It is not established whether central blood pressure (CBP), evaluated by radial pulse wave analysis, is useful to predict cardiovascular prognosis in treated hypertensives. We tested the hypothesis that CBP predicts future cardiovascular events in treated hypertensives.Design and Method:
This study is the main analysis of the ABC-J follow-up study which was conducted to evaluate the predictive values of central BP for cardiovascular events in Japanese treated hypertensives from 27 institutions in Japan. The study design was a prospective, observational cohort study, and a total of 3,564 subjects were analyzed. Radial pulse wave analyses using applanation tonometry (HEM-9000AI, Omron Health Care) were performed. The primary outcomes were: cerebrovascular disease, fatal and nonfatal myocardial infarction, sudden cardiac death, acute aortic dissection, and fatal arrhythmic events. The final diagnoses were determined by the event committee.Results:
The mean age was 66.0 ± 10.9 yrs, and 50.7% were male. The mean brachial BP and central BP were 138 ± 18 mmHg, and 128 ± 19 mmHg. When the central SBP was divided into quintiles (1st: 73.0–111.7; 2nd: 112.0–122.6; 3rd: 122.7–131.0; 4th: 132.0–142.5; 5th: 143.0–215.0 mmHg), the number of events was least in the 2nd quintile and set it as the reference. In Cox regression analysis adjusting for age, sex, BMI, creatinine, diabetes, use of beta-blocker, and histories of MI/stroke, the groups with 3rd [Hazard ratio (HR) 3.43, 95%CI 1.24–9.49, P = 0.017], 4th (HR 3.96, 1.47–10.7, P = 0.007), and 5th quintiles (HR 3.01, 1.07–8.49, P = 0.038) had significantly higher incidence of cardiovascular events compared to the 2nd quintile. The results essentially unchanged when brachial DBP was additionally adjusted. When the same analysis was performed with the quintiles of brachial SBP, only the group with 4th quintile was associated with higher incidence of cardiovascular disease (HR 3.88, 1.59–9.45, P = 0.003).Conclusions:
In treated hypertensives, higher central SBP was associated with worse cardiovascular outcomes.