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Peripheral blood pressure by Dinamap and central blood pressure by applanation tonometry in outpatient general
Luiz Miguel Santiago1, Ana Rita Simões, Paula Ricardo Miranda
1Centro de Saúde de Eiras, Agrupamento dos Centros de Saúde do Baixo Mondego, Coimbra, Portugal. lmsantiago@netcabo.pt
Insights
Central blood pressure (CBP) control is linked to better peripheral blood pressure (PBP) and lower pulse pressures. Achieving controlled CBP also correlates with a significantly improved augmentation index (AI) in hypertensive patients.
Area of Science:
- Cardiovascular Medicine
- Hypertension Research
- Clinical Hemodynamics
Background:
- Central blood pressure (CBP) is a superior marker for cardiovascular risk compared to peripheral blood pressure (PBP).
- Understanding hemodynamic variations in hypertensive patients is crucial for risk stratification and management.
Purpose of the Study:
- To evaluate how augmentation index (AI), peripheral pulse pressure (pPP), central pulse pressure (cPP), and subendocardial viability ratio (SEVR) differ in hypertensive patients based on their central and peripheral blood pressure control.
- To investigate the relationship between blood pressure control levels and key hemodynamic parameters.
Main Methods:
- Observational, cross-sectional study conducted in a general practice in Central Portugal.
- Measurements of PBP, CBP, pPP, cPP, and AI were taken after a resting period.
- Defined controlled pressures as PBP <140/90 mmHg, CBP <130/80 mmHg, pPP <55 mmHg, and cPP <45 mmHg.
Main Results:
- In a sample of 92 hypertensive patients, PBP was controlled in 59.8% and CBP in 57.6%.
- Controlled PBP and CBP were associated with significantly lower pPP and cPP.
- Controlled CBP was also linked to a significantly lower AI, while SEVR was within the desirable range for 92.2% of subjects.
Conclusions:
- Both PBP and CBP control are achievable in a significant proportion of hypertensive patients.
- Achieving controlled blood pressure, particularly central blood pressure, is associated with favorable hemodynamic profiles, including lower pulse pressures and improved augmentation index.
- The study highlights the importance of monitoring central blood pressure for a comprehensive assessment of cardiovascular risk in hypertension.
Introduction:
Central blood pressure (CBP) is the pressure exerted by the blood column at any given moment on the aortic and carotid artery walls, which is a close proxy for the blood pressure inside the brain and the heart, and is thus a better marker of cardiovascular morbidity and mortality than peripheral blood pressure (PBP).
Objective:
To assess how the augmentation index (AI), peripheral pulse pressure (pPP), central pulse pressure (cPP) and subendocardial viability ratio (SEVR) vary in hypertensive patients according to level of control of CBP and PBP.
Methods:
We performed an observational, cross-sectional study in a convenience sample from a general practice in Central Portugal over a period of four days in May 2010. Measurements were taken after a four-minute resting period. The following values were considered to reflect controlled pressures: PBP <140/90 mmHg, CBP <130/80 mmHg, pPP <55 mmHg and cPP <45 mmHg.
Results:
The sample included 92 patients, 38 male (41.3%), mean age 62.3±11.1 years, with no significant difference in gender distribution. PBP was controlled in 55 (59.8%), and CBP in 53 (57.6%). Both PBP and CBP were controlled in 50 patients (54.3%) and neither was controlled in 34 (37.9%). pPP and cPP were significantly lower in those with controlled PBP (p<0.001) and CBP (p<0.001). AI was non-significantly lower in those with controlled PBP (78±9 vs. 80.7) and those with controlled CBP (78±9 vs.81±7) (p=0.02). SEVR was within the desirable range in 92 patients (92.2%). 78.4% of individuals were taking drugs acting on the renin angiotensin aldosterone system (RAAS).
Conclusions:
In a convenience sample of 92 patients, PBP and CBP were controlled in 59.8% and 57.6%, respectively. Those with controlled PBP had significantly better peripheral systolic and diastolic blood pressure, CBP, pPP and cPP; the same was true of those with controlled CBP, who also had a significantly better AI. The percentage of the cardiac cycle in diastole had a desirable value for 92,2% of the subjects.
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