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https://hdl.handle.net/2440/81218
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Type: | Journal article |
Title: | Derivation and validation of diagnostic thresholds for central blood pressure measurements based on long-term cardiovascular risks |
Author: | Cheng, H. Chuang, S. Sung, S. Yu, W. Pearson, A. Lakatta, E. Pan, W. Chen, C. |
Citation: | Journal of the American College of Cardiology, 2013; 62(19):1780-1787 |
Publisher: | Elsevier Science Inc |
Issue Date: | 2013 |
ISSN: | 0735-1097 1558-3597 |
Statement of Responsibility: | 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. |
DOI: | 10.1016/j.jacc.2013.06.029 |
Published version: | http://dx.doi.org/10.1016/j.jacc.2013.06.029 |
Appears in Collections: | Aurora harvest Medicine publications |
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