title: Brachial blood pressure but not carotid arterial waveforms predict cardiovascular events in elderly female hypertensives.
abstract: Central arterial waveforms and related indices of large artery properties can be determined with relative ease. This would make them an attractive adjunct in the risk stratification for cardiovascular disease. Although they have been associated with some classical risk factors and the presence of coronary disease, their prospective value in predicting cardiovascular outcomes is unknown. The present study determined the relative predictive value for cardiovascular disease-free survival of large artery properties as compared with noninvasive brachial blood pressure alone in a population of elderly female hypertensive subjects. We measured systemic arterial compliance, central systolic pressure, and carotid augmentation index in a subset of female participants in the Second Australian National Blood Pressure Study (untreated blood pressure 169/88+/-12/8 mm Hg). There were a total of 53 defined events during a median of 4.1 years of follow-up in 484 women with complete measurements. Although baseline blood pressures at the brachial artery predicted cardiovascular disease-free survival (hazard ratio [HR], 2.3; 95% CI, 1.3 to 4.1 for pulse pressure > or =81 versus <81 mm Hg; P=0.01), no such relation was found for carotid augmentation index (HR, 0.80; 95% CI, 0.44 to 1.44; P value not significant) or systemic arterial compliance (HR, 1.25; 95% CI, 0.72 to 2.16; P value not significant). Blood pressure, but not noninvasively measured central arterial waveforms, predict outcome in the older female hypertensive patient. Thus, blood pressure measurement alone is superior to measurement of arterial waveforms in predicting outcome in this group.
authors.affiliation: Baker Medical Research Institute, Melbourne, Victoria, 8008, Australia. a.dart@alfred.org.au
authors.forename: Anthony M
authors.initials: AM
authors.lastname: Dart
authors.forename: Christoph D
authors.initials: CD
authors.lastname: Gatzka
authors.forename: Bronwyn A
authors.initials: BA
authors.lastname: Kingwell
authors.forename: Kristyn
authors.initials: K
authors.lastname: Willson
authors.forename: James D
authors.initials: JD
authors.lastname: Cameron
authors.forename: Yu-Lu
authors.initials: YL
authors.lastname: Liang
authors.forename: Karen L
authors.initials: KL
authors.lastname: Berry
authors.forename: Lindon M H
authors.initials: LM
authors.lastname: Wing
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Reid
authors.forename: Philip
authors.initials: P
authors.lastname: Ryan
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Beilin
authors.forename: Garry L R
authors.initials: GL
authors.lastname: Jennings
authors.forename: Colin I
authors.initials: CI
authors.lastname: Johnston
authors.forename: John J
authors.initials: JJ
authors.lastname: McNeil
authors.forename: Graham J
authors.initials: GJ
authors.lastname: Macdonald
authors.forename: Trefor O
authors.initials: TO
authors.lastname: Morgan
authors.forename: Malcolm J
authors.initials: MJ
authors.lastname: West
mesh_terms: D000368:Aged; D001794:Blood Pressure; D001795:Blood Pressure Determination; D001916:Brachial Artery / Q000503:physiopathology*; D002318:Cardiovascular Diseases / Q000209:etiology*; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology*; D004452:Echocardiography; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011674:Pulse; D012212:Rheology; D012307:Risk Factors; D016037:Single-Blind Method; D016019:Survival Analysis; D013599:Systole