CENTRAL AORTIC PRESSURE IMPROVES PREDICTION OF CARDIOVASCULAR EVENTS COMPARED TO BRACHIAL BLOOD PRESSURE IN 14-YEAR FOLLOW-UP OF A HYPERTENSIVE COHORT

Objective: the purpose of this study was to assess components of central aortic pressure (cBP), brachial blood pressure (bBP) and indices of arterial stiffness for prediction of cardiovascular events in a hypertensive cohort. Design and method: A total of 850 hypertensive patients was enrolled in the study between July 2007 and October 2023 from the Department of Hypertension, Ruijin Hospital, Shanghai, China. Noninvasive measurements of cBP (SphygmoCor), bBP, central augmentation index (cAIx), augmented pressure (cAP), carotid-femoral pulse wave velocity (cf-PWV) and and carotid intima-media thickness (IMT) were obtained in 681 patients for 14-year follow-up (age 61 ± 9 years, 425 males). The primary end-point of cardiovascular events was defined as nonfatal ischemic or hemorrhagic stroke and myocardial infarction or death from cardiovascular disease. Cox proportional hazards models were used to evaluate the predictive value of central and peripheral systolic BP (cSBP, bSBP) and pulse pressure (cPP, bPP). Results: For the 14-year follow-up, total and major cardiovascular events were 265 (38.7%) and 178 (26.1%) respectively. Major cardiovascular events were higher in male than in female (p = 0.038) but no difference for cerebrovascular events (p = 0.201. bPP and bSBP were similar for male and female (p > 0.05) but cSBP, cPP, cAP, cAIX were higher in female. After adjusting for confounding factors (age, sex, smoking, body mass index, use of antihypertensive drugs, heart rate, presence of lipidemia and diabetes, heart), cSBP cPP showed higher hazard ratios (HR/10mmHg) for major cardiovascular events compared to peripheral pressure indices (pSBP, pPP) at age > 60 years (cSBP: HR = 1.103, pSBP: HR = 1.102, [p = 0.029]; cPP: HR = 1.138, pPP: HR = 1.016, [p = 0.037]). Each SD increase in c-fPWV (3m/s) was associated with 17.3% (1.016-1.353, [p = 0.029]) increase in older male major cardiovascular events. Conclusions: cf-PWV was found to be a potential biomarker of hypertension in male at age > 60 years. cBP improved prediction of CVD compared to bBP at age > 60years with hypertension, with cPP being an independent predictor of cardiovascular events at 14-year follow-up.