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Central Systolic Blood Pressure and Left Ventricular Mass: Findings From the International 24-Hour Aortic Blood
Kathrin Danninger1, Elpida Athanasopoulou2, Mohsen Agharazii3,4
1Cardiology Department Klinikum Wels-Grieskirchen Wels Austria.
Insights
Twenty-four-hour central systolic blood pressure (cSBP), calibrated using mean/diastolic pressure, strongly correlates with left ventricular mass index (LVMi) and hypertrophy. This measurement offers superior prediction of cardiac damage compared to brachial SBP, aiding hypertension management.
Area of Science:
- Cardiology
- Hypertension Research
- Ambulatory Blood Pressure Monitoring
Background:
- Central systolic blood pressure (cSBP) may better reflect organ pressure and hypertensive cardiac damage than brachial SBP.
- Twenty-four-hour ambulatory blood pressure monitoring offers deeper cardiovascular load insights.
- Investigating 24-hour cSBP's association with left ventricular mass index (LVMi) and hypertrophy is crucial.
Purpose of the Study:
- To assess the relationship between 24-hour central systolic blood pressure (cSBP) and left ventricular mass index (LVMi).
- To determine if 24-hour cSBP is a better predictor of left ventricular hypertrophy (LVH) than brachial SBP.
- To evaluate the clinical utility of central blood pressure monitoring in hypertension management.
Main Methods:
- Analysis of data from 2367 participants across 21 international centers.
- Noninvasive recording of 24-hour brachial and central SBPs using the Mobil-O-Graph device, with two calibration methods for cSBP (cSBP C1, cSBP C2).
- Echocardiographic derivation of LVMi and classification of BP phenotypes based on 24-hour brachial BPs, further stratified by cSBP.
Main Results:
- 24-hour cSBP C2 showed the strongest correlation with LVMi across diverse participant strata (P<0.001).
- 24-hour cSBP C2 demonstrated superior prediction of LV hypertrophy (AUC=0.68).
- Both brachial BP phenotype and central SBP status independently predicted LVMi, with 14.4% discordant classifications impacting LVMi.
Conclusions:
- 24-hour central SBP (cSBP C2) is more closely associated with LVMi and LV hypertrophy than brachial SBP.
- Central pressure monitoring, particularly cSBP C2, holds significant clinical value for risk assessment.
- Incorporating central pressure monitoring can enhance hypertension management strategies.
Background:
Central systolic blood pressure (cSBP) reflects the pressure experienced by vital organs and may be more closely related to hypertensive cardiac damage than brachial SBP. Twenty-four-hour ambulatory blood pressure monitoring provides additional insight into cardiovascular load beyond office readings. This study investigated the association of 24-hour cSBP, measured noninvasively with a validated device, with left ventricular mass index (LVMi) and LV hypertrophy.
Methods:
We analyzed data from 21 centers worldwide (n=2367; 45.5% women; mean age 49.5 years) participating in the International 24-Hour Aortic Blood Pressure Consortium. Brachial and central 24-hour SBPs were recorded using the Mobil-O-Graph device, calibrated by either systolic/diastolic (cSBP C1) or mean/diastolic (cSBP C2) pressure; LVMi was derived echocardiographically. BP phenotypes (normotension, isolated diastolic and systolic hypertension, and systolic-diastolic hypertension) were based on 24-hour brachial BPs, subdivided by cSBP.
Results:
LVMi correlated most strongly with 24-hour cSBP C2 (P<0.001) consistently, across sex, body mass index (BMI), age, and treatment strata. Receiver operating characteristic analysis showed superior prediction of LV hypertrophy for 24-hour cSBP C2 (area under the curve=0.68). Both brachial BP phenotype and central SBP status were independently associated with LVMi (P=0.0045 and <0.001, respectively), without interaction. Discordant classification occurred in 14.4% of participants and was linked to higher LVMi in normotension and lower LVMi in systolic-diastolic hypertension.
Conclusions:
Twenty-four-hour central SBP calibrated with oscillometric mean/diastolic pressure (cSBP C2), is more closely associated with LVMi and LV hypertrophy than brachial SBP. These findings highlight the potential clinical value of incorporating central pressure monitoring into risk assessment and hypertension management.
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01:17Measurement of Blood Pressure
01:24Blood Pressure
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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.
01:23Assessment of blood pressure in brachial artery(two-step method)