Hypertension still remains the main cardiovascular risk factor. Given its high prevalence, identification of patients with the higher risk of facing a cardiovascular event (CVE) is matter of concern. Several tools have been proposed. In particular ambulatory blood pressure (BP) measurement has proven its superiority to office BP but other parameters like arterial stiffness measurement as well as central BP may contribute to a better risk level assessment. To date, there is no data about the potential interest of 24-H non invasive central BP recording for CVE prediction.Objective:
Objective: To evaluate the interest of ambulatory central BP measurements compared to ambulatory peripheral BP and arterial stiffness measurements for cardiovascular events prediction in hypertensive patients.Design and method:
Young patients (age < 60 years) from the Bordeaux Hypertensive cohort were included. CVE were defined as stroke, acute coronary event, heart failure and cardiovascular mortality. At baseline, all patients had a 24-H recording of their central and peripheral BP as well as their arterial stiffness using the QKD interval method.Results:
593 subjects (342 males, mean age = 47 ± 10 years) were followed up for 10 ± 6 years. The mean 24 h peripheral systolic BP 130 ± 15 mmHg and pulse pressure (PP) (43 ± 10 mmHg) were as expected higher than 24 h mean aortic systolic (125 ± 16 mmHg) and PP (38 ± 7 mmHg). 70 CVE occurred. In multivariable cox model analysis, including age, sex, average 24 h peripheral pulse pressure, smoking status, dyslipidemia, diabetes mellitus and arterial stiffness, the average central pulse pressure remains statically significant for cardiovascular events prediction (p < 0.05).Conclusions:
Central pulse pressure over 24H is a powerful predictor of cardiovascular risk independent of peripheral pulse pressure and arterial stiffness. These new data, if confirmed by others, should accelerate the use of the central parameters for cardiovascular risk management.