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Importance of calibration method in central blood pressure for cardiac structural abnormalities

Citation

Negishi, K and Yang, H and Wang, Y and Nolan, MT and Negishi, T and Pathan, F and Marwick, TH and Sharman, JE, Importance of calibration method in central blood pressure for cardiac structural abnormalities, American Journal of Hypertension, 29, (9) pp. 1070-1076. ISSN 0895-7061 (2016) [Refereed Article]

Copyright Statement

Copyright 2016 American Journal of Hypertension, Ltd.

DOI: doi:10.1093/ajh/hpw039

Abstract

Background: Central blood pressure (CBP) independently predicts cardiovascular risk, but calibration methods may affect accuracy of central systolic blood pressure (CSBP). Standard central systolic blood pressure (Stan-CSBP) from peripheral waveforms is usually derived with calibration using brachial SBP and diastolic BP (DBP). However, calibration using oscillometric mean arterial pressure (MAP) and DBP (MAP-CSBP) is purported to provide more accurate representation of true invasive CSBP. This study sought to determine which derived CSBP could more accurately discriminate cardiac structural abnormalities.

Methods: A total of 349 community-based patients with risk factors (715years, 161 males) had CSBP measured by brachial oscillometry (Mobil-O-Graph, IEM GmbH, Stolberg, Germany) using 2 calibration methods: MAP-CSBP and Stan-CSBP. Left ventricular hypertrophy (LVH) and left atrial dilatation (LAD) were measured based on standard guidelines.

Results: MAP-CSBP was higher than Stan-CSBP (14920 vs. 12815mm Hg, P < 0.0001). Although they were modestly correlated (rho = 0.74, P < 0.001), the Bland-Altman plot demonstrated a large bias (21mm Hg) and limits of agreement (24mm Hg). In receiver operating characteristic (ROC) curve analyses, MAP-CSBP significantly better discriminated LVH compared with Stan-CSBP (area under the curve (AUC) 0.66 vs. 0.59, P = 0.0063) and brachial SBP (0.62, P = 0.027). Continuous net reclassification improvement (NRI) (P < 0.001) and integrated discrimination improvement (IDI) (P < 0.001) corroborated superior discrimination of LVH by MAP-CSBP. Similarly, MAP-CSBP better distinguished LAD than Stan-CSBP (AUC 0.63 vs. 0.56, P = 0.005) and conventional brachial SBP (0.58, P = 0.006), whereas Stan-CSBP provided no better discrimination than conventional brachial BP (P = 0.09).

Conclusions: CSBP is calibration dependent and when oscillometric MAP and DBP are used, the derived CSBP is a better discriminator for cardiac structural abnormalities.

Item Details

Item Type:Refereed Article
Keywords:blood pressure determinations, blood vessels, cardiovascular diagnostic technique, heart function tests, hypertension, pulse wave analysis
Research Division:Medical and Health Sciences
Research Group:Cardiorespiratory Medicine and Haematology
Research Field:Cardiology (incl. Cardiovascular Diseases)
Objective Division:Health
Objective Group:Clinical Health (Organs, Diseases and Abnormal Conditions)
Objective Field:Cardiovascular System and Diseases
Author:Negishi, K (Dr Kazuaki Negishi)
Author:Yang, H (Ms Hong Yang)
Author:Wang, Y (Ms Ying Wang)
Author:Nolan, MT (Mr Mark Nolan)
Author:Negishi, T (Dr Tomoko Negishi)
Author:Pathan, F (Dr Faraz Pathan)
Author:Marwick, TH (Professor Tom Marwick)
Author:Sharman, JE (Professor James Sharman)
ID Code:108574
Year Published:2016
Web of Science® Times Cited:7
Deposited By:Menzies Institute for Medical Research
Deposited On:2016-04-26
Last Modified:2017-11-03
Downloads:0

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