Diagnostic Threshold for Central Blood Pressure Enhances Cardiovascular Risk Stratification

Overview

This large retrospective cohort study established a diagnostic threshold of 135 mmHg for central systolic blood pressure (cSBP), corresponding to the traditional brachial SBP threshold of 140 mmHg. Individuals with isolated central hypertension exhibited significantly elevated cardiovascular risk, comparable to those with concordant hypertension, while isolated brachial hypertension was associated with low risk.

Background

Hypertension is a leading cause of cardiovascular disease globally, traditionally diagnosed using brachial blood pressure measurements. Central blood pressure better reflects the pressure load on vital organs and may more accurately predict cardiovascular risk. However, central BP measurement has not been widely adopted clinically due to lack of established diagnostic thresholds and inconsistent evidence on its incremental prognostic value. This study addresses these gaps by defining an outcome-derived central BP threshold and evaluating its utility in cardiovascular risk stratification.

Data Highlights

Key Findings

• A central systolic BP threshold of 135 mmHg was identified as equivalent to the brachial SBP threshold of 140 mmHg for hypertension diagnosis.
• Approximately 3.65% of participants had isolated central hypertension, associated with a 70% increased risk of cardiovascular events compared to normotension.
• Isolated brachial hypertension (2.23% prevalence) was not associated with increased cardiovascular risk.
• Concordant hypertension (both brachial and central elevated) was associated with a 51% increased risk of cardiovascular events.
• Incorporating central BP measurements improved cardiovascular risk prediction beyond brachial BP alone.

Clinical Implications

Clinicians should consider measuring central blood pressure to better identify patients at elevated cardiovascular risk, especially those with isolated central hypertension who may be missed by brachial BP assessment alone. The established 135 mmHg central SBP threshold provides a practical diagnostic benchmark to guide risk stratification and management decisions. Incorporation of central BP into routine practice could enhance prevention strategies for cardiovascular disease.

Conclusion

This study validates a central systolic blood pressure threshold of 135 mmHg as a clinically meaningful diagnostic cut-off that improves cardiovascular risk stratification beyond traditional brachial measurements. Central hypertension, even when isolated, confers significant cardiovascular risk warranting clinical attention.

References

1. Lee EKP et al. 2024 -- Establishing and validating a diagnostic benchmark for central blood pressure in evaluating cardiovascular risk factors
2. ESC 2024 Guidelines -- Hypertension Management
3. European Society of Hypertension 2024 -- Central Blood Pressure Measurement Recommendations