Department of Cardiology and Hypertension, Bordeaux University Hospital, Bordeaux, France
University of Bordeaux, INSERM, Bordeaux Population Health Research Center, Bordeaux, France.
J Am Heart Assoc. 2018 Feb 23;7(5):e008225. doi: 10.1161/JAHA.117.008225.
Central blood pressure (BP) is a promising marker to identify subjects with higher cardiovascular risk than expected by traditional risk factors. Significant results have been obtained in populations with high cardiovascular risk, but little is known about low-cardiovascular-risk patients, although the differences between central and peripheral BP (amplification) are usually greater in this population. The study aim was to evaluate central BP over 24 hours for cardiovascular event prediction in hypertensive subjects with low cardiovascular risk.
Peripheral and central BPs were recorded during clinical visits and over 24 hours in hypertensive patients with low cardiovascular risk (Systematic Coronary Risk Evaluation ≤5%). Our primary end point is the occurrence of a cardiovascular event during follow-up. To assess the potential interest in central pulse pressure over 24 hours, we performed Cox proportional hazard models analysis and comparison of area under the curves using the contrast test for peripheral and central BP. A cohort of 703 hypertensive subjects from Bordeaux were included. After the first 24 hours of BP measurement, the subjects were then followed up for an average of 112.5±70 months. We recorded 65 cardiovascular events during follow-up. Amplification was found to be significantly associated with cardiovascular events when added to peripheral 24-hour pulse pressure (=0.0259). The area under the curve of 24-hour central pulse pressure is significantly more important than area under the curve of office BP (=0.0296), and there is a trend of superiority with the area under the curve of peripheral 24-hour pulse pressure.
Central pulse pressure over 24 hours improves the prediction of cardiovascular events for hypertensive patients with low cardiovascular risk compared to peripheral pulse pressure.
中心血压（BP）是一种很有前途的标志物，可以识别出比传统危险因素预期更高心血管风险的患者。在心血管风险较高的人群中已经获得了显著的结果，但对于低心血管风险患者知之甚少，尽管在该人群中中心血压和外周血压（放大）之间的差异通常更大。本研究旨在评估低心血管风险的高血压患者 24 小时中心血压对心血管事件的预测价值。
在低心血管风险（系统性冠状动脉风险评估≤5%）的高血压患者中，在临床就诊期间和 24 小时内记录外周和中心血压。我们的主要终点是随访期间发生心血管事件。为了评估 24 小时中心脉搏压的潜在意义，我们进行了 Cox 比例风险模型分析，并使用外周和中心 BP 的对比检验比较了曲线下面积。纳入了来自波尔多的 703 例高血压患者。在首次测量 BP 后的 24 小时内，然后对患者进行平均 112.5±70 个月的随访。我们在随访期间记录了 65 例心血管事件。当将外周 24 小时脉搏压的放大与心血管事件相加时，发现放大与心血管事件显著相关（=0.0259）。24 小时中心脉搏压的曲线下面积明显大于诊室 BP 的曲线下面积（=0.0296），并且与外周 24 小时脉搏压的曲线下面积有优势的趋势。
与外周 24 小时脉搏压相比，24 小时中心脉搏压可改善低心血管风险高血压患者心血管事件的预测。
