Central hemodynamics and the discrepancy between central blood pressure and brachial blood pressure.
Jin-Sun Park, Joon-Han Shin, Jeong-Bae Park, Dong-Ju Choi, Ho-Joong Youn, Chang-Gyu Park, Jun Kwan, Youngkeun Ahn, Dong-Woon Kim, Se-Joong Rim, Seung-Woo Park, Jidong Sung, Jang-Ho Bae, Korean Hypertension Research Network
Author Information
Jin-Sun Park: Department of Cardiology, Ajou University School of Medicine, Suwon, Korea. ORCID
Joon-Han Shin: Department of Cardiology, Ajou University School of Medicine, Suwon, Korea.
Jeong-Bae Park: JB Lab and Clinic, Seoul, Korea.
Dong-Ju Choi: Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea.
Ho-Joong Youn: Cardiovascular center and Cardiology Division, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Chang-Gyu Park: Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea.
Jun Kwan: Department of Cardiology, Inha University College of Medicine, Incheon, Korea.
Youngkeun Ahn: Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea.
Dong-Woon Kim: Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital and Chungbuk National University College of Medicine, Cheongju, Korea.
Se-Joong Rim: Division of Cardiology, Department of Internal Medicine, Yonsei University College Medicine, Seoul, Korea.
Seung-Woo Park: Division of Cardiology, Heart Vascular and Stroke Institute, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Jidong Sung: Division of Cardiology, Heart Vascular and Stroke Institute, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Jang-Ho Bae: Department of Cardiology, Heart Center, College of Medicine, Konyang University, Deajeon, Korea.
Despite similar brachial blood pressure, central hemodynamics could be different. The objective of the present study was to investigate the factors, which could influence the discrepancy between central BP (cBP) and brachial blood pressure. Six hundred forty-seven patients (364 males, 48 ± 12 years old) were enrolled. Using applanation tonometry, cBP was noninvasively derived. The median difference between brachial systolic BP (bSBP) and central systolic BP (cSBP) was 8 mm Hg. We defined the discrepancy between bSBP and cSBP as differences >8 mm Hg. For adjustment of cBP, population was divided into 3 groups according to the cBP: group 1, <140 mm Hg of cSBP; group 2, 140 > cSBP < 160 mm Hg; group 3, =160 mm Hg of cSBP. All the central hemodynamic parameters of the patients, including augmentation pressure, augmentation index (AI), heart rate (75 bpm) adjusted augmentation index (AI@HR75), and subendocardial viability ratio, were measured. Using multivariate logistic regression analysis, we evaluated the factors which could influence the discrepancy between bSBP and cSBP. Age, gender, augmentation pressure, AI, and AI@HR75 were correlated with the discrepancy between bSBP and cSBP. AI@HR75 was significantly correlated with the discrepancy between bSBP and cSBP (β-coefficient = -0.376, P < .001 in group 1; β-coefficient = -0.297, P < .001 in group 2; and β-coefficient = -0.545, P < .001 in group 3). In groups 1 and 2, male gender was significantly correlated with the discrepancy between bSBP and cSBP (β-coefficient = -0.857, P = .035 in group 1; β-coefficient = -1.422, P = .039 in group 2). In present study, arterial stiffness might affect the discrepancy between bSBP and cSBP. Also, male gender was closely related to the discrepancy between bSBP and cSBP especially with cSBP <160 mm Hg. Not only cSBP, the discrepancy between cSBP and bSBP should be considered for understanding the central hemodynamics.
References
Pauca AL, Wallenhaupt SL, Kon ND, Tucker WY. Does radial artery pressure accurately reflect aortic pressure? Chest. 1992;102:1193–8.
Williams B, Lacy PS, Thom SM, et al. Differential impact of blood pressure-lowering drugs on central aortic pressure and clinical outcomes: principal results of the Conduit Artery Function Evaluation (CAFE) study. Circulation. 2006;113:1213–25.
O’Rourke MF, Vlachopoulos C, Graham RM. Spurious systolic hypertension in youth. Vasc Med. 2000;5:141–5.
Hulsen HT, Nijdam ME, Bos WJ, et al. Spurious systolic hypertension in young adults; prevalence of high brachial systolic blood pressure and low central pressure and its determinants. J Hypertens. 2006;24:1027–32.
Herbert A, Cruickshank JK, Laurent S, et al. Establishing reference values for central blood pressure and its amplification in a general healthy population and according to cardiovascular risk factors. Eur Heart J. 2014;35:3122–33.
Wilkinson IB, Franklin SS, Hall IR, et al. Pressure amplification explains why pulse pressure is unrelated to risk in young subjects. Hypertension. 2001;38:1461–6.
Karamanoglu M, O’Rourke MF, Avolio AP, Kelly RP. An analysis of the relationship between central aortic and peripheral upper limb pressure waves in man. Eur Heart J. 1993;14:160–7.
Morgan T, Lauri J, Bertram D, Anderson A. Effect of different antihypertensive drug classes on central aortic pressure. Am J Hypertens. 2004;17:118–23.
ESH/ESC Task Force for the Management of Arterial Hypertension. 2013 Practice guidelines for the management of arterial hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC): ESH/ESC task force for the management of arterial hypertension. J Hypertens. 2013;31:1925–38.
Pauca AL, O’Rourke MF, Kon ND. Prospective evaluation of a method for estimating ascending aortic pressure from the radial artery pressure waveform. Hypertension. 2001;38:932–7.
Chen CH, Nevo E, Fetics B, et al. Estimation of central aortic pressure waveform by mathematical transformation of radial tonometry pressure. Validation of generalized transfer function. Circulation. 1997;95:1827–36.
Wilkinson IB, MacCallum H, Flint L, et al. The influence of heart rate on augmentation index and central arterial pressure in humans. J Physiol. 2000;525(Pt 1):263–70.
Chemla D, Nitenberg A, Teboul JL, et al. Subendocardial viability ratio estimated by arterial tonometry: a critical evaluation in elderly hypertensive patients with increased aortic stiffness. Clin Exp Pharmacol Physiol. 2008;35:909–15.
Asmar RG, London GM, O’Rourke ME, Safar ME. Improvement in blood pressure, arterial stiffness and wave reflections with a very-low-dose perindopril/indapamide combination in hypertensive patient: a comparison with atenolol. Hypertension. 2001;38:922–6.
Boutouyrie P, Lacolley P, Briet M, et al. Pharmacological modulation of arterial stiffness. Drugs. 2011;71:1689–701.
Willum-Hansen T, Staessen JA, Torp-Pedersen C, et al. Prognostic value of aortic pulse wave velocity as index of arterial stiffness in the general population. Circulation. 2006;113:664–70.
Laurent S, Katsahian S, Fassot C, et al. Aortic stiffness is an independent predictor of fatal stroke in essential hypertension. Stroke. 2003;34:1203–6.
Park JS, Choi UJ, Lim HS, et al. The Relationship between coronary artery calcification as assessed by multi-detector computed tomography and arterial stiffness. Clin Exp Hypertens. 2011;33:501–5.
Park S, Ha JW, Shim CY, et al. Gender-related difference in arterial elastance during exercise in patients with hypertension. Hypertension. 2008;51:1163–9.
Shim CY, Park S, Choi D, et al. Sex differences in central hemodynamics and their relationship to left ventricular diastolic function. J Am Coll Cardiol. 2011;57:1226–33.
Spaczyński RZ, Mitkowska A, Florczak M, et al. Decreased large-artery stiffness in midluteal phase of the menstrual cycle in healthy women of reproductive age. Ginekol Pol. 2014;85:771–7.
Adkisson EJ, Casey DP, Beck DT, et al. Central, peripheral and resistance arterial reactivity: fluctuates during the phases of the menstrual cycle. Exp Biol Med (Maywood). 2010;235:111–8.
Cheng HM, Chuang SY, Sung SH, et al. Derivation and validation of diagnostic thresholds for central blood pressure measurements based on long-term cardiovascular risks. J Am Coll Cardiol. 2013;62:1780–7.
