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Developing and validating a diagnostic threshold for central blood pressure in assessing cardiovascular risks

Shuqi Wang1, Samuel Y S Wong1, Benjamin H K Yip1

  • 1JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, JC School of Public Health and Primary Care, Prince of Wales Hospital, Shatin, Hong Kong SAR, China.

European Journal of Preventive Cardiology
|May 23, 2025
PubMed

Insights

A new threshold for central blood pressure (cBP) was established at 135 mmHg. Central hypertension, even without brachial hypertension, significantly increases cardiovascular disease (CVD) risk, improving risk prediction beyond traditional measures.

Area of Science:

  • Cardiology
  • Hypertension Research
  • Preventive Medicine

Background:

  • Traditional blood pressure (BP) measurements may not fully capture cardiovascular disease (CVD) risk.
  • Central blood pressure (cBP) offers a more direct assessment of arterial load.
  • Establishing outcome-derived thresholds for cBP is crucial for clinical application.

Purpose of the Study:

  • To establish an outcome-derived threshold for central blood pressure (cBP).
  • To evaluate the clinical utility of cBP in stratifying cardiovascular disease (CVD) risk.
  • To compare CVD risk associated with different combinations of brachial and central BP levels.

Main Methods:

  • Retrospective cohort study of 34,289 adults from the UK Biobank.
  • Primary endpoint: composite of cardiovascular mortality and non-fatal cardiovascular events.
  • Developed cBP diagnostic threshold using bootstrap and approximation methods; employed Cox regression for risk prediction analysis.

Main Results:

  • Established a central systolic blood pressure (SBP) threshold of 135 mmHg, corresponding to a brachial SBP threshold of 140 mmHg.
  • Identified distinct risk categories: concordant normotension (49.84%), isolated brachial hypertension (2.23%), isolated central hypertension (3.65%), and concordant hypertension (44.28%).
  • Isolated central hypertension (HR 1.70) and concordant hypertension (HR 1.51) showed significantly elevated CVD risk compared to normotension. Inclusion of cBP improved CVD risk prediction models.

Conclusions:

  • A central SBP diagnostic threshold of 135 mmHg is proposed.
  • Elevated central hypertension signifies increased CVD risk, irrespective of brachial blood pressure status.
  • Integrating central BP measurements enhances cardiovascular risk prediction beyond conventional brachial BP assessments.
Abstract

Keywords:
Cardiovascular diseasesCentral blood pressureHypertension

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