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Features and implications of higher systolic central than peripheral blood pressure in patients at very high risk of atherosclerotic cardiovascular disease

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Author(s)
Hyungseop KimIn-Cheol KimJongmin HwangCheol Hyun LeeYun-Kyeong ChoHyoung-Seob ParkJin-Wook ChungChang-Wook NamSeongwook HanSeung-Ho Hur
Keimyung Author(s)
Kim, Hyung SeopKim, In CheolHwang, Jong MinLee, Cheol HyunCho, Yun KyeongPark, Hyoung SeobChung, Jin-WookNam, Chang WookHan, Seong WookHur, Seung Ho
Department
Dept. of Internal Medicine (내과학)
Journal Title
J Hum Hypertens
Issued Date
2021
Volume
35
Issue
11
Abstract
Peripheral blood pressure (PBP) is usually higher than central blood pressure (CBP) due to pulse amplification; however, it is not well understood why cuff-measured PBP can be lower than CBP estimated by the late systolic pressure of radial pulse waves. We explored the implications of systolic PBP–CBP (P-CBP) differences for cardiovascular (CV) prognosis. In total, 335 patients at very high risk of atherosclerotic cardiovascular disease (ASCVD) underwent automated applanation tonometry and brachial-ankle pulse wave velocity (baPWV), and they were classified into groups according to positive or negative systolic P-CBP differences. Between-group characteristics and clinical outcomes (the composite of coronary revascularization, stroke, heart failure hospitalization, and CV death) were evaluated. Patients with negative differences had significantly higher frequency of hypertension, coronary artery disease, higher ASCVD risk burden, and elevated N-terminal pro b-type natriuretic peptide. They had higher left atrial volume index (LAVI) and lower systolic mitral septal tissue velocity (TVI-s') than those with a positive difference. These patients showed higher systolic PBP and CBP, and a higher baPWV. Multivariable analysis indicated that TVI-s', LAVI, and ASCVD risk burden were independent determinants of such systolic P-CBP differences. During a median follow-up of 12.6 months, clinical outcomes were significantly related to a negative difference (11.5% vs. 3.4%, p = 0.014), and a systolic P-CBP difference ≤ −8 mmHg was associated with a threefold higher likelihood of poor prognosis. In patients at very high risk of ASCVD, systolic P-CBP difference was associated with cardiac dysfunction and ASCVD risk burden, allowing further risk stratification.
Keimyung Author(s)(Kor)
김형섭
김인철
황종민
이철현
조윤경
박형섭
정진욱
남창욱
한성욱
허승호
Publisher
School of Medicine (의과대학)
Citation
Hyungseop Kim et al. (2021). Features and implications of higher systolic central than peripheral blood pressure in patients at very high risk of atherosclerotic cardiovascular disease. J Hum Hypertens, 35(11), 994–1002. doi: 10.1038/s41371-020-00472-6
Type
Article
ISSN
1476-5527
Source
https://www.nature.com/articles/s41371-020-00472-6
DOI
10.1038/s41371-020-00472-6
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/43839
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
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