Association of central and peripheral pulse pressure with intermediate cardiovascular phenotypes
Ulf Neisius1, Grzegorz Bilo, Chiara Taurino
1BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
Insights
Central pulse pressure (cPP) correlates more strongly with cardiovascular phenotypes than peripheral pulse pressure (pPP) in middle-aged adults. However, cPP offers no additional prognostic information beyond pPP when adjusted for key factors.
Area of Science:
- Cardiovascular Physiology
- Hypertension Research
- Biomedical Engineering
Background:
- Central pulse pressure (cPP) is suggested to be a superior predictor of cardiovascular outcomes compared to peripheral pulse pressure (pPP), especially in older populations.
- The added prognostic value of cPP over pPP in younger individuals remains unclear.
- Hypertension is prevalent in the studied middle-aged cohort, with a high percentage of participants receiving treatment.
Purpose of the Study:
- To assess the relationship between central pulse pressure (cPP) and intermediate cardiovascular phenotypes in a middle-aged cohort.
- To compare the association of cPP and peripheral pulse pressure (pPP) with cardiovascular markers.
- To determine if cPP provides additional predictive information beyond pPP in this population.
Main Methods:
- Noninvasive assessment of cPP and pPP in 535 individuals using pulse wave analysis (PWA) and tonometry.
- Evaluation of intermediate cardiovascular phenotypes: pulse wave velocity (PWV), carotid intima-media thickness (C-IMT), left-ventricular mass index (LVMI), and urinary albumin:creatinine ratio (ACR).
- Statistical analysis comparing the strength of association and predictive value of cPP versus pPP.
Main Results:
- cPP demonstrated stronger correlations with PWV, C-IMT, and LVMI compared to pPP in initial analyses.
- Both cPP and pPP showed similar associations with the urinary albumin:creatinine ratio (ACR).
- After adjusting for age, mean arterial pressure, heart rate, and hypertension status, cPP did not significantly improve the prediction of PWV, C-IMT, or LVMI compared to pPP.
Conclusions:
- In a middle-aged cohort with a high prevalence of hypertension, cPP is more closely correlated with cardiovascular phenotypes than pPP.
- Adjusting for relevant cofactors indicates that cPP does not offer additional prognostic information beyond pPP in this population.
- Findings suggest that while cPP reflects vascular changes more strongly, its independent predictive value over pPP is limited in middle-aged hypertensive individuals.
Objective:
We assessed the relationship between pulse pressure and intermediate cardiovascular phenotypes in a middle-aged cohort with high prevalence of hypertension.
Background:
It has been suggested that central pulse pressure (cPP) is a better predictor of cardiovascular outcome than peripheral pulse pressure (pPP), particularly in the elderly. Yet, it is unclear if cPP provides additional prognostic information to pPP in younger individuals.
Methods:
In 535 individuals we assessed cPP and pPP as well as the intermediate cardiovascular phenotypes pulse wave velocity (PWV; SphygmoCor, Complior, PulsePen), carotid intima-media thickness (C-IMT; carotid ultrasound), left-ventricular mass index (LVMI; echocardiography) and urinary albumin : creatinine ratio (ACR). cPP was derived noninvasively from brachial blood pressure by pulse wave analysis (PWA; SphygmoCor) based on radial pulse wave tonometry and a validated transfer function.
Results:
The cohort contained 331 hypertensive participants of whom 84% were treated. The average age was 46 ± 16 years. When compared to pPP, cPP had stronger associations with PWV (r = 0.471 vs. r = 0.372; P < 0.01), C-IMT (r = 0.426 vs. r = 0.235; P < 0.01) and LVMI (r = 0.385 vs. r = 0.189; P < 0.01), but equal association with ACR (r = 0.236 vs. r = 0.226; P = n.s.). In contrast, after adjustment for age, mean arterial pressure, heart rate and hypertension status there was no significant difference between cPP and pPP for prediction of PWV (adjusted R, 0.399 vs. 0.413; P = 0.066), C-IMT (adjusted R, 0.399 vs. 0.413; P = 0.487) and LVMI (adjusted R, 0.181 vs. 0.170; P = 0.094) in multivariate analysis.
Conclusion:
In our middle-aged cohort with high prevalence of hypertension cPP is more closely correlated with cardiovascular phenotypes than pPP. When adjusted for relevant cofactors, however, cPP does not provide additional information beyond pPP.
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