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Derivation and validation of diagnostic thresholds for central blood pressure measurements based on long-term
Hao-Min Cheng1, Shao-Yuan Chuang, Shih-Hsien Sung
1Joanna Briggs Institute, Faculty of Health Sciences, The University of Adelaide, Adelaide, Australia; Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan; Cardiovascular Research Center, National Yang-Ming University, Hospital, Taipei, Taiwan; Department of Medicine, National Yang-Ming University, Taipei, Taiwan.
Insights
Central blood pressure (CBP) thresholds for diagnosing hypertension were derived and validated. A CBP of 130/90 mm Hg is recommended as the cutoff for hypertension, offering better cardiovascular risk prediction than cuff BP.
Area of Science:
- Cardiology
- Hypertension Research
- Clinical Diagnostics
Background:
- Current hypertension management relies on brachial artery blood pressure (BP).
- Central blood pressure (CBP) may offer superior cardiovascular event prediction compared to cuff BP.
Purpose of the Study:
- To derive and validate outcome-driven thresholds for diagnosing hypertension using central blood pressure (CBP).
- To establish new diagnostic criteria for hypertension based on central aortic pressure measurements.
Main Methods:
- Derivation of CBP thresholds using bootstrapping and approximation methods in a cohort of 1,272 individuals.
- Validation of derived thresholds in a separate cohort of 2,501 individuals to assess predictive power for cardiovascular outcomes.
Main Results:
- Similar diagnostic thresholds for CBP were obtained from both analyses.
- Systolic/diastolic thresholds for optimal BP and hypertension were determined as 110/80 mm Hg and 130/90 mm Hg, respectively.
- Hypertension defined by CBP (≥ 130/90 mm Hg) significantly increased cardiovascular mortality risk (HR: 3.08) and improved predictive models.
Conclusions:
- Central blood pressure (CBP) of 130/90 mm Hg is proposed as the cutoff for normality, demonstrating superior discriminatory power for long-term cardiovascular events.
- These findings support the clinical application of central blood pressure measurements for hypertension diagnosis and risk stratification.
Objectives:
This study sought to derive and validate outcome-driven thresholds of central blood pressure (CBP) for diagnosing hypertension.
Background:
Current guidelines for managing patients with hypertension mainly rely on blood pressure (BP) measured at brachial arteries (cuff BP). However, BP measured at the central aorta (central BP [CBP]) may be a better prognostic factor for predicting future cardiovascular events than cuff BP.
Methods:
In a derivation cohort (1,272 individuals and a median follow-up of 15 years), we determined diagnostic thresholds for CBP by using current guideline-endorsed cutoffs for cuff BP with a bootstrapping (resampling by drawing randomly with replacement) and an approximation method. To evaluate the discriminatory power in predicting cardiovascular outcomes, the derived thresholds were tested in a validation cohort (2,501 individuals with median follow-up of 10 years).
Results:
The 2 analyses yielded similar diagnostic thresholds for CBP. After rounding, systolic/diastolic threshold was 110/80 mm Hg for optimal BP and 130/90 mm Hg for hypertension. Compared with optimal BP, the risk of cardiovascular mortality increased significantly in subjects with hypertension (hazard ratio: 3.08, 95% confidence interval: 1.05 to 9.05). Of the multivariate Cox proportional hazards model, incorporation of a dichotomous variable by defining hypertension as CBP ≥ 130/90 mm Hg was associated with the largest contribution to the predictive power.
Conclusions:
CBP of 130/90 mm Hg was determined to be the cutoff limit for normality and was characterized by a greater discriminatory power for long-term events in our validation cohort. This report represents an important step toward the application of the CBP concept in clinical practice.
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