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Published on: May 3, 2018
Association of left ventricular structural and functional abnormalities with aortic and brachial blood pressure
1Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
Insights
Aortic blood pressure variability (BPV) better identifies left ventricular abnormalities than brachial BPV. Aortic average real variability (ARV) specifically links to left ventricular hypertrophy and diastolic dysfunction.
Area of Science:
- Cardiology
- Hypertension Research
- Diagnostic Imaging
Background:
- Both blood pressure (BP) levels and BP variability (BPV) are linked to left ventricular (LV) structure and function.
- Aortic BP is considered superior to brachial BP in associating with LV abnormalities.
- The comparative association of aortic versus brachial BPV with LV abnormalities remains unclear.
Purpose of the Study:
- To investigate and compare aortic versus brachial BPV in identifying LV structural and functional abnormalities.
- To determine if aortic BPV is a better predictor of LV abnormalities compared to brachial BPV.
Main Methods:
- Included 203 participants undergoing echocardiography.
- Simultaneously measured 24-hour aortic and brachial ambulatory BP using a validated monitor.
- Calculated BPV indices, including average real variability (ARV) and weighted standard deviation (wSD).
- Assessed LV mass and LV diastolic dysfunction (LVDD) via echocardiography.
Main Results:
- Prevalence of LV hypertrophy (LVH) and LVDD increased significantly with BPV indices.
- Aortic ARV, but not brachial ARV or wSD, significantly associated with LV mass index after confounder adjustment.
- Aortic ARV independently associated with LVH (OR: 2.28) and both aortic and brachial ARV associated with LVDD.
Conclusions:
- Aortic BPV, particularly aortic ARV, appears superior to brachial BPV in associating with LV structural and functional abnormalities.
- Aortic ARV may serve as a more effective marker for identifying adverse LV remodeling and dysfunction.
Abstract:
Both brachial blood pressure (BP) level and its variability (BPV) significantly associate with left ventricular (LV) structure and function. Recent studies indicate that aortic BP is superior to brachial BP in the association with LV abnormalities. However, it remains unknown whether aortic BPV better associate with LV structural and functional abnormalities. We therefore aimed to investigate and compare aortic versus brachial BPV, in terms of the identification of LV abnormalities. Two hundred and three participants who underwent echocardiography were included in this study. Twenty-four-hour aortic and brachial ambulatory BP was measured simultaneously by a validated BP monitor (Mobil-O-Graph, Stolberg, Germany) and BPV was calculated with validated formulae. LV mass and LV diastolic dysfunction (LVDD) were evaluated by echocardiography. The prevalence of LV hypertrophy (LVH) and LVDD increased significantly with BPV indices (P⩽0.04) in trend tests. After adjustment to potential confounders, only aortic average real variability (ARV), but not brachial ARV or weighted s.d. (wSD, neither aortic nor brachial) significantly associated with LV mass index (P=0.02). Similar results were observed in logistic regression. After adjustment, only aortic ARV significantly associated with LVH (odds ratio (OR) and 95% confidence interval (CI): 2.28 (1.08, 4.82)). As for LVDD, neither the brachial nor the aortic 24-hour wSD, but the aortic and brachial ARV, associated with LVDD significantly, with OR=2.28 (95% CI: (1.03, 5.02)) and OR=2.36 (95% CI: (1.10, 5.05)), respectively. In summary, aortic BPV, especially aortic ARV, seems to be superior to brachial BPV in the association of LV structural and functional abnormalities.
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Prepare for the Procedure:
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Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.