Pulse pressure amplification a mechanical biomarker of cardiovascular risk
Athanase Benetos1, Frédérique Thomas, Laure Joly
1Department of Geriatrics CHU de Nancy, and INSERM U691, University of Nancy, Nancy, France.
Insights
The carotid/brachial (C/B) ratio, a measure of pulse pressure amplification, independently predicts cardiovascular risk. This ratio offers a valuable tool for assessing cardiovascular risk in large population studies.
Area of Science:
- Cardiovascular Medicine
- Vascular Physiology
- Epidemiology
Background:
- Brachial and carotid pulse pressure (PP) are established predictors of cardiovascular (CV) risk, particularly in elderly populations.
- Pulse pressure amplification, represented by the carotid/brachial (C/B) ratio, reflects physiological differences in PP between these arterial sites.
- The C/B ratio's potential as an independent predictor of CV risk warrants investigation.
Purpose of the Study:
- To determine if the carotid/brachial (C/B) ratio serves as an independent predictor of cardiovascular (CV) risk.
- To evaluate the predictive value of C/B ratio for CV mortality in a large population cohort.
Main Methods:
- Utilized sphygmomanometry and pulse wave analysis to measure brachial and carotid PP in a Paris population (n=834).
- Developed a nomogram to calculate carotid PP based on age, sex, body height, brachial PP, and plasma glucose.
- Applied Cox regression analysis to a large cohort (125,151 subjects) followed for 12 years, calculating multi-adjusted hazard ratios (HRs) for brachial PP, calculated carotid PP, and C/B ratio.
Main Results:
- Brachial PP and calculated carotid PP were significantly associated with both CV and all-cause mortality.
- The C/B ratio demonstrated a strong independent association with CV mortality (HR: 1.22) and all-cause mortality (HR: 1.41).
- Confounding variables, including drug treatment, did not significantly alter these associations.
Conclusions:
- Brachial PP, calculated carotid PP, and C/B ratio-derived pulse pressure amplification all predict cardiovascular mortality.
- The C/B ratio is less reliant on blood pressure calibration compared to brachial and carotid PP.
- The C/B ratio's robustness makes it suitable for direct application in large-scale population studies for CV risk assessment.
Objectives:
The aim of this study was to determine whether the carotid/brachial (C/B) ratio is an independent predictor of cardiovascular (CV) risk.
Background:
Brachial and carotid pulse pressure (PP) are independent predictors of CV risk, mainly in elderly patients. Because PP is physiologically lower at the brachial than at the carotid arterial site, PP amplification is represented by the C/B ratio and could independently predict CV risk.
Methods:
In a Paris population (n = 834), brachial and carotid PP were measured from sphygmomanometry and pulse wave analysis. With stepwise multiple regression, carotid PP was calculated from a nomogram including age, sex, body height, brachial PP, and plasma glucose. This model was applied to 125,151 subjects, followed for 12 years, during which 3,997 deaths occurred (735 of CV origin). With Cox regression analysis, multi-adjusted hazard ratios (HRs) were calculated for 1 SD increase of brachial PP, calculated carotid PP, and C/B ratio.
Results:
Brachial PP was significantly associated with both CV and all-cause mortality (HR: 1.16, 95% confidence interval [CI]: 1.13 to 1.19, and HR: 1.13, 95% CI: 1.10 to 1.17, respectively). Calculated carotid PP predicted a similar risk (HR: 1.21, 95% CI: 1.15 to 1.28, and HR: 1.18, 95% CI: 1.12 to 1.25, respectively). Finally, the C/B ratio was a strong risk predictor (HR: 1.22, 95% CI: 1.12 to 1.32, and HR: 1.41, 95% CI: 1.14 to 1.73, respectively). Addition of drug treatment and other confounding variables did not statistically modify the results.
Conclusions:
Brachial PP, calculated carotid PP, and C/B PP amplification all predict CV mortality. In contrast to brachial and carotid PP, the C/B ratio is less dependent on blood pressure calibration and thus can be directly applicable to large population studies.
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