Mitchell Gary F, Hwang Shih-Jen, Larson Martin G, Hamburg Naomi M, Benjamin Emelia J, Vasan Ramachandran S, Levy Daniel, Vita Joseph A
aCardiovascular Engineering, Inc., Norwood bBoston University and NHLBI's Framingham Study, Framingham, Massachusetts cPopulation Sciences Branch, National Heart, Lung, and Blood Institute, Bethesda, Maryland dBiostatistics Department, Boston University School of Public Health eEvans Department of Medicine fWhitaker Cardiovascular Institute gSection of Preventive Medicine, Boston University School of Medicine hDepartment of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA *Joseph A. Vita deceased.
J Hypertens. 2016 Aug;34(8):1528-34. doi: 10.1097/HJH.0000000000000968.
Relations between central pulse pressure (PP) or pressure amplification and major cardiovascular disease (CVD) events are controversial. Estimates of central aortic pressure derived using radial artery tonometry and a generalized transfer function may better predict CVD risk beyond the predictive value of brachial SBP.
Augmentation index, central SBP, central PP, and central-to-peripheral PP amplification were evaluated using radial artery tonometry and a generalized transfer function as implemented in the SphygmoCor device (AtCor Medical, Itasca, Illinois, USA). We used proportional hazards models to examine relations between central hemodynamics and first-onset major CVD events in 2183 participants (mean age 62 years, 58% women) in the Framingham Heart Study.
During median follow-up of 7.8 (limits 0.2-8.9) years, 149 participants (6.8%) had an incident event. Augmentation index (P = 0.6), central aortic systolic pressure (P = 0.20), central aortic PP (P = 0.24), and PP amplification (P = 0.15) were not related to CVD events in multivariable models that adjusted for age, sex, brachial cuff systolic pressure, use of antihypertensive therapy, total and high-density lipoprotein cholesterol concentrations, smoking, and presence of diabetes. In a model that included standard risk factors, model fit was improved (P = 0.03) when brachial systolic pressure was added after central, whereas model fit was not improved (P = 0.30) when central systolic pressure was added after brachial.
After considering standard risk factors, including brachial cuff SBP, augmentation index, central PP and PP amplification derived using radial artery tonometry, and a generalized transfer function were not predictive of CVD risk.
中心脉压（PP）或压力放大与主要心血管疾病（CVD）事件之间的关系存在争议。使用桡动脉压平法和广义传递函数得出的中心主动脉压估计值，可能比肱动脉收缩压（SBP）的预测价值能更好地预测CVD风险。
使用桡动脉压平法和广义传递函数（如SphygmoCor设备[美国伊利诺伊州伊塔斯卡的AtCor Medical公司]所采用的）评估增强指数、中心SBP、中心PP以及中心到外周的PP放大。我们采用比例风险模型，在弗雷明汉心脏研究的2183名参与者（平均年龄62岁，58%为女性）中，研究中心血流动力学与首次发生的主要CVD事件之间的关系。
在中位随访7.8（范围0.2 - 8.9）年期间，149名参与者（6.8%）发生了事件。在对年龄、性别、肱动脉袖带收缩压、抗高血压治疗的使用、总胆固醇和高密度脂蛋白胆固醇浓度、吸烟以及糖尿病的存在进行校正的多变量模型中，增强指数（P = 0.6）、中心主动脉收缩压（P = 0.20）、中心主动脉PP（P = 0.24）和PP放大（P = 0.15）与CVD事件无关。在一个包含标准风险因素的模型中，当在纳入中心指标后加入肱动脉收缩压时，模型拟合得到改善（P = 0.03），而当在纳入肱动脉指标后加入中心收缩压时，模型拟合未得到改善（P = 0.30）。
在考虑包括肱动脉袖带SBP在内的标准风险因素后，使用桡动脉压平法和广义传递函数得出的增强指数、中心PP和PP放大并不能预测CVD风险。
