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Central vs. Brachial Blood Pressure and Pulse Pressure Amplification for Mortality Risk Prediction in Patients
Clara Daschner1, Marcus E Kleber1,2, Niklas Ayasse1
1Fifth Department of Medicine, Faculty of Medicine of the University of Heidelberg, University Medical Center Mannheim UMM, Mannheim, Baden-Württemberg, Germany.
Insights
Pulse pressure amplification, not standard blood pressure measurements, independently predicts mortality in high-risk patients. Lower pulse pressure amplification is associated with increased cardiovascular and all-cause mortality.
Area of Science:
- Cardiovascular Medicine
- Hypertension Research
- Clinical Epidemiology
Background:
- Arterial hypertension is a major risk factor for cardiovascular disease (CVD) morbidity and mortality.
- Central blood pressure (BP) is the gold standard, but non-invasive measurement reliability is debated.
- This study investigated the predictive value of central vs. brachial BP and pulse pressure amplification (delta-PP) for mortality.
Purpose of the Study:
- To compare the predictive value of invasively measured central BP with non-invasively measured brachial BP for mortality.
- To analyze pulse pressure amplification (delta-PP) as an independent predictor of cardiovascular and all-cause mortality.
Main Methods:
- Analysis of systolic BP (SBP), diastolic BP (DBP), mean arterial BP (MAP), pulse pressure (PP), and delta-PP in 3,316 patients from the LURIC study.
- Patients were referred for coronary angiography.
- Cox proportional hazards models were used to assess mortality prediction.
Main Results:
- Brachial SBP, MAP, and PP were associated with increased all-cause and CV mortality in univariate analysis.
- Central SBP and PP showed weaker associations with mortality compared to brachial measures.
- Only delta-PP independently predicted mortality after multivariate adjustment, with decreased delta-PP linked to increased mortality risk.
Conclusions:
- Brachial and central BP parameters were not independent predictors of mortality in this cohort.
- Pulse pressure amplification (delta-PP) emerged as an independent predictor of mortality.
- Reduced pulse pressure amplification signifies increased mortality risk in patients with medium to high CV risk.
Background:
Arterial hypertension is a significant risk factor for cardiovascular (CV) morbidity and mortality. Although central blood pressure (BP) evaluation is considered the gold standard, the reliability of non-invasive measurements remains unclear. Therefore, we compared the predictive value of invasively measured central BP with non-invasively measured brachial BP and analyzed pulse pressure (PP) amplification (delta-PP; the difference between central and peripheral PP) as an independent predictor of mortality.
Methods:
We analyzed systolic BP (SBP), diastolic BP (DBP), mean arterial BP (MAP), PP, and delta-PP as predictors of CV and all-cause mortality in the Ludwigshafen Risk and Cardiovascular Health (LURIC) study, involving 3,316 patients referred for coronary angiography.
Results:
All brachial BP parameters, except DBP, were significantly linked to all-cause and CV mortality in a univariate analysis. A 10 mm Hg increase in SBP, MAP, and PP corresponded to increased risks of all-cause (11%, 10%, and 19%) and CV mortality (11%, 11%, and 18%). Central SBP and PP showed similar, but numerically weaker, associations with increased risks of all-cause (5% and 10%) and CV mortality (4% and 8%). After adjusting for age, sex, body mass index, diabetes mellitus, and eGFR, only delta-PP independently predicted mortality with a 10 mm Hg increase linked to a 4% reduction in all causes and a 6% reduction in CV mortality.
Conclusions:
Neither brachial nor centrally measured BP parameters were independent mortality predictors in contrast to PP amplification, which remained an independent predictor of mortality in multivariate analysis, in a cohort with a medium to high CV risk profile. As PP amplification decreased, mortality increased.
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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)
01:10Pre-Procedural Guidelines for Assessing Blood Pressure
01:15Assessment of blood pressure in brachial artery(one-step method)
Prepare for the Procedure:
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