Pulse pressure amplification a mechanical biomarker of cardiovascular risk.
OBJECTIVE
The aim of this study was to determine whether the carotid/brachial (C/B) ratio is an independent predictor of cardiovascular (CV) risk.


BACKGROUND
Brachial and carotid pulse pressure (PP) are independent predictors of CV risk, mainly in elderly patients. Because PP is physiologically lower at the brachial than at the carotid arterial site, PP amplification is represented by the C/B ratio and could independently predict CV risk.


METHODS
In a Paris population (n = 834), brachial and carotid PP were measured from sphygmomanometry and pulse wave analysis. With stepwise multiple regression, carotid PP was calculated from a nomogram including age, sex, body height, brachial PP, and plasma glucose. This model was applied to 125,151 subjects, followed for 12 years, during which 3,997 deaths occurred (735 of CV origin). With Cox regression analysis, multi-adjusted hazard ratios (HRs) were calculated for 1 SD increase of brachial PP, calculated carotid PP, and C/B ratio.


RESULTS
Brachial PP was significantly associated with both CV and all-cause mortality (HR: 1.16, 95% confidence interval [CI]: 1.13 to 1.19, and HR: 1.13, 95% CI: 1.10 to 1.17, respectively). Calculated carotid PP predicted a similar risk (HR: 1.21, 95% CI: 1.15 to 1.28, and HR: 1.18, 95% CI: 1.12 to 1.25, respectively). Finally, the C/B ratio was a strong risk predictor (HR: 1.22, 95% CI: 1.12 to 1.32, and HR: 1.41, 95% CI: 1.14 to 1.73, respectively). Addition of drug treatment and other confounding variables did not statistically modify the results.


CONCLUSIONS
Brachial PP, calculated carotid PP, and C/B PP amplification all predict CV mortality. In contrast to brachial and carotid PP, the C/B ratio is less dependent on blood pressure calibration and thus can be directly applicable to large population studies.
Benetos
Athanase
A
Department of Geriatrics CHU de Nancy, and INSERM U691, University of Nancy, Nancy, France.
Thomas
Frédérique
F
Joly
Laure
L
Blacher
Jacques
J
Pannier
Bruno
B
Labat
Carlos
C
Salvi
Paolo
P
Smulyan
Harold
H
Safar
Michel E
ME
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure / Q000502:physiology*; D001827:Body Height; D001916:Brachial Artery / Q000503:physiopathology*; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology*; D002339:Carotid Arteries / Q000503:physiopathology*; D002423:Cause of Death; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012016:Reference Values; D012044:Regression Analysis; D018570:Risk Assessment / Q000706:statistics & numerical data; D012737:Sex Factors; D055815:Young Adult
D015415:Biomarkers; D001786:Blood Glucose