BACKGROUND: Whether cardiovascular risk is more tightly associated with central (cSBP) than brachial (bSBP) systolic pressure remains debated, because of their close correlation and uncertain thresholds to differentiate cSBP into normotension versus hypertension. METHODS: In a person-level meta-analysis of the International Database of Central Arterial Properties for Risk Stratification (n=5576; 54.1% women; mean age 54.2 years), outcome-driven thresholds for cSBP were determined and whether the cross-classification of cSBP and bSBP improved risk stratification was explored. cSBP was tonometrically estimated from the radial pulse wave using SphygmoCor software. RESULTS: Over 4.1 years (median), 255 composite cardiovascular end points occurred. In multivariable bootstrapped analyses, cSBP thresholds (in mm Hg) of 110.5 (95% CI, 109.1-111.8), 120.2 (119.4-121.0), 130.0 (129.6-130.3), and 149.5 (148.4-150.5) generated 5-year cardiovascular risks equivalent to the American College of Cardiology/American Heart Association bSBP thresholds of 120, 130, 140, and 160. Applying 120/130 mm Hg as cSBP/bSBP thresholds delineated concordant central and brachial normotension (43.1%) and hypertension (48.2%) versus isolated brachial hypertension (5.0%) and isolated central hypertension (3.7%). With concordant normotension as reference, the multivariable hazard ratios for the cardiovascular end point were 1.30 (95% CI, 0.58-2.94) for isolated brachial hypertension, 2.28 (1.21-4.30) for isolated central hypertension, and 2.02 (1.41-2.91) for concordant hypertension. The increased cardiovascular risk associated with isolated central and concordant hypertension was paralleled by cerebrovascular end points with hazard ratios of 3.71 (1.37-10.06) and 2.60 (1.35-5.00), respectively. CONCLUSIONS: Irrespective of the brachial blood pressure status, central hypertension increased cardiovascular and cerebrovascular risk indicating the importance of controlling central hypertension.

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

Biomedical Sciences Group Faculty of Medicine 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 Shanghai China

Department of Cardiology the 1st Affiliated Hospital of Sun Yat Sen University Guangzhou China

Department of Cardiovascular Medicine Shanghai Key Laboratory of Hypertension Shanghai Institute of Hypertension State Key Laboratory of Medical Genomics National Research Centre for Translational Medicine Ruijin Hospital Shanghai Jiaotong University School of Medicine China

Department of Chronic Disease Prevention Finnish Institute for Health and Welfare Turku Finland

Department of Medicine TurkuUniversity Hospital and University of Turku

Department of Medicine University of Padua Italy

Faculty of Medicine Charles University Pilsen Czech Republic

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

Research Institute Alliance for the Promotion of Preventive Medicine Mechelen Belgium

Research Unit Environment and Health KU Leuven Department of Public Health and Primary Care University of Leuven Belgium

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

Servicio de Clínica Médica Sección Hipertensión Arterial Hospital Italiano de Buenos Aires Argentina

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