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Discovery of new blood pressure phenotypes and relation to accuracy of cuff devices used in daily clinical practice

Citation

Picone, DS and Schultz, MG and Peng, X and Black, JA and Dwyer, N and Roberts-Thomson, P and Chen, C-H and Cheng, H-M and Pucci, G and Wang, J-G and Sharman, JE, Discovery of new blood pressure phenotypes and relation to accuracy of cuff devices used in daily clinical practice, Hypertension, 71 pp. 1-9. ISSN 0194-911X (2018) [Refereed Article]


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DOI: doi:10.1161/HYPERTENSIONAHA.117.10696

Abstract

Cuff blood pressure (BP) is the reference standard for management of high BP, but the method is inaccurate and can lead to BP misclassification. The aims of this study were to determine whether distinctive BP phenotypes exist based on BP transmission (amplification) variability from central-to-peripheral arteries and whether applying one standard cuff BP measurement approach (eg, oscillometry) to all people could discriminate the BP phenotypes. Intra-arterial BP was measured at the ascending aorta and brachial and radial arteries in 126 participants (6110 years; 69% male) after coronary angiography. Central-to-peripheral systolic BP (SBP) transmission (SBP amplification) was defined by ≥5 mm Hg SBP increase between the aorta-to-brachial or brachial-to-radial arteries. Standard cuff BP was measured 4 different times using 3 different devices. Three independent investigators also provided data (n=255 from 4 studies) using another 3 separate cuff BP devices. Four distinct BP phenotypes were discovered based on variability in SBP amplification: phenotype 1, both aortic-to-brachial and brachial-to-radial SBP amplification; phenotype 2, only aortic-to-brachial SBP amplification; phenotype 3, only brachial-to-radial SBP amplification; and phenotype 4, neither aortic-to-brachial nor brachial-to-radial SBP amplification. Aortic SBP was significantly higher among phenotypes 3 and 4 compared with phenotypes 1 and 2 (P=0.00074), but this was not discriminated using any standard cuff BP measures (P=0.31). Data from independent investigators confirmed the key findings. This is the first-in-human discovery of BP phenotypes that have significantly different BPs, but which are not discriminated by standard cuff BP devices used in daily clinical practice. Improved BP device accuracy may be achieved by considering individual phenotypic BP differences.

Item Details

Item Type:Refereed Article
Keywords:blood pressure, catheterization, hemodynamics, phenotype, sphygmomanometers
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:Picone, DS (Mr Dean Picone)
Author:Schultz, MG (Dr Martin Schultz)
Author:Peng, X (Miss Xiaoqing Peng)
Author:Black, JA (Dr Andrew Black)
Author:Dwyer, N (Dr Nathan Dwyer)
Author:Roberts-Thomson, P (Dr Philip Roberts-Thomson)
Author:Sharman, JE (Professor James Sharman)
ID Code:125281
Year Published:2018
Deposited By:Menzies Institute for Medical Research
Deposited On:2018-04-11
Last Modified:2018-04-11
Downloads:0

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