title: Invasively Measured Aortic Systolic Blood Pressure and Office Systolic Blood Pressure in Cardiovascular Risk Assessment: A Prospective Cohort Study.
abstract: Aortic systolic blood pressure (BP) represents the hemodynamic cardiac and cerebral burden more directly than office systolic BP. Whether invasively measured aortic systolic BP confers additional prognostic value beyond office BP remains debated. In this study, office systolic BP and invasively measured aortic systolic BP were recorded in 21 908 patients (mean age: 63 years; 58% men; 14% with diabetes mellitus) with stable angina pectoris undergoing elective coronary angiography during January 2001 to December 2012. Multivariate Cox models were used to assess the association with incident myocardial infarction, stroke, and death. Discrimination and reclassification were assessed using Harrell's C and the Continuous Net Reclassification Index. Data were analyzed with and without stratification by diabetes mellitus status. During a median follow-up period of 3.7 years (range: 0.1-10.8 years), 422 strokes, 511 myocardial infarctions, and 1530 deaths occurred. Both office and aortic systolic BP were associated with stroke in patients with diabetes mellitus (hazard ratio per 10 mm Hg, 1.18 [95% confidence interval, 1.07-1.30] and 1.14 [95% confidence interval, 1.05-1.24], respectively) and with myocardial infarction in patients without diabetes mellitus (hazard ratio, 1.07 [95% confidence interval, 1.02-1.12] and 1.05 [95% confidence interval, 1.01-1.10], respectively). In models including both BP measurements, aortic BP lost statistical significance and aortic BP did not confer improvement in either C-statistics or net reclassification analysis. In conclusion, invasively measured aortic systolic BP does not add prognostic information about cardiovascular outcomes and all-cause mortality compared with office BP in patients with stable angina pectoris, either with or without diabetes mellitus.
authors.affiliation: From the Department of Endocrinology and Internal Medicine (E.L., S.T.K., N.B.R., P.L.P.), Diagnostic Center, Regional Hospital Silkeborg (K.W.H.), and Department of Cardiology (H.E.B.), Aarhus University Hospital, Aarhus C, Denmark; The Danish Diabetes Academy (E.L.) and Department of Cardiology (L.O.J.), Odense University Hospital, Odense, Denmark; Department of Clinical Medicine (E.L.) and Department of Clinical Epidemiology (M.M.), Aarhus University, Aarhus C, Denmark; Department of Cardiology, Hospital of Southern Jutland, Aabenraa, Denmark (M.G.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (H.M.); Department of Cardiology, Hospital of South-Western Jutland, Esbjerg, Denmark (K.K.T.); Department of Cardiology, Viborg Regional Hospital, Viborg, Denmark (H.S.); Cardiac Imaging Center, Hospital Unit West, Herning, Denmark (M.B.); Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark (B.R.); and Department of Public Health, Aarhus University, Aarhus C, Denmark (A.H., D.W.). esben.laugesen@clin.au.dk.
authors.forename: Esben
authors.initials: E
authors.lastname: Laugesen
authors.affiliation: From the Department of Endocrinology and Internal Medicine (E.L., S.T.K., N.B.R., P.L.P.), Diagnostic Center, Regional Hospital Silkeborg (K.W.H.), and Department of Cardiology (H.E.B.), Aarhus University Hospital, Aarhus C, Denmark; The Danish Diabetes Academy (E.L.) and Department of Cardiology (L.O.J.), Odense University Hospital, Odense, Denmark; Department of Clinical Medicine (E.L.) and Department of Clinical Epidemiology (M.M.), Aarhus University, Aarhus C, Denmark; Department of Cardiology, Hospital of Southern Jutland, Aabenraa, Denmark (M.G.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (H.M.); Department of Cardiology, Hospital of South-Western Jutland, Esbjerg, Denmark (K.K.T.); Department of Cardiology, Viborg Regional Hospital, Viborg, Denmark (H.S.); Cardiac Imaging Center, Hospital Unit West, Herning, Denmark (M.B.); Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark (B.R.); and Department of Public Health, Aarhus University, Aarhus C, Denmark (A.H., D.W.).
authors.forename: Søren T
authors.initials: ST
authors.lastname: Knudsen
authors.affiliation: From the Department of Endocrinology and Internal Medicine (E.L., S.T.K., N.B.R., P.L.P.), Diagnostic Center, Regional Hospital Silkeborg (K.W.H.), and Department of Cardiology (H.E.B.), Aarhus University Hospital, Aarhus C, Denmark; The Danish Diabetes Academy (E.L.) and Department of Cardiology (L.O.J.), Odense University Hospital, Odense, Denmark; Department of Clinical Medicine (E.L.) and Department of Clinical Epidemiology (M.M.), Aarhus University, Aarhus C, Denmark; Department of Cardiology, Hospital of Southern Jutland, Aabenraa, Denmark (M.G.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (H.M.); Department of Cardiology, Hospital of South-Western Jutland, Esbjerg, Denmark (K.K.T.); Department of Cardiology, Viborg Regional Hospital, Viborg, Denmark (H.S.); Cardiac Imaging Center, Hospital Unit West, Herning, Denmark (M.B.); Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark (B.R.); and Department of Public Health, Aarhus University, Aarhus C, Denmark (A.H., D.W.).
authors.forename: Klavs W
authors.initials: KW
authors.lastname: Hansen
authors.affiliation: From the Department of Endocrinology and Internal Medicine (E.L., S.T.K., N.B.R., P.L.P.), Diagnostic Center, Regional Hospital Silkeborg (K.W.H.), and Department of Cardiology (H.E.B.), Aarhus University Hospital, Aarhus C, Denmark; The Danish Diabetes Academy (E.L.) and Department of Cardiology (L.O.J.), Odense University Hospital, Odense, Denmark; Department of Clinical Medicine (E.L.) and Department of Clinical Epidemiology (M.M.), Aarhus University, Aarhus C, Denmark; Department of Cardiology, Hospital of Southern Jutland, Aabenraa, Denmark (M.G.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (H.M.); Department of Cardiology, Hospital of South-Western Jutland, Esbjerg, Denmark (K.K.T.); Department of Cardiology, Viborg Regional Hospital, Viborg, Denmark (H.S.); Cardiac Imaging Center, Hospital Unit West, Herning, Denmark (M.B.); Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark (B.R.); and Department of Public Health, Aarhus University, Aarhus C, Denmark (A.H., D.W.).
authors.forename: Niklas B
authors.initials: NB
authors.lastname: Rossen
authors.affiliation: From the Department of Endocrinology and Internal Medicine (E.L., S.T.K., N.B.R., P.L.P.), Diagnostic Center, Regional Hospital Silkeborg (K.W.H.), and Department of Cardiology (H.E.B.), Aarhus University Hospital, Aarhus C, Denmark; The Danish Diabetes Academy (E.L.) and Department of Cardiology (L.O.J.), Odense University Hospital, Odense, Denmark; Department of Clinical Medicine (E.L.) and Department of Clinical Epidemiology (M.M.), Aarhus University, Aarhus C, Denmark; Department of Cardiology, Hospital of Southern Jutland, Aabenraa, Denmark (M.G.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (H.M.); Department of Cardiology, Hospital of South-Western Jutland, Esbjerg, Denmark (K.K.T.); Department of Cardiology, Viborg Regional Hospital, Viborg, Denmark (H.S.); Cardiac Imaging Center, Hospital Unit West, Herning, Denmark (M.B.); Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark (B.R.); and Department of Public Health, Aarhus University, Aarhus C, Denmark (A.H., D.W.).
authors.forename: Lisette Okkels
authors.initials: LO
authors.lastname: Jensen
authors.affiliation: From the Department of Endocrinology and Internal Medicine (E.L., S.T.K., N.B.R., P.L.P.), Diagnostic Center, Regional Hospital Silkeborg (K.W.H.), and Department of Cardiology (H.E.B.), Aarhus University Hospital, Aarhus C, Denmark; The Danish Diabetes Academy (E.L.) and Department of Cardiology (L.O.J.), Odense University Hospital, Odense, Denmark; Department of Clinical Medicine (E.L.) and Department of Clinical Epidemiology (M.M.), Aarhus University, Aarhus C, Denmark; Department of Cardiology, Hospital of Southern Jutland, Aabenraa, Denmark (M.G.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (H.M.); Department of Cardiology, Hospital of South-Western Jutland, Esbjerg, Denmark (K.K.T.); Department of Cardiology, Viborg Regional Hospital, Viborg, Denmark (H.S.); Cardiac Imaging Center, Hospital Unit West, Herning, Denmark (M.B.); Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark (B.R.); and Department of Public Health, Aarhus University, Aarhus C, Denmark (A.H., D.W.).
authors.forename: Michael G
authors.initials: MG
authors.lastname: Hansen
authors.affiliation: From the Department of Endocrinology and Internal Medicine (E.L., S.T.K., N.B.R., P.L.P.), Diagnostic Center, Regional Hospital Silkeborg (K.W.H.), and Department of Cardiology (H.E.B.), Aarhus University Hospital, Aarhus C, Denmark; The Danish Diabetes Academy (E.L.) and Department of Cardiology (L.O.J.), Odense University Hospital, Odense, Denmark; Department of Clinical Medicine (E.L.) and Department of Clinical Epidemiology (M.M.), Aarhus University, Aarhus C, Denmark; Department of Cardiology, Hospital of Southern Jutland, Aabenraa, Denmark (M.G.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (H.M.); Department of Cardiology, Hospital of South-Western Jutland, Esbjerg, Denmark (K.K.T.); Department of Cardiology, Viborg Regional Hospital, Viborg, Denmark (H.S.); Cardiac Imaging Center, Hospital Unit West, Herning, Denmark (M.B.); Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark (B.R.); and Department of Public Health, Aarhus University, Aarhus C, Denmark (A.H., D.W.).
authors.forename: Henrik
authors.initials: H
authors.lastname: Munkholm
authors.affiliation: From the Department of Endocrinology and Internal Medicine (E.L., S.T.K., N.B.R., P.L.P.), Diagnostic Center, Regional Hospital Silkeborg (K.W.H.), and Department of Cardiology (H.E.B.), Aarhus University Hospital, Aarhus C, Denmark; The Danish Diabetes Academy (E.L.) and Department of Cardiology (L.O.J.), Odense University Hospital, Odense, Denmark; Department of Clinical Medicine (E.L.) and Department of Clinical Epidemiology (M.M.), Aarhus University, Aarhus C, Denmark; Department of Cardiology, Hospital of Southern Jutland, Aabenraa, Denmark (M.G.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (H.M.); Department of Cardiology, Hospital of South-Western Jutland, Esbjerg, Denmark (K.K.T.); Department of Cardiology, Viborg Regional Hospital, Viborg, Denmark (H.S.); Cardiac Imaging Center, Hospital Unit West, Herning, Denmark (M.B.); Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark (B.R.); and Department of Public Health, Aarhus University, Aarhus C, Denmark (A.H., D.W.).
authors.forename: Kristian K
authors.initials: KK
authors.lastname: Thomsen
authors.affiliation: From the Department of Endocrinology and Internal Medicine (E.L., S.T.K., N.B.R., P.L.P.), Diagnostic Center, Regional Hospital Silkeborg (K.W.H.), and Department of Cardiology (H.E.B.), Aarhus University Hospital, Aarhus C, Denmark; The Danish Diabetes Academy (E.L.) and Department of Cardiology (L.O.J.), Odense University Hospital, Odense, Denmark; Department of Clinical Medicine (E.L.) and Department of Clinical Epidemiology (M.M.), Aarhus University, Aarhus C, Denmark; Department of Cardiology, Hospital of Southern Jutland, Aabenraa, Denmark (M.G.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (H.M.); Department of Cardiology, Hospital of South-Western Jutland, Esbjerg, Denmark (K.K.T.); Department of Cardiology, Viborg Regional Hospital, Viborg, Denmark (H.S.); Cardiac Imaging Center, Hospital Unit West, Herning, Denmark (M.B.); Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark (B.R.); and Department of Public Health, Aarhus University, Aarhus C, Denmark (A.H., D.W.).
authors.forename: Hanne
authors.initials: H
authors.lastname: Søndergaard
authors.affiliation: From the Department of Endocrinology and Internal Medicine (E.L., S.T.K., N.B.R., P.L.P.), Diagnostic Center, Regional Hospital Silkeborg (K.W.H.), and Department of Cardiology (H.E.B.), Aarhus University Hospital, Aarhus C, Denmark; The Danish Diabetes Academy (E.L.) and Department of Cardiology (L.O.J.), Odense University Hospital, Odense, Denmark; Department of Clinical Medicine (E.L.) and Department of Clinical Epidemiology (M.M.), Aarhus University, Aarhus C, Denmark; Department of Cardiology, Hospital of Southern Jutland, Aabenraa, Denmark (M.G.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (H.M.); Department of Cardiology, Hospital of South-Western Jutland, Esbjerg, Denmark (K.K.T.); Department of Cardiology, Viborg Regional Hospital, Viborg, Denmark (H.S.); Cardiac Imaging Center, Hospital Unit West, Herning, Denmark (M.B.); Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark (B.R.); and Department of Public Health, Aarhus University, Aarhus C, Denmark (A.H., D.W.).
authors.forename: Morten
authors.initials: M
authors.lastname: Bøttcher
authors.affiliation: From the Department of Endocrinology and Internal Medicine (E.L., S.T.K., N.B.R., P.L.P.), Diagnostic Center, Regional Hospital Silkeborg (K.W.H.), and Department of Cardiology (H.E.B.), Aarhus University Hospital, Aarhus C, Denmark; The Danish Diabetes Academy (E.L.) and Department of Cardiology (L.O.J.), Odense University Hospital, Odense, Denmark; Department of Clinical Medicine (E.L.) and Department of Clinical Epidemiology (M.M.), Aarhus University, Aarhus C, Denmark; Department of Cardiology, Hospital of Southern Jutland, Aabenraa, Denmark (M.G.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (H.M.); Department of Cardiology, Hospital of South-Western Jutland, Esbjerg, Denmark (K.K.T.); Department of Cardiology, Viborg Regional Hospital, Viborg, Denmark (H.S.); Cardiac Imaging Center, Hospital Unit West, Herning, Denmark (M.B.); Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark (B.R.); and Department of Public Health, Aarhus University, Aarhus C, Denmark (A.H., D.W.).
authors.forename: Bent
authors.initials: B
authors.lastname: Raungaard
authors.affiliation: From the Department of Endocrinology and Internal Medicine (E.L., S.T.K., N.B.R., P.L.P.), Diagnostic Center, Regional Hospital Silkeborg (K.W.H.), and Department of Cardiology (H.E.B.), Aarhus University Hospital, Aarhus C, Denmark; The Danish Diabetes Academy (E.L.) and Department of Cardiology (L.O.J.), Odense University Hospital, Odense, Denmark; Department of Clinical Medicine (E.L.) and Department of Clinical Epidemiology (M.M.), Aarhus University, Aarhus C, Denmark; Department of Cardiology, Hospital of Southern Jutland, Aabenraa, Denmark (M.G.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (H.M.); Department of Cardiology, Hospital of South-Western Jutland, Esbjerg, Denmark (K.K.T.); Department of Cardiology, Viborg Regional Hospital, Viborg, Denmark (H.S.); Cardiac Imaging Center, Hospital Unit West, Herning, Denmark (M.B.); Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark (B.R.); and Department of Public Health, Aarhus University, Aarhus C, Denmark (A.H., D.W.).
authors.forename: Morten
authors.initials: M
authors.lastname: Madsen
authors.affiliation: From the Department of Endocrinology and Internal Medicine (E.L., S.T.K., N.B.R., P.L.P.), Diagnostic Center, Regional Hospital Silkeborg (K.W.H.), and Department of Cardiology (H.E.B.), Aarhus University Hospital, Aarhus C, Denmark; The Danish Diabetes Academy (E.L.) and Department of Cardiology (L.O.J.), Odense University Hospital, Odense, Denmark; Department of Clinical Medicine (E.L.) and Department of Clinical Epidemiology (M.M.), Aarhus University, Aarhus C, Denmark; Department of Cardiology, Hospital of Southern Jutland, Aabenraa, Denmark (M.G.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (H.M.); Department of Cardiology, Hospital of South-Western Jutland, Esbjerg, Denmark (K.K.T.); Department of Cardiology, Viborg Regional Hospital, Viborg, Denmark (H.S.); Cardiac Imaging Center, Hospital Unit West, Herning, Denmark (M.B.); Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark (B.R.); and Department of Public Health, Aarhus University, Aarhus C, Denmark (A.H., D.W.).
authors.forename: Adam
authors.initials: A
authors.lastname: Hulman
authors.affiliation: From the Department of Endocrinology and Internal Medicine (E.L., S.T.K., N.B.R., P.L.P.), Diagnostic Center, Regional Hospital Silkeborg (K.W.H.), and Department of Cardiology (H.E.B.), Aarhus University Hospital, Aarhus C, Denmark; The Danish Diabetes Academy (E.L.) and Department of Cardiology (L.O.J.), Odense University Hospital, Odense, Denmark; Department of Clinical Medicine (E.L.) and Department of Clinical Epidemiology (M.M.), Aarhus University, Aarhus C, Denmark; Department of Cardiology, Hospital of Southern Jutland, Aabenraa, Denmark (M.G.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (H.M.); Department of Cardiology, Hospital of South-Western Jutland, Esbjerg, Denmark (K.K.T.); Department of Cardiology, Viborg Regional Hospital, Viborg, Denmark (H.S.); Cardiac Imaging Center, Hospital Unit West, Herning, Denmark (M.B.); Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark (B.R.); and Department of Public Health, Aarhus University, Aarhus C, Denmark (A.H., D.W.).
authors.forename: Daniel
authors.initials: D
authors.lastname: Witte
authors.affiliation: From the Department of Endocrinology and Internal Medicine (E.L., S.T.K., N.B.R., P.L.P.), Diagnostic Center, Regional Hospital Silkeborg (K.W.H.), and Department of Cardiology (H.E.B.), Aarhus University Hospital, Aarhus C, Denmark; The Danish Diabetes Academy (E.L.) and Department of Cardiology (L.O.J.), Odense University Hospital, Odense, Denmark; Department of Clinical Medicine (E.L.) and Department of Clinical Epidemiology (M.M.), Aarhus University, Aarhus C, Denmark; Department of Cardiology, Hospital of Southern Jutland, Aabenraa, Denmark (M.G.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (H.M.); Department of Cardiology, Hospital of South-Western Jutland, Esbjerg, Denmark (K.K.T.); Department of Cardiology, Viborg Regional Hospital, Viborg, Denmark (H.S.); Cardiac Imaging Center, Hospital Unit West, Herning, Denmark (M.B.); Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark (B.R.); and Department of Public Health, Aarhus University, Aarhus C, Denmark (A.H., D.W.).
authors.forename: Hans Erik
authors.initials: HE
authors.lastname: Bøtker
authors.affiliation: From the Department of Endocrinology and Internal Medicine (E.L., S.T.K., N.B.R., P.L.P.), Diagnostic Center, Regional Hospital Silkeborg (K.W.H.), and Department of Cardiology (H.E.B.), Aarhus University Hospital, Aarhus C, Denmark; The Danish Diabetes Academy (E.L.) and Department of Cardiology (L.O.J.), Odense University Hospital, Odense, Denmark; Department of Clinical Medicine (E.L.) and Department of Clinical Epidemiology (M.M.), Aarhus University, Aarhus C, Denmark; Department of Cardiology, Hospital of Southern Jutland, Aabenraa, Denmark (M.G.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (H.M.); Department of Cardiology, Hospital of South-Western Jutland, Esbjerg, Denmark (K.K.T.); Department of Cardiology, Viborg Regional Hospital, Viborg, Denmark (H.S.); Cardiac Imaging Center, Hospital Unit West, Herning, Denmark (M.B.); Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark (B.R.); and Department of Public Health, Aarhus University, Aarhus C, Denmark (A.H., D.W.).
authors.forename: Per L
authors.initials: PL
authors.lastname: Poulsen
mesh_terms: D000367:Age Factors; D000368:Aged; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods*; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D002423:Cause of Death; D015331:Cohort Studies; D003718:Denmark; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality* / Q000503:physiopathology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D020521:Stroke / Q000209:etiology / Q000401:mortality* / Q000503:physiopathology; D016019:Survival Analysis; D013599:Systole / Q000502:physiology
keywords: all-cause mortality aortic blood pressure; cerebral infarction; diabetes mellitus; myocardial infarction office blood pressure; stroke