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Updated: Jul 1, 2025
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Aortic Calcification is Associated With the Difference Between Invasive Central and Cuff-Measured Brachial Blood
Jakob Nyvad1, Kent Lodberg Christensen2, Gratien Andersen3
1Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark.
Insights
Aortic calcification in chronic kidney disease (CKD) patients is linked to higher invasive central systolic blood pressure (invCSBP) compared to cuffSBP. This suggests hidden hypertension in CKD patients with advanced aortic calcification.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Radiology
Background:
- Chronic kidney disease (CKD) is linked to vascular calcification and elevated central systolic blood pressure (invCSBP) versus cuff-based brachial systolic blood pressure (cuffSBP).
- The specific role of aortic wall calcification in this discrepancy remains unclear.
Purpose of the Study:
- To investigate the impact of aortic calcification on the difference between invCSBP and cuffSBP across all stages of CKD.
Main Methods:
- invCSBP and cuffSBP were measured simultaneously in 168 CKD patients during coronary angiography.
- Aortic calcification was quantified using Agatston scores from non-contrast computed tomography scans.
Main Results:
- Aortic calcification was associated with a significant increase in invCSBP relative to cuffSBP.
- This association persisted after adjusting for various clinical factors, including estimated glomerular filtration rate (eGFR).
Conclusions:
- Advanced aortic calcification in CKD patients correlates with higher invCSBP for a given cuffSBP.
- This indicates potential underestimation of central hypertension in CKD patients with significant aortic calcification.
Background:
Chronic kidney disease (CKD) is associated with accelerated vascular calcification and increased central systolic blood pressure when measured invasively (invCSBP) relative to cuff-based brachial systolic blood pressure (cuffSBP). The contribution of aortic wall calcification to this phenomenon has not been clarified. We, therefore, examined the effects of aortic calcification on cuffSBP and invCSBP in a cohort of patients representing all stages of CKD.
Methods:
During elective coronary angiography, invCSBP was measured in the ascending aorta with a fluid-filled catheter with simultaneous recording of cuffSBP using an oscillometric device. Furthermore, participants underwent a non-contrast computed tomography scan of the entire aorta with observer-blinded calcification scoring of the aortic wall ad modum Agatston.
Results:
We included 168 patients (mean age 67.0 ± 10.5, 38 females) of whom 38 had normal kidney function, while 30, 40, 28, and 32 had CKD stages 3a, 3b, 4, and 5, respectively. Agatston scores adjusted for body surface area ranged from 48 to 40,165. We found that invCSBP increased 3.6 (95% confidence interval 1.4-5.7) mm Hg relative to cuffSBP for every 10,000-increment in aortic Agatston score. This association remained significant after adjustment for age, diabetes, antihypertensive treatment, smoking, eGFR, and BP level. No such association was found for diastolic BP.
Conclusions:
Patients with advanced aortic calcification have relatively higher invCSBP for the same cuffSBP as compared to patients with less calcification. Advanced aortic calcification in CKD may therefore result in hidden central hypertension despite apparently well-controlled cuffSBP. ClinicalTrials.gov identifier: NCT04114695.
Related Concept Videos
01:21Sites for measruring blood pressure
The Brachial Artery: Primary Site for Blood Pressure Measurement
01:23Assessment of blood pressure in brachial artery(two-step method)
01:28Special considerations while measuring blood pressure
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.
01:17Measurement of Blood Pressure
01:18Hypertension and Regulation of Blood Pressure
01:15Assessment of blood pressure in brachial artery(one-step method)
Prepare for the Procedure: