Pulsatile blood pressure (BP) confers cardiovascular risk. Whether associations of cardiovascular end points are tighter for central systolic BP (cSBP) than peripheral systolic BP (pSBP) or central pulse pressure (cPP) than peripheral pulse pressure (pPP) is uncertain. Among 5608 participants (54.1% women; mean age, 54.2 years) enrolled in nine studies, median follow-up was 4.1 years. cSBP and cPP, estimated tonometrically from the radial waveform, averaged 123.7 and 42.5 mm Hg, and pSBP and pPP 134.1 and 53.9 mm Hg. The primary composite cardiovascular end point occurred in 255 participants (4.5%). Across fourths of the cPP distribution, rates increased exponentially (4.1, 5.0, 7.3, and 22.0 per 1000 person-years) with comparable estimates for cSBP, pSBP, and pPP. The multivariable-adjusted hazard ratios, expressing the risk per 1-SD increment in BP, were 1.50 (95% CI, 1.33-1.70) for cSBP, 1.36 (95% CI, 1.19-1.54) for cPP, 1.49 (95% CI, 1.33-1.67) for pSBP, and 1.34 (95% CI, 1.19-1.51) for pPP (P<0.001). Further adjustment of cSBP and cPP, respectively, for pSBP and pPP, and vice versa, removed the significance of all hazard ratios. Adding cSBP, cPP, pSBP, pPP to a base model including covariables increased the model fit (P<0.001) with generalized R2 increments ranging from 0.37% to 0.74% but adding a second BP to a model including already one did not. Analyses of the secondary end points, including total mortality (204 deaths), coronary end points (109) and strokes (89), and various sensitivity analyses produced consistent results. In conclusion, associations of the primary and secondary end points with SBP and pulse pressure were not stronger if BP was measured centrally compared with peripherally.

1st Department of Cardiology Interventional Electrocardiology and Hypertension Jagiellonian University Medical College Kraków Poland

Center for Primary Care and Public Health Unisanté University of Lausanne Switzerland

Centre for Molecular and Vascular Biology KU Leuven Department of Cardiovascular Sciences University of Leuven Belgium

Centro de Nefrología and Departamento de Fisiopatología Hospital de Clínicas Universidad de la República Montevideo Uruguay

Department of Cardiology Shanghai General Hospital

Department of Medicine Turku University Hospital and University of Turku Finland

Department of Medicine University of Padua Italy

Department of Nephrology and Hypertension Inselspital Bern University Hospital University of Bern Switzerland

Department of Pharmacology and Cardiovascular Research Institute Maastricht

Division of Nephrology University Hospital of Geneva Geneva Switzerland

Faculty of Medicine Charles University Pilsen Czech Republic

From the Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations Shanghai Key Laboratory of Hypertension Shanghai Institute of Hypertension Ruijin Hospital

Hypertension Unit Department of Hypertension and Diabetology Medical University of Gdańsk Poland

NPA Alliance for the Promotion of Preventive Medicine Mechelen Belgium

Population Studies Unit Department of Chronic Disease Prevention National Institute for Health and Welfare Turku Finland

Research Unit Hypertension and Cardiovascular Epidemiology KU Leuven Department of Cardiovascular Sciences University of Leuven Belgium

Service of Nephrology and Hypertension Lausanne University Hospital and University of Lausanne Switzerland

Shanghai Jiao Tong University School of Medicine China; Servicio de Clínica Médica Sección Hipertensión Arterial Hospital Italiano de Buenos Aires Argentina

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