Central vs. Brachial Blood Pressure and Pulse Pressure Amplification for Mortality Risk Prediction in Patients Undergoing Coronary Angiography

Clara Daschner; Marcus E Kleber; Niklas Ayasse; Ksenija Stach; Gökhan Yücel; Faeq Husain-Syed; Alexander Niessner; Bernd Krüger; Winfried März; Bernhard K Krämer; Babak Yazdani

doi:10.1093/ajh/hpae156

Central vs. Brachial Blood Pressure and Pulse Pressure Amplification for Mortality Risk Prediction in Patients Undergoing Coronary Angiography

Am J Hypertens. 2024 Dec 19:hpae156. doi: 10.1093/ajh/hpae156. Online ahead of print.

Authors

Clara Daschner¹, Marcus E Kleber^{1

2}, Niklas Ayasse¹, Ksenija Stach¹, Gökhan Yücel³, Faeq Husain-Syed⁴, Alexander Niessner^{5

6}, Bernd Krüger⁷, Winfried März^{1

2

8}, Bernhard K Krämer^{1

9

10}, Babak Yazdani¹

Affiliations

¹ Fifth Department of Medicine, University Medical Center Mannheim UMM, Faculty of Medicine of the University of Heidelberg, Mannheim, Germany.
² Synlab Academy, SYNLAB Holding Deutschland GmbH, Mannheim and Augsburg, Germany.
³ First Department of Medicine, University Medical Center Mannheim UMM, Faculty of Medicine of the University of Heidelberg, Mannheim, Germany.
⁴ Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus-Liebig-University Giessen, Giessen, Germany.
⁵ Department of Internal Medicine II, Medical University of Vienna, Austria.
⁶ Second Medical Department with Cardiology and Intensive Care Medicine, Klinik Landstrasse, Vienna, Austria.
⁷ Medical Clinic III, Hospital Darmstadt, Darmstadt, Germany.
⁸ Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Austria.
⁹ Center for Preventive Medicine Baden-Württemberg (CPMBW), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
¹⁰ European Center for Angioscience ECAS, Faculty of Medicine of the University of Heidelberg, Mannheim, Germany.

PMID: 39699029
DOI: 10.1093/ajh/hpae156

Abstract

Background: Arterial hypertension is a significant risk factor for cardiovascular (CV) morbidity and mortality. Although central blood pressure (BP) evaluation is considered the gold standard, the reliability of non-invasive measurements remains unclear. Therefore, we compared the predictive value of invasively measured central BP with non-invasively measured brachial BP and analyzed pulse pressure (PP) amplification (delta-PP; difference between central and peripheral PP) as an independent predictor of mortality.

Methods: We analyzed systolic (SBP), diastolic (DBP), mean arterial BP (MAP), PP and delta-PP as predictors of CV and all-cause mortality in the Ludwigshafen Risk and Cardiovascular Health (LURIC) study, involving 3316 patients referred for coronary angiography.

Results: All brachial BP parameters, except DBP, were significantly linked to all-cause and CV mortality in a univariate analysis. A 10 mmHg increase in SBP, MAP, and PP corresponded to increased risks of all-cause (11%, 10%, and 19%) and CV mortality (11%, 11%, and 18%). Central SBP and PP showed similar, but numerically weaker, associations with increased risks of all-cause (5% and 10%) and CV mortality (4% and 8%).After adjusting for age, sex, BMI, diabetes mellitus, and eGFR, only delta-PP independently predicted mortality with a 10 mmHg increase linked to a 4% reduction in all-cause and 6% reduction in CV mortality.

Conclusions: Neither brachial nor centrally measured BP parameters were independent mortality predictors in contrast to PP amplification, which remained an independent predictor of mortality in multivariate analysis, in a cohort with a medium to high CV risk profile. As PP amplification decreased, mortality increased.

Keywords: Pulse pressure; Pulse pressure amplification; arterial hypertension; arterial stiffness; coronary artery disease; heart failure.

© The Author(s) 2024. Published by Oxford University Press on behalf of American Journal of Hypertension, Ltd. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.