Association of central and peripheral pulse pressure with intermediate cardiovascular phenoytpes

Objective We assessed the relationship between pulse
pressure and intermediate cardiovascular phenotypes in a
middle-aged cohort with high prevalence of hypertension.
Background It has been suggested that central pulse
pressure (cPP) is a better predictor of cardiovascular
outcome than peripheral pulse pressure (pPP), particularly
in the elderly. Yet, it is unclear if cPP provides additional
prognostic information to pPP in younger individuals.
Methods In 535 individuals we assessed cPP and pPP as
well as the intermediate cardiovascular phenotypes pulse
wave velocity (PWV; SphygmoCor, Complior, PulsePen),
carotid intima-media thickness (C-IMT; carotid ultrasound),
left-ventricular mass index (LVMI; echocardiography) and
urinary albumin : creatinine ratio (ACR). cPP was derived
noninvasively from brachial blood pressure by pulse wave
analysis (PWA; SphygmoCor) based on radial pulse wave
tonometry and a validated transfer function.
Results The cohort contained 331 hypertensive participants
of whom 84% were treated. The average age was 46W16
years. When compared to pPP, cPP had stronger
associations with PWV (rU0.471 vs. rU0.372; P<0.01),
C-IMT (rU0.426 vs. rU0.235; P<0.01) and LVMI (rU0.385
vs. rU0.189; P<0.01), but equal association with ACR
(rU0.236 vs. rU0.226; PUn.s.). In contrast, after
adjustment for age, mean arterial pressure, heart rate and
hypertension status there was no significant difference
between cPP and pPP for prediction of PWV (adjusted R2,
0.399 vs. 0.413; PU0.066), C-IMT (adjusted R2, 0.399 vs.
0.413; PU0.487) and LVMI (adjusted R2, 0.181 vs. 0.170;
PU0.094) in multivariate analysis.
Conclusion In our middle-aged cohort with high prevalence
of hypertension cPP is more closely correlated with
cardiovascular phenotypes than pPP. When adjusted for
relevant cofactors, however, cPP does not provide
additional information beyond pPP.