Prediction of cardiovascular events in short-term follow-up: comparison of brachial and central aortic blood pressure

Objectives: Central aortic pressure can have stronger association with cardiac and cerebral function and may provide additional information compared to peripheral blood pressure. The aim of this study was to assess indices of central and peripheral pressure for prediction of cardiovascular events over a relatively short mean follow-up period of approximately 2 years. Methods: The study cohort of 668 patients (age 61 ± 9 years, 425 males, mean follow-up period 25 ± 3.9 months) was drawn from hospital in-patients with primary hypertension. Intima-media thickness (IMT), carotid–femoral pulse wave velocity, central aortic and brachial pressure, augmentation index (Aix), and augmentation pressure (AP) (SphygmoCor) were measured noninvasively. Results: With adjustment for confounding factors, central systolic (cSP) and pulse pressure (cPP) showed higher hazard ratios (HR/10 mm Hg) for cardiovascular events compared to peripheral pressure indices (pSP, pPP) at age > 60 years (cSP: HR = 1.18, pSP: HR = 1.17, p = 0.034; cPP: HR = 1.28 pPP, HR = 1.2 p = 0.019), each SD increase in IMT and in AP was associated with 1.4 times higher risk of increased total events in older patients. For males, each SD increase in AP was associated with a 1.36 times higher risk of increased total events. For females, each SD decrease in central aortic AIx and AP was associated with 0.4 and 0.5 times lower risk of increased total and major cardiovascular events, respectively. This sex difference is most likely due to lack of age-related increase of AIx in females after age >60 years compared to males. Conclusion: In this longitudinal study, central aortic pressure improved prediction of CV events compared to peripheral pressure during a short-term follow up approximately 2 years for age 60 > years.