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Mortality in Relation to Brachial Versus Central Ambulatory Blood Pressure
De-Wei An1, Ying Wang1, Yi-Bang Cheng1
1Department of Cardiovascular Medicine, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, State Key Laboratory of Medical Genomics, National Research Centre for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, China (D.-W.A., Y.W., Y.-B.C., D.-Y.Z., Q.-F.H., J.-F.H., M.-X.L., Q.-H.G., C.-S.S., T.-Y.X., J.-G.W., J.A.S., Y.L.).
Insights
Central systolic blood pressure (cSBP) did not offer better mortality risk prediction than brachial systolic blood pressure (bSBP) in 24-hour ambulatory monitoring. Brachial systolic blood pressure measurement is sufficient for cardiovascular risk stratification.
Area of Science:
- Cardiology
- Hypertension Research
- Predictive Analytics in Medicine
Background:
- The clinical utility of central systolic blood pressure (cSBP) over brachial systolic blood pressure (bSBP) for risk stratification is debated.
- This study evaluated the association of 24-hour ambulatory cSBP and bSBP with total and cardiovascular mortality.
Purpose of the Study:
- To determine if 24-hour ambulatory cSBP provides superior risk stratification for mortality compared to bSBP.
- To assess the association of calibrated cSBP (cSBPc1, cSBPc2) and bSBP with cardiovascular outcomes.
Main Methods:
- Analysis of the Shanghai Ruijin Ambulatory BP Monitoring Registry (2017-2023) including 36,594 participants.
- 24-hour ambulatory bSBP and cSBP were recorded; cSBP was calibrated using two methods (cSBPc1, cSBPc2).
- Cox proportional hazard regression models (linear and nonlinear) were used to assess associations with total and cardiovascular mortality over a median follow-up of 4.0 years.
Main Results:
- Nonlinear Cox models showed a better fit than linear models for both total and cardiovascular mortality (P<0.001).
- Adding 24-hour SBP to the base model improved risk prediction (C statistics, P≤0.06).
- Adding calibrated cSBP (cSBPc1 or cSBPc2) to a model already including bSBP did not significantly improve risk prediction (P>0.054).
Conclusions:
- Central systolic blood pressure (cSBP) measurement did not enhance mortality risk prediction compared to brachial systolic blood pressure (bSBP).
- Standard 24-hour ambulatory brachial systolic blood pressure monitoring is adequate for blood pressure-based risk stratification.
Background:
Whether central systolic blood pressure (cSBP) compared with brachial systolic blood pressure (bSBP) improves risk stratification remains debated. This study investigated whether cSBP is more closely associated with total and cardiovascular mortality than bSBP when recorded by 24-hour ambulatory BP monitoring with an arm cuff-based oscillometric monitor.
Methods:
Consecutive patients referred for ambulatory BP monitoring and enrolled in the Shanghai Ruijin Ambulatory BP Monitoring Registry (2017-2023) were analyzed. bSBP and cSBP were recorded over 24 hours. cSBP was calibrated on brachial systolic and diastolic BP (cSBPc1) or on mean arterial pressure and brachial diastolic BP (cSBPc2). Total and cardiovascular mortality up to December 31, 2024, was assessed by record linkage with International Classification of Diseases, Tenth Revision, coded death certificates. Linear and nonlinear Cox proportional hazard regression was applied with age as the underlying time-scale and adjusted for established cardiovascular risk factors.
Results:
Over 4.0 years of follow-up, 505 of 36 594 participants (52.8% women; median age, 53.4 years) died, 174 from cardiovascular disease. With multivariable adjustment applied, the nonlinear compared with linear Cox models provided a better model fit for both end points (P<0.001), irrespective of the period of the day and the calibration method of cSBP. Adding any 24-hour SBP to the base model increased the C statistics for total and cardiovascular mortality (0.003≤P≤0.06). Adding cSBPc1 or cSBPc2 to the base model extended by bSBP also increased the C statistics, but not by a statistically significant amount (0.054≤P≤0.22).
Conclusions:
cSBP compared with bSBP did not improve the associations with mortality. Measurement of the ambulatory bSBP is adequate for BP-based risk stratification.
Related Concept Videos
01:21Sites for measuring blood pressure
The Brachial Artery: Primary Site for Blood Pressure Measurement
01:23Assessment of blood pressure in brachial artery(two-step method)
01:15Assessment of blood pressure in brachial artery(one-step method)
Prepare for the Procedure:
01:17Measurement of Blood Pressure
01:10Pre-Procedural Guidelines for Assessing 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.