Central pressure more strongly relates to vascular disease and outcome than does brachial pressure

The strong heart study

Mary J. Roman, Richard B. Devereux, Jorge Kizer, Elisa T. Lee, James M. Galloway, Tauqeer Ali, Jason G. Umans, Barbara V. Howard

Research output: Contribution to journalArticle

802 Citations (Scopus)

Abstract

Brachial blood pressure is predictive of cardiovascular outcome; however central pressure may better represent the load imposed on the coronary and cerebral arteries and thereby bear a stronger relationship to vascular damage and prognosis. Relations of brachial and central pressures to carotid artery hypertrophy (intimal-medial thickness and vascular mass), extent of atherosclerosis (plaque score), and incident cardiovascular events were examined in the Strong Heart Study. Central pressures were calculated using radial applanation tonometry. Among 3520 participants, central and brachial pulse pressures were more strongly related to vascular hypertrophy and extent of atherosclerosis than were systolic pressures. Central pulse pressure was more strongly related to all 3 arterial measures than was brachial pulse pressure (r=0.364 versus 0.309 for plaque score; P<0.001 for comparison of Spearman correlation coefficient; r=0.293 versus 0.249 for intimal-medial thickness; P<0.002; r=0.320 versus 0.289 for vascular mass; P<0.05). Among the 2403 participants free of clinical cardiovascular disease at baseline, 319 suffered fatal or nonfatal cardiovascular events during mean follow-up of 4.8±1.3 years. After adjustment for age, gender, current smoking, body mass index, cholesterol:HDL ratio, creatinine, fibrinogen, diabetes, and heart rate, central pulse pressure predicted cardiovascular events more strongly than brachial pulse pressure (hazards ratio=1.15 per 10 mm Hg, χ=13.4, P<0.001 versus hazards ratio=1.10, χ=6.9, P=0.008). In conclusion, noninvasively-determined central pulse pressure is more strongly related to vascular hypertrophy, extent of atherosclerosis, and cardiovascular events than is brachial blood pressure. These findings support prospective examination of use of central blood pressure as a treatment target in future trials.

Original languageEnglish (US)
Pages (from-to)197-203
Number of pages7
JournalHypertension
Volume50
Issue number1
DOIs
StatePublished - Jul 2007
Externally publishedYes

Fingerprint

Vascular Diseases
Arm
Blood Pressure
Pressure
Blood Vessels
Tunica Intima
Hypertrophy
Atherosclerosis
Cerebral Arteries
Manometry
Carotid Arteries
Fibrinogen
HDL Cholesterol
Creatinine
Coronary Vessels
Body Mass Index
Cardiovascular Diseases
Heart Rate
Smoking

Keywords

  • Arterial stiffness
  • Atherosclerosis
  • Blood pressure

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Central pressure more strongly relates to vascular disease and outcome than does brachial pressure : The strong heart study. / Roman, Mary J.; Devereux, Richard B.; Kizer, Jorge; Lee, Elisa T.; Galloway, James M.; Ali, Tauqeer; Umans, Jason G.; Howard, Barbara V.

In: Hypertension, Vol. 50, No. 1, 07.2007, p. 197-203.

Research output: Contribution to journalArticle

Roman, Mary J. ; Devereux, Richard B. ; Kizer, Jorge ; Lee, Elisa T. ; Galloway, James M. ; Ali, Tauqeer ; Umans, Jason G. ; Howard, Barbara V. / Central pressure more strongly relates to vascular disease and outcome than does brachial pressure : The strong heart study. In: Hypertension. 2007 ; Vol. 50, No. 1. pp. 197-203.
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