data to compare pulse pressure ratios across different groups and age ranges.

Main Results:

  • Individuals with cardiovascular risk factors or disease showed a significantly increased pulse pressure ratio compared to healthy individuals.
  • Aging was associated with an increased pulse pressure ratio, yet a notable difference between brachial and aortic systolic pressure persisted in older adults.
  • Over 70% of individuals with high-normal brachial pressure had similar central aortic pressures as those with stage 1 hypertension, indicating significant overlap.

Conclusions:

  • Cardiovascular risk factors significantly alter the pulse pressure ratio, affecting central systolic pressure.
  • Peripheral blood pressure measurements are insufficient for reliably inferring central aortic pressure.
  • Direct assessment of central pressure may enhance cardiovascular risk identification and patient management.

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