The predictive value of central aortic blood pressure on new onset stroke and differences between brachial blood pressure in a Chinese hypertensive population, a prospective cohort study

Objectives This study aimed to investigate the association between noninvasive central aortic blood pressure and the risk of first stroke in a Chinese community–based population, meanwhile compare the prediction ability of central SBP and peripheral SBP. Methods A total of 8473 Chinese participants without history of stroke and atrial fibrillation at baseline were selected from “Hypertension and Stroke Prevention and Control Project” for analysis. The endpoint of the study was first total stroke and stroke subtypes (ischemic stroke and hemorrhagic stroke). Cox proportional hazards regression, smoothing curve fitting, subgroup analysis, and Kaplan-Meier curve were used to analysis the relationship between central/peripheral systolic blood pressure and first stroke. Results Participants were 60.9±9.6 years old, 63.5% were males, and 96.1% had hypertension. After a mean 3.3-year follow-up, the incidence of first total stroke, first ischemic stroke and first hemorrhagic stroke were 5.1%, 4.6%, and 0.5%, respectively. In multivariate logistic-regression analyses, central and peripheral SBP were both independently associated with first total stroke and first ischemic stroke after adjusting for various confounders. Peripheral SBP's significant association with first total and ischemic stroke disappeared when combined analyzed with central SBP, whereas central SBP was still significantly related with first total and ischemic stroke after adjustment of peripheral SBP. For first hemorrhagic stroke, no significant differences were observed between central SBP and peripheral SBP. Subgroup analysis showed that the central SBP-first stroke association was significantly stronger in males (HR: 1.38; 95% CI: 1.16, 1.63) than in females (HR: 1.10; 95% CI: 0.97, 1.24; P-interaction = 0.028). Conclusions Among the Chinese community–based population, central SBP is a stronger predictor compared with peripheral SBP for first stroke, especially ischemic stroke. FUNDunding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Key R&D Projects, JiangxiOutstanding Person Foundation

Plasma uric acid is related to large arterial stiffness but not to other hemodynamic variables: a study in 606 normotensive and never-medicated hypertensive subjects

Background Elevated level of plasma uric acid (PUA) has been associated with cardiovascular disease, but whether uric acid is an independent risk factor or merely a marker remains controversial. Methods We investigated in a cross-sectional setting the association of PUA with hemodynamics in 606 normotensive and never-medicated hypertensive subjects (295 men, 311 women, age range 19–73 years) without cardiovascular disease or gout. In all except 15 individuals, PUA was within the normal range. Supine hemodynamics were recorded using whole-body impedance cardiography and radial tonometric pulse wave analysis. Results The mean concentrations of PUA in age, sex and body mass index adjusted quartiles were 234, 278, 314, and 373 µmol/l, respectively. The highest PUA quartile presented with higher aortic to popliteal pulse wave velocity (PWV) than the lowest quartile (8.7 vs. 8.2 m/s, p = 0.026) in analyses additionally adjusted for plasma concentrations of C-reactive protein, low density lipoprotein cholesterol, triglycerides, and mean aortic blood pressure. No differences in radial and aortic blood pressure, wave reflections, heart rate, cardiac output, and systemic vascular resistance were observed between the quartiles. In linear regression analysis, PUA was an independent explanatory factor for PWV (β = 0.168, p < 0.001, R2 of the model 0.591), but not for systolic or diastolic blood pressure. When the regression analysis was performed separately for men and women, PUA was an independent predictor of PWV in both sexes. Conclusions PUA concentration was independently and directly associated with large arterial stiffness in individuals without cardiovascular disease and PUA levels predominantly within the normal range. Trial registration ClinicalTrials.gov NCT01742702.