Mean Central Blood Pressure Research Articles

Urinary hydration biomarkers, but not renal blood velocity, are impacted by a 161-km ultra-endurance footrace

PURPOSE: Recent data suggest that dehydration (i.e., increases in urine specific gravity (USG) and osmolality (OSM)) may contribute to increased risk of acute kidney injury (AKI) [1]. AKI may be transiently elevated in a substantial proportion of athletes upon completing ultra-endurance running events (42km) [2], indicating potential kidney strain via reductions in renal perfusion. However, there are limited data on the effects of ultra-endurance running events on renal blood velocity (RBV). Therefore, we sought to investigate the effects of the 2023 161-km Western States Endurance Run (WSER) on hydration biomarkers and RBV. We hypothesized that USG and OSM would be higher and that RBV would be lower post- versus pre-race. METHODS: We included 17 participants (3F/14M, 44±10yrs, 175±7cm, 69±9kg) with urine samples and RBV data in this analysis. We measured USG with a refractometer and OSM with an osmometer. We assessed RBV in the decubitus position using sonography at the renal and segmental arteries (GE Logiq e). Renal vascular conductance, the ease with which blood flows through kidney vasculature, was calculated as RBV/supine central mean blood pressure (SphygmoCor XCEL). Pre-race measures were collected ≤72 hours before WSER and post-race measures were collected ≤1 hour after finishing. Normality was assessed and paired, two-sided t-tests or Wilcoxon paired tests were used to compare pre- vs. post-race measures. Normalized differences were calculated ([pre-post]/pre) to assess associations between variables using Pearson’s correlation. We set α a priori to ≤ 0.05. Results: The WSER elicited an increase in USG (1.010±0.007 vs 1.026±0.011, p=0.002) and urine OSM (420±220 vs 740±305 mOsm/kg, p=0.003). However, RBV was unaffected post-race in the renal (49.3±10.0 vs 44.6±13.4 cm·s−1, p=0.285) and segmental artery (28.9±6.4 vs 27.5±1.6 cm·s−1, p=0.345). There were no differences in vascular conductance in the renal (0.55±0.10 vs 0.53±0.19 cm·s−1/mmHg, p=0.808) or the segmental artery (0.325±0.02 vs 0.325±0.02 cm·s−1/mmHg, p=0.903). No associations were observed between changes in RBV and changes in hydration biomarkers ( ps>0.243). CONCLUSIONS: We observed large elevations in USG and OSM, which may suggest a transient increase in workload within the kidneys, but no change in renal or segmental artery vascular conductance after WSER. Future analyses are needed to investigate whether AKI biomarkers may be elevated after the completion of ultra-endurance events, particularly among higher-risk runners. National Institutes of Health K01HL160772 (JCW), American Heart Association 23CDA1037938 (JCW), Western States Endurance Run Medical Research Program (GJG), NIH-K01HL147998 (ATR), Auburn University Offce of Vice President for Research Support Program (ATR). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

IMPACT OF CELIPROLOL THERAPY ON BLOOD PRESSURE AND HEART RATE IN PATIENTS WITH VASCULAR EHLERS-DANLOS SYNDROME

Objective: Vascular Ehlers-Danlos syndrome (vEDS) is an inherited connective tissue disorder characterized by arterial fragility. Celiprolol is a beta1-adrenoceptor antagonist with partial beta2 agonist activity that has been shown to reduce rates of vascular events in this setting, though the underlying mechanisms are not yet fully understood. Aim of the present study was to assess the impact of Celiprolol on blood pressure (BP) and heart rate (HR) in patients with vEDS. Design and method: Patients with genetically confirmed disease referred to our Institution between 2011 and 2022 were divided into two groups according to whether or not they were on Celiprolol therapy. The former were included if on Celiprolol at the dose of 400 mg daily for at least 12 months. Each participant underwent office blood pressure (BP) measurement, 24-h ambulatory BP monitoring (ABPM), and pulse wave analysis (PWA) of the radial artery with calculation of central pulse pressure (PP) and augmentation index (AIx). Results: Overall, 18 patients (11 females) were included. Mean age was 36 years and mean body mass index (BMI) was 22.1 kg/m2. Eleven patients were on Celiprolol therapy. No significant differences were found between groups in terms of age, sex, BMI, and presence of hypertension (p>0.05). Patients on Celiprolol therapy displayed higher values of systolic BP (SBP) (124 vs 113 mmHg; p = 0.128), diastolic BP (DBP) (76 vs 67 mmHg; p = 0.236), mean BP (92 vs 83 mmHg; p = 0.173), and HR at office BP measurement, as well as lower AIx (126 vs 140%; p = 0.176) at PWA, although the difference was not statistically significant. Similarly, no significant difference was found for all ABPM parameters (24-h, day-time, and night-time SBP, DBP, mean BP, and HR), as well as central SBP, central DBP, central mean BP, and PP at PWA between groups (p>0.05). Conclusions: Our study suggests little impact of Celiprolol therapy on both BP and HR in patients with vEDS, which hints additional mechanisms behind its protective effect in this clinical setting. Further studies on larger cohorts are needed to clarify these aspects.

Associations of aortic stiffness and intra-aortic flow parameters with epicardial adipose tissue in patients with type-2 diabetes.

It has been shown that increased aortic stiffness is related to type-2 diabetes (T2D) which is considered as a risk factor for cardiovascular disease. Among other risk factors is epicardial adipose tissue (EAT) which is increased in T2D and is a relevant biomarker of metabolic severity and adverse outcome. To assess aortic flow parameters in T2D patients as compared to healthy individuals and to evaluate their associations with EAT accumulation as an index of cardiometabolic severity in T2D patients. Thirty-six T2D patients as well as 29 healthy controls matched by age and sex were included in this study. Participants had cardiac and aortic MRI exams at 1.5 T. Imaging sequences included cine SSFP for left ventricle (LV) function and EAT assessment and aortic cine and phase-contrast imaging for strain and flow parameters quantification. In this study, we found LV phenotype to be characterized by concentric remodeling with decreased stroke volume index despite global LV mass within a normal range. EAT was increased in T2D patients compared to controls (p<0.0001). Moreover, EAT, a biomarker of metabolic severity, was negatively correlated to ascending aortic (AA) distensibility (p=0.048) and positively to the normalized backward flow volume (p=0.001). These relationships remained significant after further adjustment for age, sex and central mean blood pressure. In a multivariate model, presence/absence of T2D and AA normalized backward flow (BF) to forward flow (FF) volumes ratio are both significant and independent correlates of EAT. In our study, aortic stiffness as depicted by an increased backward flow volume and decreased distensibility seems to be related to EAT volume in T2D patients. This observation should be confirmed in the future on a larger population while considering additional biomarkers specific to inflammation and using a longitudinal prospective study design.

The correlation between central blood pressure and carotid intima media thickness in the hypertensives

Objectives: The aim of this research was to evaluate the relationship and correlation between central blood pressure and carotid intima media thickness (CIMT) in the hypertensives. Subjects - Methods: A descriptive cross-sectional study compared a control group in 210 study subjects (including 105 hypertensives and 105 normotensives). Results: There was a statistically significant positive correlation with moderate level between peripheral systolic blood pressure, central systolic blood pressure, peripheral pulse pressure, central pulse pressure and carotid intima media thickness (r was equal to 0.402, 0.436, 0.368, 0.421 respectively, p&lt; 0.001). Central pulse pressure had a weak ability to delineate in the diagnosis of carotid intima-media damage in the hypertensives, AUC = 0.649, p &lt; 0.05. CIMT (R2: 22,4%) = 0.289 – 0.094*(Gender) + 0.004*(Age) + 0.004*(Central mean blood pressure) + 0.005*(Central pulse pressure). Conclusions: Central blood pressure was correlated with carotid intima media thickness in hypertensive patients. Key words: central blood pressure, pulse pressure, carotid intima media thickness

Association of AGT, ACE, NOS3 polymorphism with subclinical arterial wall changes and cardiovascular diseases risk factors.

Aim:Renin-Angiotensin-Aldosterone System activation (RAAS) and nitric oxide (NO) decline are leading to changes in arterial wall, which, in turn, is increasing risk of cardiovascular diseases (CVD). There is limited evidence on influence of AGT, ACE, NOS3polymorphism on pulse wave velocity (PWV) carotid artery intima-media thickness (cIMT), endothelium-dependent vasodilation (EDVD), presence of atherosclerotic plaques and risk factors of CVD. Aim of this study was to find association between AGT, ACE, NOS3polymorphism and PWV, cIMT, EDV, presence of atherosclerotic plaques and risk factors of CVD in a healthy population.Methods:We examined association of AGTс.521СТpolymorphism, AСEInsDel polymorphism, NOS3 с.894GT polymorphismwith arterial wall changes and risk factors of CVD in 160 healthy people of different ages. Results:CT genotype ofAGTс.521СТpolymorphism was associated with lower levels of systolic blood pressure (BP) (p=0,013)and central systolic BP (p=0,029), higher level of Insulin-Like Growth Factor (IGF) (p=0,027). DD genotype ofACEInsDel polymorphism was associated with higher waist/hip ratio (p=0,044), lower level of high density lipoprotein cholesterol (p=0,01), lower index of EDVD (p=0,042),most commonly found endothelial dysfunction (ED) (p=0,026).GG genotype ofNOS3с.894GT polymorphism was associated with higher levels of central systolic BP (p=0,022) and central mean BP (p=0,033),total cholesterol (p=0,025), low density lipoprotein cholesterol(p=0,014) and IGF (p=0,042),most commonly found ED (p=0,007), albuminuria (p =0,032) and insulin resistance (p=0,03).Conclusion:We found association of AСE andNOS3polymorphism with endothelial dysfunction and metabolic parameters.

P4702Blood pressure lowering by peripheral arterial angioplasty

Abstract Objective We hypothesized that the endovascular treatment of flow limiting peripheral stenosis may decrease arterial blood pressure (BP). Methods We prospectively enrolled 381 consecutive patients with PAD scheduled for PTA. Clinical baseline characteristics and BP responses to PTA or angiography were analyzed. In a subgroup of 30 patients, we analyzed intra-procedural central aortic BP before and after PTA of iliac (n=15) and femoropoliteal arteries (n=10) and diagnostic angiography (n=5). Results Systolic BP (SBP) decreased after PTA of iliac (−19 mmHg, 95% CI: −15, −23 mmHg), femoropopliteal (−12 mmHg, 95% CI: −9, −15 mmHg), and BTK arteries (−7 mmHg, 95% CI: −1, −14 mmHg) but not after diagnostic angiography (−2 mmHg, 95% CI: 2, −6 mmHg) as compared to baseline. Diastolic BP (DBP) decreased after iliac (−5 mmHg, 95% CI: −2, −9 mmHg) and femoropopliteal (−4 mmHg, 95% CI: −1, −6 mmHg) angioplasty, but not after BTK PTA (1 mmHg, 95% CI: 6, −8 mmHg) or angiography (5 mmHg, 95% CI: −10, 12 mmHg). Mean central BP (CBP) acutely decreased after iliac (−20 mmHg [95% CI: −12, −32 mmHg] / −7 mmHg [95% CI: −6, −9 mmHg]) and femoropopliteal artery PTA (−9 mmHg [95% CI: −8, −12 mmHg] / −4 mmHg [95% CI: −3, −6 mmHg]) but not after diagnostic angiography. Iliac PTA achieved the most pronounced peripheral and central SBP lowering effect (p&lt;0.05, iliac PTA vs. all other). Baseline clinical and demographic characteristics of overall study population and break-down according to most proximal flow limiting stenosis (a) Baseline characteristics Total Iliac Fempop. BTK Diagnostic n (%) 381 (100) 119 (31) 208 (55) 39 (10) 15 (4) Age (yrs) 70±11 66±11 74±9 70±12 67±12 Male (%) 275 (72) 85 (71) 146 (70) 32 (82) 12 (80) Smoker (%) 241 (63) 98 (83) 114 (55) 20 (50) 9 (60) Hypertension (%) 337 (88) 106 (89) 187 (90) 32 (82) 12 (80) Hyperlipidemia (%) 290 (76) 100 (84) 149 (71) 29 (75) 12 (80) CAD (%) 268 (70) 91 (76) 144 (69) 24 (61) 9 (60) Diabetes (%) 207 (54) 30 (25) 142 (68) 26 (68) 9 (60) Renal failure (%) 167 (44) 38 (32) 101 (48) 22 (57) 6 (40) Antihypertensive treatment (%) 350 (92) 108 (90) 194 (93) 33 (86) 15 (100) Baseline ABI 0.53±0.10 0.56±0.12 0.53±0.1 0.48±0.09 0.54±0.14 ABI before discharge 0.9±0.12 0.94±0.12 0.92±0.11 0.86±0.14 0.54±0.14 pBP baseline vs. post PTA/Angio Conclusion Endovascular treatment of proximal PAD lowers significantly central and peripheral blood pressure. Effect size increases with more proximal lesions.

The presentation and management of hypertension in a large cohort of Takayasu arteritis

The objective of this study was to explore the presentation and management of hypertension secondary to Takayasu arteritis (TA) in a large cohort, single center in China. We retrospectively analyzed 381 TA patients with hypertension hospitalized in Fuwai hospital between Jan. 2004 and Feb. 2014. Diagnosis of hypertension was according to clinic blood pressure or the central blood pressure measured during angiography. Renal artery stenosis was the most common cause (264, 69.3%), followed by the thoracic descending aorta stenosis (98, 25.7%), abdominal aorta stenosis (78, 20.5%), and severe aortic regurgitation (45, 11.8%). More than two kinds of pathologies were found in 98 (25.7%) patients. The mean age of hypertension onset was 25.0 ± 14.3years. The mean blood pressure of upper extremity in patients without bilateral subclavian artery stenosis (321, 84.3%) was 176.0 ± 29.4mmHg/97.2 ± 23.0mmHg, while in 60 (15.7%) patients with bilateral subclavian artery stenosis, the mean central blood pressure was 192.7 ± 30.8mmHg/102.4 ± 121.1mmHg. A total of 305 were followed for 38.4 ± 36.7months, and the rate of blood pressure control, improvement, and failure was 50.8, 41.0, and 8.2%, respectively. Immunosuppressive therapy (OR 2.402, 95% confidence interval 1.253-4.603, P = 0.008) and the pathogenesis of hypertension (P = 0.010) were associated with prognosis of hypertension. The pathogenesis of hypertension due to TA is very complex and multifactorial. Renal artery stenosis is most frequently observed, followed by stenosis of the thoracic descending aorta, abdominal aorta, and severe aortic regurgitation. Immunosuppressive therapy and identifying the pathogenesis of hypertension is of great importance in patients with TA.

Central blood pressure monitoring method oriented to wearable devices

Arterial hypertension affects a quarter of the world’s population and is a major risk factor for cardiovascular disease. Blood pressure (BP) is one of the most relevant parameters used for continual monitoring of possible hypertension states in the elderly population. Furthermore, emerging evidence suggests that central blood pressure is a more accurate predictor of future cardiovascular events than brachial pressure, thus potentially providing a better hemodynamic determinant for clinical outcomes. This work presents a non-invasive Central (Aortic) blood pressure estimation method based on the pulse transit time (ptt) principle estimated from electrocardiogram (ECG) and ballistocardiogram (BCG) recordings. As the measured transit time presented takes place mainly within the aortic domain, we estimate aortic blood pressure instead of brachial pressure. Validation of the proposed method was performed with a small sample of healthy volunteers at a local gym. An Atcor Medical SphygmoCor device was used to monitor central and brachial blood pressure (systolic, mean, and diastolic) during rests of the strength maneuvers. Pulse transit time was estimated from ECG and BCG recordings and simultaneously recorded with all BP readings. Results showed that Systolic and Mean central blood pressures were most strongly correlated with ppt-estimated blood pressure in comparison to all other blood pressure readings; Bland-Altman plots showed an almost zero mean error (|μ|< 0.02mmHg) and bounded standard deviation σ< 5mmHg for all systolic and mean central BP readings. Experimental data, thus showed promissory results for monitoring aortic blood pressure via ptt. The scope of this pilot work is to provide initial validation of this method in order to develop a compact miniaturized device that allows the integration of wireless blood pressure monitoring into a wearable system.

PP.06.33

Objective: Hypertension and age have been associated with changes in aortic and left ventricle anatomy in general population. Our objectives were to assess determinants of aortic anatomic indices in hypertension using cardiovascular magnetic resonance (CMR).Design and method: Heart and of proximal aorta CMR exam (1.5T Siemens) was performed. Ascending aortic diameters (D) were calculated using the ARTFUN software and an automated segmentation of SSFP cine acquisitions acquired in the axial view, during breath-holding, at the level of pulmonary bifurcation perpendicular to the aorta. Aortic arch (AoA) width (W) defined as the distance between the center of the ascending and descending aorta cross-sections. AoA height (H) defined as the length of the orthogonal projection of the inflection point of the AoA centerline, positioned at the top of the arch, on the width of the aortic arch. AoA length (L) was estimated from SSFP acquisitions as the distance between the ascending and proximal descending aorta locations used for flow measurements. Telediastolic Left Ventricle indexed mass (M) and volumes (V) were semi-automatically calculated using the QMASS ® software on small axis Cine sequences. Central Blood pressures (BP) recorded using SPhygmocor ® just before MRI were used to define BP levels. Results: Population included 80 subjects (mean age 52 ± 13; 53% male): 23 controls and 57 treated hypertensives (28 controlled and 29 uncontrolled). Male proportion was 51%. Demographics were comparable in the 3 groups but age was a slightly younger in controls. M/V differed between the 3 groups (p < .03): 3.8, 3.9 and 4.4 in control subjects, controlled and uncontrolled hypertensives respectively. AoA W, L, H and D differed between control subjects and uncontrolled hypertensives (Figure 1 p < .001). Univariate analysis showed that significant associations of W and M/V with age, central mean BP (cMBP), BMI and gender whereas L and H only correlated to age and gender. Multivariate analysis showed after adjustment for age, gender, BMI, cMBP, independent influence of cMBP, and age on AoW and D as well as with M and M/V ratio. Conclusions: Along with age, hypertension is an independent determinant of aortic anatomy

Abstract 18500: Determinants of Cardiac Loading During Long Duration Spaceflight

INTRODUCTION: Prolonged exposure to microgravity (bedrest) leads to a decrease in cardiac mass by ~1%/week due to reduced cardiac work. However, the magnitude of reduction with long duration spaceflight with modern countermeasures is unknown. One purpose of this study (Integrated CardioVascular) is to quantify cardiac work and mass in astronauts during 6 months on the International Space Station (ISS). METHODS: Data from 5 astronauts who completed a long duration stay on the ISS (~6 months) were analyzed. Cardiac mass (MRI) was measured pre- and post-flight. Continuous finger blood pressure waveforms (Volume-Clamp) for 24 hours were measured before and the end of flight (15 days before they returned to the earth). Cardiac mass was estimated by (epicardial volume - endocardial volume)*1.05 g/mL. Daily stroke work and cardiac work were calculated by the sum of each stroke volume (ΣSV, SV; stroke voluem) and stroke work (ΣSV*cmBPs, cmBPs; mean central blood pressure during systole) per day, respectively. The central blood pressure waveform was mathematically reconstructed from the finger blood pressure waveform. Beat-to-beat SV was estimated with BP waveform analysis (Modelflow). RESULTS: The %change in cardiac mass was variable (+1% on average) with divergent responses among astronauts (-4%~ +14%). All astronauts showed the reduction of cardiac work (-15±9%), while 4 of 5 showed the reduction of stroke work (-8±12%). A strong positive linear relationship was shown between % changes in cardiac work vs. mass (R 2 =0.471) as well as %changes in stroke work vs. cardiac mass (R 2 =0.905). CONCLUSIONS: Cardiac atrophy during long duration spaceflight is highly dependent on the relative changes in cardiac work and stroke work from preflight to the end of the mission. Current countermeasures may be protective in some, but not all astronauts.

Rosuvastatin in patients with arterial hypertension and dyslipidemia: effects on microcirculation and pulse wave parameters

Aim. To investigate the parameters of pulse wave contour analysis (PWCA) and microcirculation (MC) in patients with arterial hypertension (AH), dyslipidemia (DLP), and high cardiovascular risk levels (SCORE &gt;5%); to compare the dynamics of these parameters during the treatment with rosuvastatin or atorvastatin. Material and methods. The study included 82 patients (mean age 53±10 years) with the high-risk AH (SCORE levels &gt;5%), DLP, and no strict contraindications to statins. All patients were randomised into two comparable groups: Group I (n=40; mean age 51±10 years), receiving atorvastatin and standard AH treatment; and Group II (n=42; mean age 52±10 years), receiving rosuvastatin and standard AH treatment. At baseline and after 5 weeks, all patients underwent the MC assessment (conjunctival biomicroscopy) and PWCA (AngioScan-01). The following parameters were assessed: stiffness index (SI), reflection index (RI), augmentation index (AIx), and increased pulse wave amplitude (PWA). Results. In the atorvastatin group, mean SI values were 5,87±2,05 m/s, RI values 35,64±19,98%, mean AIx values for heart rate of 75 beats per minute (AIx75) 41,21±14,56%, and mean central blood pressure (BP, Spa) levels 144,35±22,31 mm Hg. In the rosuvastatin group, the respective values were 5,01±2,56 m/s (SI), 37,01±14,56% (RI), 41,23±14,35% (AIx75), and 148,98±7,89 mm Hg (BP, Spa). All participants demonstrated PW Types A and B, as a marker of increased arterial stiffness, and positive AIx and AIx75 values. The treatment with atorvastatin and rosuvastatin was associated with a significant reduction in ∆SI (-0,87 and -0,89 m/s, respectively). Both groups demonstrated a non-significant reduction in ∆RI (-7,89 and -7,21%, respectively) and ∆AIx (-1,88 and -1,92%, respectively). PWA increased by 1,82±0,62 times in the atorvastatin group and by 1,95±0,81 times in the rosuvastatin group. At baseline, both groups demonstrated disturbed conjunctival MC (arterio-venular coefficient 1:3, stasis, and Stage III erythrocyte aggregation). Atorvastatin and rosuvastatin treatment was linked to a regression in the last two parameters, which could be explained by the improved vascular wall elasticity. Conclusion. In high-risk patients with AH, the PWCA data suggested an increase in arterial stiffness, which was combined with conjunctival MC disturbances. Statin therapy improved not only blood lipid levels, but also MC, vascular stiffness, and endothelial function parameters, which was more pronounced in the rosuvastatin group.

Central blood pressure is an independent predictor of future hypertension in young to middle-aged stage 1 hypertensives

Aim. The aim of the present study was to evaluate the association of central blood pressure (BP) with organ damage and risk of future hypertension in a cohort of young to middle-aged patients. Methods. We studied 305 subjects screened for stage 1 hypertension to determine which subjects developed hypertension needing therapy according to current guidelines. Central BP was obtained from radial artery tonometry. Organ damage was the presence of left ventricular hypertrophy and/or microalbuminuria. Results. In a multiple logistic regression including ambulatory 24-h BP, central mean BP was associated with presence of end-organ damage (p = 0.003). In the subjects divided according to whether their central mean BP was above or below the median, subjects with high central mean BP presented an earlier impairment of arterial distensibility and developed sustained hypertension more frequently compared with those with low central mean BP (p < 0.001). In logistic analyses, central mean BP was an independent predictor of future hypertension (p < 0.001) and remained associated with outcome when 24-h BP was included in the same model (p = 0.006). Conclusions. In young to middle-aged subjects in the early stage of hypertension, central mean BP is a useful adjunct to brachial BPs to better define the individual risk profile.

Pulsatile but Not Steady Component of Blood Pressure Predicts Cardiovascular Events in Coronary Patients

Although the differences between central and peripheral blood pressure (BP) values have been known for decades, the consequences of decision making based on peripheral rather than central BP have only recently been recognized. There are only a few studies assessing the relationship between intraaortic BP and cardiovascular risk. In addition, the relationship between central BP and the risk of cardiovascular events in a large group of coronary patients has not yet been evaluated. Therefore, the aim of the study was to determine the prognostic significance of central BP-derived indices in patients undergoing coronary angiography. Invasive central BPs were taken at baseline, and study end points were ascertained during over a 4.5-year follow-up in 1109 consecutive patients. The primary end point (cardiovascular death or myocardial infarction or stroke or cardiac arrest or heart transplantation or myocardial revascularization) occurred in 246 (22.2%) patients. Central pulsatility was the most powerful predictor of the primary end point (hazard ratio [HR] 1.30, 95% confidence interval [CI] 1.14 to 1.48). Central pulse pressure was also independently related to the primary end point (HR 1.25, 95% CI 1.09 to 1.43). Central mean BP as well as peripheral BP parameters were not independently related to the primary end point risk. Central pulsatility was also related to risk of cardiovascular death or myocardial infarction or stroke. The pulsatile component of BP is the most important factor related to the cardiovascular risk in coronary patients. It is more closely associated with cardiovascular risk than steady component of BP.