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J Am Coll Cardiol. 2013 Nov 5;62(19):1780-7. doi: 10.1016/j.jacc.2013.06.029. Epub 2013 Jul 10.

Derivation and validation of diagnostic thresholds for central blood pressure measurements based on long-term cardiovascular risks.

Author information

1
Joanna Briggs Institute, Faculty of Health Sciences, The University of Adelaide, Adelaide, Australia; Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan; Cardiovascular Research Center, National Yang-Ming University, Hospital, Taipei, Taiwan; Department of Medicine, National Yang-Ming University, Taipei, Taiwan.

Abstract

OBJECTIVES:

This study sought to derive and validate outcome-driven thresholds of central blood pressure (CBP) for diagnosing hypertension.

BACKGROUND:

Current guidelines for managing patients with hypertension mainly rely on blood pressure (BP) measured at brachial arteries (cuff BP). However, BP measured at the central aorta (central BP [CBP]) may be a better prognostic factor for predicting future cardiovascular events than cuff BP.

METHODS:

In a derivation cohort (1,272 individuals and a median follow-up of 15 years), we determined diagnostic thresholds for CBP by using current guideline-endorsed cutoffs for cuff BP with a bootstrapping (resampling by drawing randomly with replacement) and an approximation method. To evaluate the discriminatory power in predicting cardiovascular outcomes, the derived thresholds were tested in a validation cohort (2,501 individuals with median follow-up of 10 years).

RESULTS:

The 2 analyses yielded similar diagnostic thresholds for CBP. After rounding, systolic/diastolic threshold was 110/80 mm Hg for optimal BP and 130/90 mm Hg for hypertension. Compared with optimal BP, the risk of cardiovascular mortality increased significantly in subjects with hypertension (hazard ratio: 3.08, 95% confidence interval: 1.05 to 9.05). Of the multivariate Cox proportional hazards model, incorporation of a dichotomous variable by defining hypertension as CBP ≥ 130/90 mm Hg was associated with the largest contribution to the predictive power.

CONCLUSIONS:

CBP of 130/90 mm Hg was determined to be the cutoff limit for normality and was characterized by a greater discriminatory power for long-term events in our validation cohort. This report represents an important step toward the application of the CBP concept in clinical practice.

KEYWORDS:

BP; CBP; CI; DBP; PP; SBP; blood pressure; central blood pressure; confidence interval; cuff BP; diagnostic thresholds; diastolic blood pressure; high blood pressure; hypertension; peripheral blood pressure; pulse pressure; systolic blood pressure

PMID:
23850921
PMCID:
PMC3884552
DOI:
10.1016/j.jacc.2013.06.029
[Indexed for MEDLINE]
Free PMC Article
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