Invasive aortic pulse pressure is not superior to cuff pulse pressure in cardiovascular risk prediction

Esben Laugesen; Søren T Knudsen; Klavs W Hansen; Niklas B Rossen; Lisette Okkels Jensen; Michael S Hansen; Lone K Andersen; Kristian K Thomsen; Hanne Søndergaard; Morten Böttcher; Bent Raungaard; Kevin K W Olesen; Michael Mæng; Hans Erik Bøtker; Per L Poulsen

doi:10.1097/HJH.0000000000002694

Invasive aortic pulse pressure is not superior to cuff pulse pressure in cardiovascular risk prediction

Esben Laugesen^*, Søren T Knudsen, Klavs W Hansen, Niklas B Rossen, Lisette Okkels Jensen, Michael S Hansen, Lone K Andersen, Kristian K Thomsen, Hanne Søndergaard, Morten Böttcher, Bent Raungaard, Kevin K W Olesen, Michael Mæng, Hans Erik Bøtker, Per L Poulsen

^*Corresponding author for this work

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

13 Citations (Scopus)

Abstract

OBJECTIVE: Aortic pulse pressure (PP) represents the hemodynamic cardiac and cerebral burden more directly than cuff PP. The objective of this study was to investigate whether invasively measured aortic PP confers additional prognostic value beyond cuff PP for cardiovascular events and death. With increasing age, cuff PP progressively underestimates aortic PP. Whether the prognostic association between cuff PP and outcomes is age-dependent remains to be elucidated.

METHODS: Cuff PP and invasively measured aortic PP were recorded in 21 908 patients (mean age 63 years, 58% men, 14% with diabetes) with stable angina pectoris undergoing elective coronary angiography during January 2001--December 2012. Multivariate Cox models were used to assess the association with incident myocardial infarction, stroke, and death. Discrimination was assessed using Harrell's C-index.

RESULTS: During a median follow-up period of 3.7 years (range 0.1-10.8 years), 422 strokes, 511 myocardial infarctions, and 1530 deaths occurred. Both cuff and aortic PP were associated with stroke, myocardial infarction, and death in crude analyses. However, only cuff PP remained associated with stroke (hazard ratio per 10 mmHg, 1.06 (95% confidence interval (CI) 1.01--1.12)] and myocardial infarction [hazard ratio per 10 mmHg 1.05 (95% CI 1.01--1.11)] in multivariate Cox models. Both cuff and aortic PP lost significance as predictors of death in multivariate models. Age did not modify the prognostic association between cuff PP and stroke, myocardial infarction, and death.

CONCLUSION: Invasively measured aortic PP did not add prognostic information about cardiovascular outcomes and death beyond cuff PP in patients with stable angina pectoris.

Original language	English
Journal	Journal of Hypertension
Volume	39
Issue	4
Pages (from-to)	607-613
Number of pages	7
ISSN	0952-1178
DOIs	https://doi.org/10.1097/HJH.0000000000002694
Publication status	Published - Apr 2021

Keywords

blood pressure measurement
cerebral infarction
diabetes mellitus
mortality
myocardial infarction
pulse pressure

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Laugesen, E., Knudsen, S. T., Hansen, K. W., Rossen, N. B., Jensen, L. O., Hansen, M. S., Andersen, L. K., Thomsen, K. K., Søndergaard, H., Böttcher, M., Raungaard, B., Olesen, K. K. W., Mæng, M., Bøtker, H. E., & Poulsen, P. L. (2021). Invasive aortic pulse pressure is not superior to cuff pulse pressure in cardiovascular risk prediction. Journal of Hypertension, 39(4), 607-613. https://doi.org/10.1097/HJH.0000000000002694

@article{93e91deee6e74d97bca0e54d4a02a814,

title = "Invasive aortic pulse pressure is not superior to cuff pulse pressure in cardiovascular risk prediction",

abstract = "OBJECTIVE: Aortic pulse pressure (PP) represents the hemodynamic cardiac and cerebral burden more directly than cuff PP. The objective of this study was to investigate whether invasively measured aortic PP confers additional prognostic value beyond cuff PP for cardiovascular events and death. With increasing age, cuff PP progressively underestimates aortic PP. Whether the prognostic association between cuff PP and outcomes is age-dependent remains to be elucidated.METHODS: Cuff PP and invasively measured aortic PP were recorded in 21 908 patients (mean age 63 years, 58% men, 14% with diabetes) with stable angina pectoris undergoing elective coronary angiography during January 2001--December 2012. Multivariate Cox models were used to assess the association with incident myocardial infarction, stroke, and death. Discrimination was assessed using Harrell's C-index.RESULTS: During a median follow-up period of 3.7 years (range 0.1-10.8 years), 422 strokes, 511 myocardial infarctions, and 1530 deaths occurred. Both cuff and aortic PP were associated with stroke, myocardial infarction, and death in crude analyses. However, only cuff PP remained associated with stroke (hazard ratio per 10 mmHg, 1.06 (95% confidence interval (CI) 1.01--1.12)] and myocardial infarction [hazard ratio per 10 mmHg 1.05 (95% CI 1.01--1.11)] in multivariate Cox models. Both cuff and aortic PP lost significance as predictors of death in multivariate models. Age did not modify the prognostic association between cuff PP and stroke, myocardial infarction, and death.CONCLUSION: Invasively measured aortic PP did not add prognostic information about cardiovascular outcomes and death beyond cuff PP in patients with stable angina pectoris.",

keywords = "blood pressure measurement, cerebral infarction, diabetes mellitus, mortality, myocardial infarction, pulse pressure",

author = "Esben Laugesen and Knudsen, {S{\o}ren T} and Hansen, {Klavs W} and Rossen, {Niklas B} and Jensen, {Lisette Okkels} and Hansen, {Michael S} and Andersen, {Lone K} and Thomsen, {Kristian K} and Hanne S{\o}ndergaard and Morten B{\"o}ttcher and Bent Raungaard and Olesen, {Kevin K W} and Michael M{\ae}ng and B{\o}tker, {Hans Erik} and Poulsen, {Per L}",

year = "2021",

month = apr,

doi = "10.1097/HJH.0000000000002694",

language = "English",

volume = "39",

pages = "607--613",

journal = "Journal of Hypertension",

issn = "0952-1178",

publisher = "Lippincott Williams and Wilkins Ltd.",

number = "4",

}

Laugesen, E , Knudsen, ST , Hansen, KW , Rossen, NB, Jensen, LO, Hansen, MS, Andersen, LK, Thomsen, KK, Søndergaard, H , Böttcher, M, Raungaard, B, Olesen, KKW , Mæng, M , Bøtker, HE & Poulsen, PL 2021, 'Invasive aortic pulse pressure is not superior to cuff pulse pressure in cardiovascular risk prediction', Journal of Hypertension, vol. 39, no. 4, pp. 607-613. https://doi.org/10.1097/HJH.0000000000002694

Invasive aortic pulse pressure is not superior to cuff pulse pressure in cardiovascular risk prediction. / Laugesen, Esben ; Knudsen, Søren T ; Hansen, Klavs W et al.
In: Journal of Hypertension, Vol. 39, No. 4, 04.2021, p. 607-613.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - Invasive aortic pulse pressure is not superior to cuff pulse pressure in cardiovascular risk prediction

AU - Laugesen, Esben

AU - Knudsen, Søren T

AU - Hansen, Klavs W

AU - Rossen, Niklas B

AU - Jensen, Lisette Okkels

AU - Hansen, Michael S

AU - Andersen, Lone K

AU - Thomsen, Kristian K

AU - Søndergaard, Hanne

AU - Böttcher, Morten

AU - Raungaard, Bent

AU - Olesen, Kevin K W

AU - Mæng, Michael

AU - Bøtker, Hans Erik

AU - Poulsen, Per L

PY - 2021/4

Y1 - 2021/4

N2 - OBJECTIVE: Aortic pulse pressure (PP) represents the hemodynamic cardiac and cerebral burden more directly than cuff PP. The objective of this study was to investigate whether invasively measured aortic PP confers additional prognostic value beyond cuff PP for cardiovascular events and death. With increasing age, cuff PP progressively underestimates aortic PP. Whether the prognostic association between cuff PP and outcomes is age-dependent remains to be elucidated.METHODS: Cuff PP and invasively measured aortic PP were recorded in 21 908 patients (mean age 63 years, 58% men, 14% with diabetes) with stable angina pectoris undergoing elective coronary angiography during January 2001--December 2012. Multivariate Cox models were used to assess the association with incident myocardial infarction, stroke, and death. Discrimination was assessed using Harrell's C-index.RESULTS: During a median follow-up period of 3.7 years (range 0.1-10.8 years), 422 strokes, 511 myocardial infarctions, and 1530 deaths occurred. Both cuff and aortic PP were associated with stroke, myocardial infarction, and death in crude analyses. However, only cuff PP remained associated with stroke (hazard ratio per 10 mmHg, 1.06 (95% confidence interval (CI) 1.01--1.12)] and myocardial infarction [hazard ratio per 10 mmHg 1.05 (95% CI 1.01--1.11)] in multivariate Cox models. Both cuff and aortic PP lost significance as predictors of death in multivariate models. Age did not modify the prognostic association between cuff PP and stroke, myocardial infarction, and death.CONCLUSION: Invasively measured aortic PP did not add prognostic information about cardiovascular outcomes and death beyond cuff PP in patients with stable angina pectoris.

AB - OBJECTIVE: Aortic pulse pressure (PP) represents the hemodynamic cardiac and cerebral burden more directly than cuff PP. The objective of this study was to investigate whether invasively measured aortic PP confers additional prognostic value beyond cuff PP for cardiovascular events and death. With increasing age, cuff PP progressively underestimates aortic PP. Whether the prognostic association between cuff PP and outcomes is age-dependent remains to be elucidated.METHODS: Cuff PP and invasively measured aortic PP were recorded in 21 908 patients (mean age 63 years, 58% men, 14% with diabetes) with stable angina pectoris undergoing elective coronary angiography during January 2001--December 2012. Multivariate Cox models were used to assess the association with incident myocardial infarction, stroke, and death. Discrimination was assessed using Harrell's C-index.RESULTS: During a median follow-up period of 3.7 years (range 0.1-10.8 years), 422 strokes, 511 myocardial infarctions, and 1530 deaths occurred. Both cuff and aortic PP were associated with stroke, myocardial infarction, and death in crude analyses. However, only cuff PP remained associated with stroke (hazard ratio per 10 mmHg, 1.06 (95% confidence interval (CI) 1.01--1.12)] and myocardial infarction [hazard ratio per 10 mmHg 1.05 (95% CI 1.01--1.11)] in multivariate Cox models. Both cuff and aortic PP lost significance as predictors of death in multivariate models. Age did not modify the prognostic association between cuff PP and stroke, myocardial infarction, and death.CONCLUSION: Invasively measured aortic PP did not add prognostic information about cardiovascular outcomes and death beyond cuff PP in patients with stable angina pectoris.

KW - blood pressure measurement

KW - cerebral infarction

KW - diabetes mellitus

KW - mortality

KW - myocardial infarction

KW - pulse pressure

UR - http://www.scopus.com/inward/record.url?scp=85102536415&partnerID=8YFLogxK

U2 - 10.1097/HJH.0000000000002694

DO - 10.1097/HJH.0000000000002694

M3 - Journal article

C2 - 33201052

SN - 0952-1178

VL - 39

SP - 607

EP - 613

JO - Journal of Hypertension

JF - Journal of Hypertension

IS - 4

ER -

Invasive aortic pulse pressure is not superior to cuff pulse pressure in cardiovascular risk prediction

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