Related Experiment Video
Updated: Jun 6, 2025
Evaluation of the Cognitive Performance of Hypertensive Patients with Silent Cerebrovascular Lesions
Published on: April 23, 2021
Independent and joint effect of central and brachial SBP on incident stroke in hypertensive adults
Congcong Ding1, Tianyu Cao2, Zaihua Cheng1
1Department of Cardiovascular Medicine, the Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang of Jiangxi, China.
Insights
Central systolic blood pressure (cSBP) and brachial systolic blood pressure (bSBP) equally predict stroke risk. However, high levels of both cSBP and bSBP significantly increase stroke risk in hypertensive adults.
Area of Science:
- Cardiovascular Medicine
- Hypertension Research
- Stroke Prevention
Background:
- Assessing stroke risk in hypertensive individuals is crucial for effective prevention strategies.
- The independent predictive value of central systolic blood pressure (cSBP) compared to brachial systolic blood pressure (bSBP) for stroke remains unclear.
Purpose of the Study:
- To compare the predictive ability of cSBP versus bSBP for first stroke in hypertensive adults.
- To investigate the combined effect of cSBP and bSBP on the risk of first stroke.
Main Methods:
- A cohort of 8122 hypertensive adults without a history of stroke was analyzed.
- Central SBP was measured noninvasively; first stroke was the primary outcome.
- Median follow-up was 4.4 years, during which 579 first strokes occurred.
Main Results:
- Both cSBP and bSBP showed a similar 16% increased risk of first stroke per standard deviation increment.
- Models incorporating cSBP or bSBP did not show significant differences in predictive performance.
- Joint analysis revealed that the highest tertiles of both cSBP and bSBP were associated with a significantly higher risk of first stroke (HR: 1.59).
Conclusions:
- cSBP is not superior to bSBP in predicting first stroke independently.
- The combination of elevated cSBP and bSBP significantly increases stroke risk in hypertensive patients.
- These findings highlight the importance of considering both central and brachial blood pressure measurements for comprehensive stroke risk assessment.
Objective:
It is unclear whether central SBP (cSBP) is an independent predictor of stroke above and beyond brachial SBP (bSBP). This study aimed to investigate the difference between cSBP and bSBP in predicting first stroke and the joint effect of cSBP and bSBP on the risk of first stroke in hypertensive adults.
Methods:
A total of 8122 hypertensive adults without stroke history were included in this study. cSBP was measured noninvasively using A-Pulse CASPro device. The outcome was first stroke. During a median follow-up of 4.4 years, 579 first strokes were identified.
Results:
A total of 8122 hypertensive adults without stroke history were included in this study. cSBP was measured noninvasively using A-Pulse CASPro device. The outcome was first stroke. During a median follow-up of 4.4 years, 579 first strokes were identified. The risk of first stroke increased by the same 16% [hazard ratio: 1.16, 95% confidence interval (95% CI): 1.07-1.26] for per SD increment in both cSBP and bSBP. The differences in areas under the curves, continuous net reclassification indices, and integrated discrimination indices of bSBP and cSBP models for predicting first stroke were 0.003 (95% CI: -0.003, 0.008), 0.007 (95% CI: -0.058, 0.071), and -0.0002 (95% CI: -0.0028, 0.0013), respectively. When cSBP and bSBP were evaluated jointly, participants in the highest tertiles of both cSBP and bSBP had the highest risk of first stroke compared with their counterparts (hazard ratio: 1.59, 95% CI: 1.29-1.96; P -interaction = 0.034). Similar results were found for ischemic stroke and hemorrhagic stroke.
Conclusion:
Although cSBP was not found to be superior to bSBP in predicting first stroke, cSBP and bSBP were jointly associated with the risk of first stroke among hypertensive adults.
Related Concept Videos
01:23Assessment of blood pressure in brachial artery(two-step method)
01:28Factors affecting Blood pressure
Physiological Factors:
01:15Assessment of blood pressure in brachial artery(one-step method)
Prepare for the Procedure:
01:18Hypertension and Regulation of Blood Pressure
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.
01:27Regulation of Stroke Volume
Preload refers to the degree of stretch on the heart before it contracts. It's analogous to the stretching of a rubber band; the more it's stretched, the more forcefully it snaps back. This concept is encapsulated in the Frank-Starling law of the...