Central vs. Brachial Blood Pressure and Pulse Pressure Amplification for Mortality Risk Prediction in Patients Undergoing Coronary Angiography

• Published in: American journal of hypertension 2024-12
• Main Authors: Daschner, Clara, Kleber, Marcus E, Ayasse, Niklas, Stach, Ksenija, Yücel, Gökhan, Husain-Syed, Faeq, Niessner, Alexander, Krüger, Bernd, März, Winfried, Krämer, Bernhard K, Yazdani, Babak
• Format: Article
• Language: English
• ISSN: 0895-7061; 1941-7225; 1941-7225
• DOI: 10.1093/ajh/hpae156

Arterial hypertension is a significant risk factor for cardiovascular (CV) morbidity and mortality. Although central blood pressure (BP) evaluation is considered the gold standard, the reliability of non-invasive measurements remains unclear. Therefore, we compared the predictive value of invasively measured central BP with non-invasively measured brachial BP and analyzed pulse pressure (PP) amplification (delta-PP; difference between central and peripheral PP) as an independent predictor of mortality. We analyzed systolic (SBP), diastolic (DBP), mean arterial BP (MAP), PP and delta-PP as predictors of CV and all-cause mortality in the Ludwigshafen Risk and Cardiovascular Health (LURIC) study, involving 3316 patients referred for coronary angiography. All brachial BP parameters, except DBP, were significantly linked to all-cause and CV mortality in a univariate analysis. A 10 mmHg increase in SBP, MAP, and PP corresponded to increased risks of all-cause (11%, 10%, and 19%) and CV mortality (11%, 11%, and 18%). Central SBP and PP showed similar, but numerically weaker, associations with increased risks of all-cause (5% and 10%) and CV mortality (4% and 8%).After adjusting for age, sex, BMI, diabetes mellitus, and eGFR, only delta-PP independently predicted mortality with a 10 mmHg increase linked to a 4% reduction in all-cause and 6% reduction in CV mortality. Neither brachial nor centrally measured BP parameters were independent mortality predictors in contrast to PP amplification, which remained an independent predictor of mortality in multivariate analysis, in a cohort with a medium to high CV risk profile. As PP amplification decreased, mortality increased.