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CLINICAL RESEARCH: HYPERTENSION

Central But Not Brachial Blood Pressure Predicts Cardiovascular Events in an Unselected Geriatric Population

The ICARe Dicomano Study

Riccardo Pini, MD, FACC^_*,_*, M. Chiara Cavallini, MD^_*, Vittorio Palmieri, MD, PhD, Niccolò Marchionni, MD^_*, Mauro Di Bari, MD, PhD^_*, Richard B. Devereux, MD, FACC, Giulio Masotti, MD^_* and Mary J. Roman, MD, FACC

^_* Department of Critical Care Medicine and Surgery—Unit of Geriatric Cardiology, University of Firenze and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
Department of Medicine, Weill Medical College of Cornell University, New York, New York.

Manuscript received November 23, 2007; revised manuscript received March 5, 2008, accepted March 11, 2008.

^_* Reprint requests and correspondence: Dr. Riccardo Pini, Unit of Geriatric Cardiology, Via delle Oblate, 4, 50141 Florence, Italy. (Email: rpini{at}unifi.it).

Objectives: The present study investigated whether central blood pressure (BP) predicts cardiovascular (CV) events better than brachial BP in a cohort of normotensive and untreated hypertensive elderly individuals.

Background: Limited and conflicting data have been reported on the prognostic relevance of central BP compared with brachial BP.

Methods: Community-dwelling individuals 65 years of age, living in Dicomano, Italy, underwent an extensive clinical assessment in 1995 including echocardiography and carotid ultrasonography and applanation tonometry. In 2003, vital status and CV events were assessed, reviewing the electronic database of the Regional Ministry of Health. Only normotensive (n = 173) and untreated hypertensive subjects (95 diastolic and 130 isolated systolic) were included in the present analysis.

Results: During 8 years, 106 deaths, 45 of which were cardiovascular, and 122 CV events occurred. In univariate analyses, both central and brachial systolic blood pressure (SBP) and pulse pressure (PP) predicted CV events (all p < 0.005); however, in multivariate analyses, adjusting for age and gender, higher carotid SBP and PP (hazard ratios 1.19/10 and 1.23/10 mm Hg, respectively; both p < 0.0001) but neither brachial SBP nor PP independently predicted CV events. Similarly, higher carotid SBP but not brachial pressures independently predicted CV mortality (hazard ratio 1.37/10 mm Hg; p < 0.0001).

Conclusions: Our prospective study in an unselected geriatric population demonstrates superior prognostic utility of central compared with brachial BP.

Abbreviations and Acronyms   AI = augmentation index   BP = blood pressure   CI = confidence interval   CV = cardiovascular   DBP = diastolic blood pressure   FS = fractional shortening   HR = hazard ratio   IMT = intimal-medial thickness   ISH = isolated systolic hypertension   LV = left ventricle/ventricular   MBP = mean blood pressure   PP = pulse pressure   SBP = systolic blood pressure   WCSA = wall cross-sectional area

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