Clinical and Cardiometabolic Characteristics Associated with Elevated Office Central Systolic Blood Pressure in Individuals with Normal Brachial Systolic Blood Pressure

Abstract Background Residual cardiovascular risk may persist despite normal or controlled office brachial systolic blood pressure (b-SBP). Central systolic blood pressure (c-SBP) may provide complementary information on haemodynamic load not fully captured by b-SBP. We investigated whether elevated office c-SBP despite normal b-SBP identifies individuals with a less favorable cardiometabolic and vascular profile. Methods We performed a cross-sectional analysis of 3,395 adults with office b-SBP < 140. Elevated c-SBP was defined ≥ 130 mmHg.Clinical characteristics, cardiovascular risk factors, Mobil-O-Graph-derived estimated pulse wave velocity (ePWV), carotid plaque prevalence and total carotid plaque area (TCPA) were compared. Results Elevated office central SBP was present in 271 participants (8.0%). Compared with participants with central SBP < 130 mmHg, those with elevated central SBP were older, had higher body mass index, and more frequently had diagnosis of hypertension and diabetes. They also had higher e-cfPWV (8.20 ± 1.40 vs. 7.40 ± 1.43 m/s; p < 0.001), a modestly higher prevalence of carotid plaque (68.3% vs. 62.1%; p = 0.050), and larger median TCPA (21.1 vs. 14.0 mm²; p = 0.014). Elevated office c-SBP despite normal b-SBP was associated with carotid plaque in the unadjusted model (OR 1.31, 95% CI 1.01–1.72; p = 0.044), but not after adjustment for conventional cardiovascular risk factors (OR 1.13, 95% CI 0.82–1.56; p = 0.462) or after further adjustment for brachial SBP (OR 0.86, 95% CI 0.61–1.22; p = 0.403). Conclusion Elevated office c-SBP despite normal b-SBP identifies individuals with a less favorable cardiometabolic and haemodynamic profile. Although its association with carotid atherosclerosis was not independent of conventional cardiovascular risk factors and b-SBP, these findings, together with previous longitudinal evidence, raise the possibility that c-SBP may provide clinically relevant information not fully captured by office b-SBP alone. Prospective studies are warranted to determine its incremental prognostic value for cardiovascular and cerebrovascular outcomes.