Abstract
Afterload is an important determinant of left ventricular (LV) and atrial (LA) function, including myocardial strain. Central blood pressure (CBP) is the major component of cardiac afterload and independently associated with cardiovascular risk. However, the optimal means of calibrating CBP is unclear-standard CBP assessment uses systolic (SBP) and diastolic blood pressure (DBP) from brachial waveforms, but calibration with mean pressure (MAP) and DBP purports to be more accurate. Therefore, we sought to determine which CBP is best associated with LA and LV strain. CBP was measured using both standard and MAP based calibration methods in 546 participants (age 70.7 ± 4.7years, 45% male) with risk factors for heart failure. Echocardiography was performed in all patients and strain analysis conducted to assess LA/LV function. The associations of CBP with LA and LV strain were assessed using linear regression. MAP-derived CSBP (150 ± 20mmHg) was higher than standard CSBP (128 ± 15mmHg) and brachial SBP (140 ± 17mmHg, p < 0.001), whereas DBPs were similar (84 ± 10, 83 ± 10, and 82 ± 10mmHg). MAP-derived CSBP was not independently associated with LV strain (p > 0.05), however was independently associated with LA reservoir strain (p < 0.05). Brachial and central DBP were more strongly associated with LA reservoir/conduit and LV strain than brachial and central SBP. LA pump strain was not independently associated with any SBP or DBP parameter (p > 0.05). MAP-derived CBP was more accurate in identifying patients with abnormal LA and LV strain than brachial SBP and standard CBP calibration. In conclusion, CBP calibrated using MAP and DBP may be more accurate in identifying patients with abnormal LA and LV function than standard brachial calibration methods.
Highlights
Hypertension is a leading cause of morbidity and mortality[1, 2]
Brachial and central diastolic blood pressure (DBP) were more strongly associated with left atrial (LA) reservoir/conduit and left ventricular (LV) strain than brachial and central systolic blood pressure (SBP)
mean arterial pressure (MAP)-derived central blood pressure (CBP) was more accurate in identifying patients with abnormal LA and LV strain than brachial SBP and standard CBP calibration
Summary
Hypertension is a leading cause of morbidity and mortality[1, 2]. Recent changes in clinical practice guidelines have advocated for an aggressive approach in the diagnosis and treatment of hypertension[1]. Some studies demonstrated that central blood pressure (CBP) is more closely associated with cardiovascular outcomes compared with peripheral brachial BP[4,5,6,7], some did not[8]. A waveform calibration method is to use brachial systolic blood pressure (SBP) and diastolic blood pressure (DBP). This method may be associated with inaccuracy leading to underestimation of the systolic CBP and overestimation of diastolic CBP[10]. We previously reported better associations between MAP-derived CBP and cardiac anatomy as a marker of end-organ damage[11] but little is known about relationships with cardiac function. Identifying the BP parameter most closely associated with altered cardiac function is important because it may indicate those with early signs of end-organ damage related to hypertension
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