2.1 THE RELATIVE IMPORTANCE OF CENTRAL AND BRACHIAL BLOOD PRESSURE IN PREDICTING CARDIOVASCULAR EVENTS: AN INDIVIDUAL PARTICIPANT META-ANALYSIS OF PROSPECTIVE OBSERVATIONAL DATA FROM 22,433 SUBJECTS
Systolic blood pressure (SBP) differs between the brachial artery and aorta. Prospective data suggest that central pressure predicts future cardiovascular events, but it is unclear if it is superior to brachial pressure. Methods and Results: A systematic review and individual participant data meta-...
| Main Authors: | , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2016-11-01
|
| Series: | Artery Research |
| Online Access: | https://www.atlantis-press.com/article/125930367/view |
| _version_ | 1818006105745260544 |
|---|---|
| author | Carmel McEniery Yoav Ben-Shlomo Margaret May Melissa Spears Lyndia Brumback James Cameron Chen-Huan Chen Julio Chirinos Danuta Czarnecka Anthony Dart Richard Devereux Neeraj Dhaun Daniel Duprez Shih-Jen Hwang David Jacobs Piotr Jankowski Julie Janner Peter Lacy Gary Mitchell Riccardo Pini |
| author_facet | Carmel McEniery Yoav Ben-Shlomo Margaret May Melissa Spears Lyndia Brumback James Cameron Chen-Huan Chen Julio Chirinos Danuta Czarnecka Anthony Dart Richard Devereux Neeraj Dhaun Daniel Duprez Shih-Jen Hwang David Jacobs Piotr Jankowski Julie Janner Peter Lacy Gary Mitchell Riccardo Pini |
| author_sort | Carmel McEniery |
| collection | DOAJ |
| description | Systolic blood pressure (SBP) differs between the brachial artery and aorta. Prospective data suggest that central pressure predicts future cardiovascular events, but it is unclear if it is superior to brachial pressure.
Methods and Results: A systematic review and individual participant data meta-analysis from 15 studies was undertaken. Study-specific associations of central and brachial pressure with cardiovascular outcomes, with and without mutual adjustment, were determined using Cox proportional hazard models, and random effect models to estimate pooled estimates. Of 22,433 participants, 908 had a myocardial infarction (MI) and 641 a stroke. The pooled age, sex, height and heart rate adjusted hazard ratio (HR) [95% CI] per SD increase in brachial SBP was 1.17 [1.03, 1.32] for MI and 1.28 [1.13, 1.46] for stroke and 1.16 [1.02, 1.33] and 1.33 [1.15, 1.53] for central SBP, respectively. Mutual adjustment attenuated the HRs for MI: brachial SBP (1.16 [0.90, 1.48]), central SBP (1.09 [0.87, 1.38]) and stroke: brachial SBP (1.18 [0.97, 1.42]), central SBP (1.19 [0.99, 1.44]). However, associations between central SBP and stroke, after adjustment for brachial SBP, were higher in those aged <61 years than in older individuals (1.83 versus 1.08 p-interaction <0.001).
Conclusion: Brachial and central SBP have similar associations with future CV events. Larger studies are required to test whether central SBP may be a more powerful predictor of stroke risk in younger individuals. |
| first_indexed | 2024-04-14T04:56:53Z |
| format | Article |
| id | doaj.art-475f661b7cef491aad28f0a44b24f356 |
| institution | Directory Open Access Journal |
| issn | 1876-4401 |
| language | English |
| last_indexed | 2024-04-14T04:56:53Z |
| publishDate | 2016-11-01 |
| publisher | BMC |
| record_format | Article |
| series | Artery Research |
| spelling | doaj.art-475f661b7cef491aad28f0a44b24f3562022-12-22T02:11:08ZengBMCArtery Research1876-44012016-11-011610.1016/j.artres.2016.10.0052.1 THE RELATIVE IMPORTANCE OF CENTRAL AND BRACHIAL BLOOD PRESSURE IN PREDICTING CARDIOVASCULAR EVENTS: AN INDIVIDUAL PARTICIPANT META-ANALYSIS OF PROSPECTIVE OBSERVATIONAL DATA FROM 22,433 SUBJECTSCarmel McEnieryYoav Ben-ShlomoMargaret MayMelissa SpearsLyndia BrumbackJames CameronChen-Huan ChenJulio ChirinosDanuta CzarneckaAnthony DartRichard DevereuxNeeraj DhaunDaniel DuprezShih-Jen HwangDavid JacobsPiotr JankowskiJulie JannerPeter LacyGary MitchellRiccardo PiniSystolic blood pressure (SBP) differs between the brachial artery and aorta. Prospective data suggest that central pressure predicts future cardiovascular events, but it is unclear if it is superior to brachial pressure. Methods and Results: A systematic review and individual participant data meta-analysis from 15 studies was undertaken. Study-specific associations of central and brachial pressure with cardiovascular outcomes, with and without mutual adjustment, were determined using Cox proportional hazard models, and random effect models to estimate pooled estimates. Of 22,433 participants, 908 had a myocardial infarction (MI) and 641 a stroke. The pooled age, sex, height and heart rate adjusted hazard ratio (HR) [95% CI] per SD increase in brachial SBP was 1.17 [1.03, 1.32] for MI and 1.28 [1.13, 1.46] for stroke and 1.16 [1.02, 1.33] and 1.33 [1.15, 1.53] for central SBP, respectively. Mutual adjustment attenuated the HRs for MI: brachial SBP (1.16 [0.90, 1.48]), central SBP (1.09 [0.87, 1.38]) and stroke: brachial SBP (1.18 [0.97, 1.42]), central SBP (1.19 [0.99, 1.44]). However, associations between central SBP and stroke, after adjustment for brachial SBP, were higher in those aged <61 years than in older individuals (1.83 versus 1.08 p-interaction <0.001). Conclusion: Brachial and central SBP have similar associations with future CV events. Larger studies are required to test whether central SBP may be a more powerful predictor of stroke risk in younger individuals.https://www.atlantis-press.com/article/125930367/view |
| spellingShingle | Carmel McEniery Yoav Ben-Shlomo Margaret May Melissa Spears Lyndia Brumback James Cameron Chen-Huan Chen Julio Chirinos Danuta Czarnecka Anthony Dart Richard Devereux Neeraj Dhaun Daniel Duprez Shih-Jen Hwang David Jacobs Piotr Jankowski Julie Janner Peter Lacy Gary Mitchell Riccardo Pini 2.1 THE RELATIVE IMPORTANCE OF CENTRAL AND BRACHIAL BLOOD PRESSURE IN PREDICTING CARDIOVASCULAR EVENTS: AN INDIVIDUAL PARTICIPANT META-ANALYSIS OF PROSPECTIVE OBSERVATIONAL DATA FROM 22,433 SUBJECTS Artery Research |
| title | 2.1 THE RELATIVE IMPORTANCE OF CENTRAL AND BRACHIAL BLOOD PRESSURE IN PREDICTING CARDIOVASCULAR EVENTS: AN INDIVIDUAL PARTICIPANT META-ANALYSIS OF PROSPECTIVE OBSERVATIONAL DATA FROM 22,433 SUBJECTS |
| title_full | 2.1 THE RELATIVE IMPORTANCE OF CENTRAL AND BRACHIAL BLOOD PRESSURE IN PREDICTING CARDIOVASCULAR EVENTS: AN INDIVIDUAL PARTICIPANT META-ANALYSIS OF PROSPECTIVE OBSERVATIONAL DATA FROM 22,433 SUBJECTS |
| title_fullStr | 2.1 THE RELATIVE IMPORTANCE OF CENTRAL AND BRACHIAL BLOOD PRESSURE IN PREDICTING CARDIOVASCULAR EVENTS: AN INDIVIDUAL PARTICIPANT META-ANALYSIS OF PROSPECTIVE OBSERVATIONAL DATA FROM 22,433 SUBJECTS |
| title_full_unstemmed | 2.1 THE RELATIVE IMPORTANCE OF CENTRAL AND BRACHIAL BLOOD PRESSURE IN PREDICTING CARDIOVASCULAR EVENTS: AN INDIVIDUAL PARTICIPANT META-ANALYSIS OF PROSPECTIVE OBSERVATIONAL DATA FROM 22,433 SUBJECTS |
| title_short | 2.1 THE RELATIVE IMPORTANCE OF CENTRAL AND BRACHIAL BLOOD PRESSURE IN PREDICTING CARDIOVASCULAR EVENTS: AN INDIVIDUAL PARTICIPANT META-ANALYSIS OF PROSPECTIVE OBSERVATIONAL DATA FROM 22,433 SUBJECTS |
| title_sort | 2 1 the relative importance of central and brachial blood pressure in predicting cardiovascular events an individual participant meta analysis of prospective observational data from 22 433 subjects |
| url | https://www.atlantis-press.com/article/125930367/view |
| work_keys_str_mv | AT carmelmceniery 21therelativeimportanceofcentralandbrachialbloodpressureinpredictingcardiovasculareventsanindividualparticipantmetaanalysisofprospectiveobservationaldatafrom22433subjects AT yoavbenshlomo 21therelativeimportanceofcentralandbrachialbloodpressureinpredictingcardiovasculareventsanindividualparticipantmetaanalysisofprospectiveobservationaldatafrom22433subjects AT margaretmay 21therelativeimportanceofcentralandbrachialbloodpressureinpredictingcardiovasculareventsanindividualparticipantmetaanalysisofprospectiveobservationaldatafrom22433subjects AT melissaspears 21therelativeimportanceofcentralandbrachialbloodpressureinpredictingcardiovasculareventsanindividualparticipantmetaanalysisofprospectiveobservationaldatafrom22433subjects AT lyndiabrumback 21therelativeimportanceofcentralandbrachialbloodpressureinpredictingcardiovasculareventsanindividualparticipantmetaanalysisofprospectiveobservationaldatafrom22433subjects AT jamescameron 21therelativeimportanceofcentralandbrachialbloodpressureinpredictingcardiovasculareventsanindividualparticipantmetaanalysisofprospectiveobservationaldatafrom22433subjects AT chenhuanchen 21therelativeimportanceofcentralandbrachialbloodpressureinpredictingcardiovasculareventsanindividualparticipantmetaanalysisofprospectiveobservationaldatafrom22433subjects AT juliochirinos 21therelativeimportanceofcentralandbrachialbloodpressureinpredictingcardiovasculareventsanindividualparticipantmetaanalysisofprospectiveobservationaldatafrom22433subjects AT danutaczarnecka 21therelativeimportanceofcentralandbrachialbloodpressureinpredictingcardiovasculareventsanindividualparticipantmetaanalysisofprospectiveobservationaldatafrom22433subjects AT anthonydart 21therelativeimportanceofcentralandbrachialbloodpressureinpredictingcardiovasculareventsanindividualparticipantmetaanalysisofprospectiveobservationaldatafrom22433subjects AT richarddevereux 21therelativeimportanceofcentralandbrachialbloodpressureinpredictingcardiovasculareventsanindividualparticipantmetaanalysisofprospectiveobservationaldatafrom22433subjects AT neerajdhaun 21therelativeimportanceofcentralandbrachialbloodpressureinpredictingcardiovasculareventsanindividualparticipantmetaanalysisofprospectiveobservationaldatafrom22433subjects AT danielduprez 21therelativeimportanceofcentralandbrachialbloodpressureinpredictingcardiovasculareventsanindividualparticipantmetaanalysisofprospectiveobservationaldatafrom22433subjects AT shihjenhwang 21therelativeimportanceofcentralandbrachialbloodpressureinpredictingcardiovasculareventsanindividualparticipantmetaanalysisofprospectiveobservationaldatafrom22433subjects AT davidjacobs 21therelativeimportanceofcentralandbrachialbloodpressureinpredictingcardiovasculareventsanindividualparticipantmetaanalysisofprospectiveobservationaldatafrom22433subjects AT piotrjankowski 21therelativeimportanceofcentralandbrachialbloodpressureinpredictingcardiovasculareventsanindividualparticipantmetaanalysisofprospectiveobservationaldatafrom22433subjects AT juliejanner 21therelativeimportanceofcentralandbrachialbloodpressureinpredictingcardiovasculareventsanindividualparticipantmetaanalysisofprospectiveobservationaldatafrom22433subjects AT peterlacy 21therelativeimportanceofcentralandbrachialbloodpressureinpredictingcardiovasculareventsanindividualparticipantmetaanalysisofprospectiveobservationaldatafrom22433subjects AT garymitchell 21therelativeimportanceofcentralandbrachialbloodpressureinpredictingcardiovasculareventsanindividualparticipantmetaanalysisofprospectiveobservationaldatafrom22433subjects AT riccardopini 21therelativeimportanceofcentralandbrachialbloodpressureinpredictingcardiovasculareventsanindividualparticipantmetaanalysisofprospectiveobservationaldatafrom22433subjects |