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|Title:||Derivation and validation of diagnostic thresholds for central blood pressure measurements based on long-term cardiovascular risks|
|Citation:||Journal of the American College of Cardiology, 2013; 62(19):1780-1787|
|Publisher:||Elsevier Science Inc|
|Hao-Min Cheng, Shao-Yuan Chuang, Shih-Hsien Sung, Wen-Chung Yu, Alan Pearson, Edward G. Lakatta, Wen-Harn Pan, Chen-Huan Chen|
|Abstract:||<h4>Objectives</h4>This study sought to derive and validate outcome-driven thresholds of central blood pressure (CBP) for diagnosing hypertension.<h4>Background</h4>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.<h4>Methods</h4>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).<h4>Results</h4>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.<h4>Conclusions</h4>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:||central blood pressure; diagnostic thresholds; high blood pressure; hypertension|
|Rights:||Copyright © 2013 American College of Cardiology Foundation.|
|Appears in Collections:||Medicine publications|
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