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Comparison between Central and Peripheral Pulse Pressure as Determinants of Intermediate Cardiovascular PhenotypesC Delles, U Neisius, G Bilo, C Taurino, JD McClure, MP Schneider,K Kawecka-Jaszcz, K Stolarz-Skrzypek, Ł Klima, JA Staessen,T Kuznetsova, J Redon, F Martinez, E Agabiti Rosei, O Melander,F Zannad, P Rossignol, S Laurent, C Collin, L Lonati,A Zanchetti, AF Dominiczak
BHF Glasgow Cardiovascular Research CentreInstitute of Cardiovascular and Medical SciencesUniversity of Glasgow
Cardiovascular ContinuumBlood Pressure Determines Cardiovascular Risk
Prospective Studies Collaboration. Lancet 2002
Cardiovascular ContinuumPulse Pressure Refines Cardiovascular Risk
Franklin SS et al. Circulation 1999
Cardiovascular Continuum
Franklin SS et al. Circulation 2001
Pulse Pressure Refines Cardiovascular Risk
Cardiovascular ContinuumQuestion
Is central blood pressure a better predictor of cardiovascular riskthan peripheral blood pressure
in young to middle-aged people?
Cardiovascular ContinuumQuestion
Is central v pulse v pressure a better predictor of cardiovascular riskthan peripheral v pulse v pressure
in young to middle-aged people?
Cardiovascular ContinuumQuestion
Is central v pulse v pressure a better predictor of intermediate CV phenotypes
than peripheral v pulse v pressurein young to middle-aged people?
Cardiovascular ContinuumInGenious HyperCare
10
1112
13 1417 16 15
98
1-37 64
29
518 21
19
20
22
23
24
2526-27
30
31
10
1112
13 1417 16 15
98
1-37 64
29
518 21
19
20
22
23
24
2526-27
30
31
Index Patient
• Hypertension diagnosed < 50 years• Caucasian• Age 18-60• Index patient on treatment with ≥ 2 drugs or
SBP ≥ 160 • DBP ≥ 95 on two different occasions if
untreated • At least three 1st degree relatives of whom at
least one should be affected (< 50 years ) and at least one from a different generation
Cardiovascular ContinuumPatients
Hypertensive n=331
Normotensive n=204
P-value
Age, years 51±15 39±16 <0.001 Sex, male/female 156/175 85/119 0.026 Height, cm 168±9 168±9 ns Weight, kg 79.6 [70.0;91.0] 70.9 [61.5;82.2] <0.001 BMI, kg/m² 27.7 [25.0;31.4] 24.9 [22.0;28.4] <0.001 Sitting pSBP, mmHg 141±16 128±14 <0.001 Sitting pDBP, mmHg 85±10 78±9 <0.001 Sitting Heart rate, /min 69±12 71±10 ns Coronary heart disease, % 4.4 2.0 0.02 Creatinine, μmol/L 78 [64;87] 72 [62; 83] 0.01 eGFR, mL/min 89±21 99±25 <0.001 Diabetes mellitus, % 10.0 3.0 <0.001 Supine pSBP, mmHg 135 [125;146] 126 [117;135] <0.001 Supine pDBP, mmHg 81±11 76±9 <0.001 Supine cSBP, mmHg 123 [114;135] 113 [102;124] <0.001 Supine cDBP, mmHg 82±11 77±10 <0.001 Supine pPP, mmHg 54 [46;63] 49 [43;57] <0.001 Supine cPP, mmHg 42 [35;50] 34 [29;43] <0.001 C-IMT, mm 0.62 [0.52;0.75] 0.55 [0.48;0.65] <0.001 LVMI, g/m².7 41.6 [35.4;49.0] 35.4 [30.5;41.5] <0.001 PWV, m/s 8.12 [7.08;9.70] 7.00 [6.10;7.88] <0.001 ACR, mg/mmol 0.74 [0.48;1.28] 0.69 [0.39;1.17] ns
Cardiovascular ContinuumMethods
• Blood pressure (Omron)• Pulse wave analysis (mostly SphygmoCor)• Pulse wave velocity (mostly SphygmoCor)• Carotid intima-media thickness• Echocardiography• Urinary albumin:creatinine ratio
Cardiovascular ContinuumPulse Pressure and Age
Decade
cP
P/p
PP
ns
ns
ns
ns ns ns
HypertensivesNormotensives
Cardiovascular ContinuumUnivariate Analysis
Central Pulse Pressure Peripheral Pulse Pressure lo
g(p
uls
ew
ave
vel
oci
ty)
r = 0.471
P < 0.001
r = 0.372
P < 0.001
A B
log
(in
tim
a-m
ed
ia t
hic
kne
ss)
r = 0.426P < 0.001
r = 0.235P < 0.001
C D
log(central pulse pressure) log(peripheral pulse pressure)
log
(LV
MI)
r = 0.385P < 0.001
r = 0.189P < 0.001
FE
log
(AC
R)
G H
r = 0.236P < 0.001
r = 0.226P < 0.001
Cardiovascular ContinuumUnivariate Analysis
Central Pulse Pressure Peripheral Pulse Pressure lo
g(p
uls
ew
ave
vel
oci
ty)
r = 0.471
P < 0.001
r = 0.372
P < 0.001
A B
log
(in
tim
a-m
ed
ia t
hic
kne
ss)
r = 0.426P < 0.001
r = 0.235P < 0.001
C D
log(central pulse pressure) log(peripheral pulse pressure)
log
(LV
MI)
r = 0.385P < 0.001
r = 0.189P < 0.001
FE
log
(AC
R)
G H
r = 0.236P < 0.001
r = 0.226P < 0.001
Cardiovascular ContinuumMultivariate Analysis
Central Peripheral
β P-value β P-value
log(PWV)
R2adj 0.399 0.413
Hypertension, (yes/no) 0.112 0.003 0.086 0.020
Heart Rate, bpm 0.128 0.001 0.098 0.009
Age, yrs 0.460 <0.001 0.515 <0.001
MAP, mmHg 0.089 0.044 0.111 0.006
log(PP) 0.226 <0.001 0.220 <0.001
Cardiovascular ContinuumMultivariate Analysis
Central Peripheral
β P-value β P-value
log(C-IMT)
R2adj 0.429 0.428
Age, yrs 0.598 <0.001 0.633 <0.001
log(PP) 0.097 0.020 0.076 0.037
log(LVMI)
R2adj 0.181 0.170
Age, yrs 0.318 <0.001 0.386 <0.001
log(PP) 0.160 0.002 0.085 0.051
Summary
• Central pulse pressure is more strongly correlated with intermediate cardiovascular phenotypes than peripheral pulse pressure.
• In a young to middle-aged cohort of normotensive and well-controlled hypertensive subjects, age is the major determinant of intermediate cardiovascular phenotypes.
• When adjusted for relevant cofactors including age, models containing either cPP or pPP predict intermediate cardiovascular phenotypes equally well.
• Limitations: cross-sectional design, case-control design and family structure.
Perspective and Clinical Relevance
• Assessment of central haemodynamic parameters provides an integrated view on blood pressure and other determinants of cardiovascular phenotypes.
• Our data do not support the notion that central blood pressure is a superior determinant of risk than peripheral blood pressure if age is taken into account.
• Large and prospective studies on the use of central haemodynamic parameters in clinical practice are still required – and under way.
Cardiovascular ContinuumResults by Gender
gender
FemaleMale
200
150
100
50
0
age (years)cPP (mmHg)pPP (mmHg)PWV (dm/s)C-IMT (10-2 mm)LVMI (g/m2.7)4
Cardiovascular ContinuumBlood Pressure and Cardiovascular Risk
Prospective Studies Collaboration. Lancet 2002
Central BP and Antihypertensive Treatment
Williams B et al. Circulation 2006
Atenolol basedAmlodipine based
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