Out-of-office and central blood pressure for risk stratification: A cross-sectional study in patients treated for hypertension

Schultz, Martin G., Gilroy, Deborah, Wright, Leah, Bishop, Warrick L.J., Abhayaratna, Walter P., Stowasser, Michael and Sharman, James E. (2012) Out-of-office and central blood pressure for risk stratification: A cross-sectional study in patients treated for hypertension. European Journal of Clinical Investigation, 42 4: 393-401. doi:10.1111/j.1365-2362.2011.02595.x


Author Schultz, Martin G.
Gilroy, Deborah
Wright, Leah
Bishop, Warrick L.J.
Abhayaratna, Walter P.
Stowasser, Michael
Sharman, James E.
Title Out-of-office and central blood pressure for risk stratification: A cross-sectional study in patients treated for hypertension
Journal name European Journal of Clinical Investigation   Check publisher's open access policy
ISSN 0014-2972
1365-2362
Publication date 2012-04
Year available 2011
Sub-type Article (original research)
DOI 10.1111/j.1365-2362.2011.02595.x
Volume 42
Issue 4
Start page 393
End page 401
Total pages 9
Place of publication Oxford, England, U.K.
Publisher Wiley-Blackwell Publishing
Collection year 2012
Language eng
Formatted abstract
Background  Central blood pressure (BP) predicts mortality independent of office brachial BP. Whether central BP may be useful to differentiate BP control requires examination and was the first aim of this study. Secondly, we sought to determine the variability in central BP among patients from different categories of BP control [controlled hypertension (CH), masked hypertension (MH), white coat (WCHT) and uncontrolled hypertension (UH)].

Materials and methods 
We assessed patients with uncomplicated hypertension using measurement of central BP (SphygmoCor 8.1), brachial BP and 24-h ambulatory BP monitoring. BP control was defined according to guidelines using office BP and 24-h BP.

Results 
Of the 201 patients (63 ± 8 years, 51% men), 67 (33%) were classified as CH; 59 (29%) with MH; 31 (15%) with WCHT; and 44 (22%) with UH. There were no differences in central BP parameters (augmentation pressure, augmentation index, pulse pressure) between patients with CH and MH or between patients with WCHT and UH (P > 0·05 for all). However, there was significant overlap in central systolic BP between BP control categories. For example, 27% of patients with normal brachial systolic BP had central systolic BP above age- and gender-specific normal values, including patients from three classifications of BP control (CH: n = 27; MH: n = 22; and WCHT: n = 4).

Conclusion
  Office central BP alone cannot delineate categories of BP control. However, given the high degree of variability in central BP among patients from different categories of BP control, measurement of central BP may result in significant reclassification of risk related to BP.
Keyword Central blood pressure
Hypertension
Pressure waveform analysis
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Article first published online: 28 SEP 2011

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2012 Collection
School of Medicine Publications
 
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Created: Tue, 30 Aug 2011, 10:20:40 EST by Matthew Lamb on behalf of School of Medicine