Journal
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
Volume 62, Issue 19, Pages 1780-1787Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jacc.2013.06.029
Keywords
central blood pressure; diagnostic thresholds; high blood pressure; hypertension
Categories
Funding
- National Science Council [NSC 96-2314-B-010-035-MY3]
- Taipei Veterans General Hospital [V98C1-028]
- Research Foundation of Cardiovascular Medicine (Taipei, Taiwan, Republic of China)
- Research and Development [NO1-AG-1-2118]
- Intramural Research Program of the National Institute on Aging, National Institutes of Health, National Health Research Institutes in Taiwan [NHRI-EX93-9225PP, NHRI-EX94-9225PP, PH-102-PP-19, NSC 5-2314-B-001-012-MY3, NSC 102-2314-B-400-001]
- Department of Health in Taiwan [DOH80-2, DOH81-021, DOH8202-1027, DOH83-TD-015, DOH-84TD-006]
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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. (C) 2013 by the American College of Cardiology Foundation
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