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Picone DS, Schultz MG, Armstrong MK, Black JA, Bos WJW, Chen CH, Cheng HM, Cremer A, Dwyer N, Hughes AD, Kim HL, Lacy PS, Laugesen E, Liang F, Ohte N, Okada S, Omboni S, Ott C, Pereira T, Pucci G, Schmieder RE, Sinha MD, Stouffer GA, Takazawa K, Roberts-Thomson P, Wang JG, Weber T, Westerhof BE, Williams B, Sharman JE. Identifying Isolated Systolic Hypertension From Upper-Arm Cuff Blood Pressure Compared With Invasive Measurements. Hypertension 2021; 77:632-639. [PMID: 33390047 DOI: 10.1161/hypertensionaha.120.16109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Isolated systolic hypertension (ISH) is the most common form of hypertension and is highly prevalent in older people. We recently showed differences between upper-arm cuff and invasive blood pressure (BP) become greater with increasing age, which could influence correct identification of ISH. This study sought to determine the difference between identification of ISH by cuff BP compared with invasive BP. Cuff BP and invasive aortic BP were measured in 1695 subjects (median 64 years, interquartile range [55-72], 68% male) from the INSPECT (Invasive Blood Pressure Consortium) database. Data were recorded during coronary angiography among 29 studies, using 21 different cuff BP devices. ISH was defined as ≥130/<80 mm Hg using cuff BP compared with invasive aortic BP as the reference. The prevalence of ISH was 24% (n=407) according to cuff BP but 38% (n=642) according to invasive aortic BP. There was fair agreement (Cohen κ, 0.36) and 72% concordance between cuff and invasive aortic BP for identifying ISH. Among the 28% of subjects (n=471) with misclassification of ISH status by cuff BP, 20% (n=96) of the difference was due to lower cuff systolic BP compared with invasive aortic systolic BP (mean, -16.4 mm Hg [95% CI, -18.7 to -14.1]), whereas 49% (n=231) was from higher cuff diastolic BP compared with invasive aortic diastolic BP (+14.2 mm Hg [95% CI, 11.5-16.9]). In conclusion, compared with invasive BP, cuff BP fails to identify ISH in a sizeable portion of older people and demonstrates the need to improve cuff BP measurements.
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Affiliation(s)
- Dean S Picone
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (D.S.P., M.G.S., M.K.A., J.A.B., N.D., P.R.-T., J.E.S.)
| | - Martin G Schultz
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (D.S.P., M.G.S., M.K.A., J.A.B., N.D., P.R.-T., J.E.S.)
| | - Matthew K Armstrong
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (D.S.P., M.G.S., M.K.A., J.A.B., N.D., P.R.-T., J.E.S.)
| | - J Andrew Black
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (D.S.P., M.G.S., M.K.A., J.A.B., N.D., P.R.-T., J.E.S.).,Royal Hobart Hospital, Australia (J.A.B., N.D., P.R.-T.)
| | - Willem Jan W Bos
- St Antonius Hospital, Department of Internal Medicine, Nieuwegein, the Netherlands (W.J.B.).,Department of Internal Medicine, Leiden University Medical Center, the Netherlands (W.J.B.)
| | - Chen-Huan Chen
- Department of Medicine, National Yang-Ming University School of Medicine, Department of Medical Education, Taipei Veterans General Hospital, Taiwan (C.-H.C., M.-H.C.)
| | - Hao-Min Cheng
- Department of Medicine, National Yang-Ming University School of Medicine, Department of Medical Education, Taipei Veterans General Hospital, Taiwan (C.-H.C., M.-H.C.)
| | - Antoine Cremer
- Department of Cardiology/Hypertension, University Hospital of Bordeaux, France (A.C.)
| | - Nathan Dwyer
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (D.S.P., M.G.S., M.K.A., J.A.B., N.D., P.R.-T., J.E.S.).,Royal Hobart Hospital, Australia (J.A.B., N.D., P.R.-T.)
| | - Alun D Hughes
- Institute of Cardiovascular Sciences, University College London, United Kingdom (A.D.H., B.W.)
| | - Hack-Lyoung Kim
- Division of Cardiology, Seoul National University Boramae Hospital, South Korea (H.-L.K.)
| | - Peter S Lacy
- Institute of Cardiovascular Sciences University College London (UCL) and National Institute for Health Research (NIHR) UCL/UCL Hospitals Biomedical Research Centre, United Kingdom (P.S.L., B.W.)
| | - Esben Laugesen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Denmark (E.L.)
| | - Fuyou Liang
- School of Naval Architecture, Ocean and Civil Engineering, Shanghai Jiao Tong University, China (F.L.).,Institute for Personalized Medicine, Sechenov University, Moscow, Russia (F.L.)
| | - Nobuyuki Ohte
- Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Japan (N.O.)
| | - Sho Okada
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Japan (S. Okada)
| | - Stefano Omboni
- Clinical Research Unit, Italian Institute of Telemedicine, Varese, Italy (S. Omboni).,Scientific Research Department of Cardiology, Science and Technology Park for Biomedicine, Sechenov First Moscow State Medical University, Russian Federation (S. Omboni)
| | - Christian Ott
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Germany (C.O., R.E.S.)
| | - Telmo Pereira
- Department of Physiology, Polytechnic Institute of Coimbra, ESTES, Lousã, Portugal (T.P.)
| | - Giacomo Pucci
- Unit of Internal Medicine at Terni University Hospital, Department of Medicine, University of Perugia, Italy (G.P.)
| | - Roland E Schmieder
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Germany (C.O., R.E.S.)
| | - Manish D Sinha
- Department of Clinical Pharmacology and Department of Paediatric Nephrology, Kings College London, Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, United Kingdom (M.D.S.)
| | - George A Stouffer
- Division of Cardiology, University of North Carolina at Chapel Hill (G.A.S.)
| | - Kenji Takazawa
- Center for Health Surveillance and Preventive Medicine, Tokyo Medical University Hospital, Japan (K.T.)
| | - Philip Roberts-Thomson
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (D.S.P., M.G.S., M.K.A., J.A.B., N.D., P.R.-T., J.E.S.).,Royal Hobart Hospital, Australia (J.A.B., N.D., P.R.-T.)
| | - Ji-Guang Wang
- Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, China (J.W.)
| | - Thomas Weber
- Cardiology Department, Klinikum Wels-Grieskirchen, Wels, Austria (T.W.)
| | - Berend E Westerhof
- Cardiovascular and Respiratory Physiology, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, the Netherlands (B.E.W.)
| | - Bryan Williams
- Institute of Cardiovascular Sciences, University College London, United Kingdom (A.D.H., B.W.).,Institute of Cardiovascular Sciences University College London (UCL) and National Institute for Health Research (NIHR) UCL/UCL Hospitals Biomedical Research Centre, United Kingdom (P.S.L., B.W.)
| | - James E Sharman
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (D.S.P., M.G.S., M.K.A., J.A.B., N.D., P.R.-T., J.E.S.)
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Peng X, Schultz MG, Picone DS, Dwyer N, Black JA, Roberts-Thomson P, Sharman JE. Non-invasive measurement of reservoir pressure parameters from brachial-cuff blood pressure waveforms. J Clin Hypertens (Greenwich) 2018; 20:1703-1711. [PMID: 30450732 DOI: 10.1111/jch.13411] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 08/27/2018] [Accepted: 09/07/2018] [Indexed: 01/09/2023]
Abstract
Reservoir pressure parameters [eg, reservoir pressure (RP) and excess pressure (XSP)] are biomarkers derived from blood pressure (BP) waveforms that have been shown to predict cardiovascular events independent of conventional cardiovascular risk markers. However, whether RP and XSP can be derived non-invasively from operator-independent cuff device measured brachial or central BP waveforms has never been examined. This study sought to achieve this by comparison of cuff reservoir pressure parameters with intra-aortic reservoir pressure parameters. 162 participants (aged 61 ± 10 years, 72% male) undergoing coronary angiography had the simultaneous measurement of cuff BP waveforms (via SphygmoCor XCEL, AtCor Medical) and intra-aortic BP waveforms (via fluid-filled catheter). RP and XSP derived from cuff acquired brachial and central BP waveforms were compared with intra-aortic measures. Concordance between brachial-cuff and intra-aortic measurement was moderate-to-good for RP peak (36 ± 11 vs 48 ± 14 mm Hg, P < 0.001; ICC 0.77, 95% CI: 0.71-0.82), and poor-to-moderate for XSP peak (28 ± 10 vs 24 ± 9 mm Hg, P < 0.001; ICC 0.49, 95% CI: 0.35-0.60). Concordance between central-cuff and intra-aortic measurement was moderate-to-good for RP peak (35 ± 9 vs 46 ± 14 mm Hg, P < 0.001; ICC 0.77, 95% CI: 0.70-0.82), but poor for XSP peak (12 ± 3 vs 24 ± 9 mm Hg, P < 0.001; ICC 0.12, 95% CI: -0.13 to 0.31). In conclusion, both brachial-cuff and central-cuff methods can reasonably estimate intra-aortic RP, whereas XSP can only be acceptably derived from brachial-cuff BP waveforms. This should enable widespread application to determine the clinical significance, but there is significant room for refinement of the method.
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Affiliation(s)
- Xiaoqing Peng
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Martin G Schultz
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Dean S Picone
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Nathan Dwyer
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.,Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - J Andrew Black
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.,Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Philip Roberts-Thomson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.,Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - James E Sharman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
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