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Discovery of new blood pressure phenotypes and relation to accuracy of cuff devices used in daily clinical practice

Picone, DS ORCID: 0000-0002-4760-1634, Schultz, MG ORCID: 0000-0003-3458-1811, Peng, X, Black, JA, Dwyer, N ORCID: 0000-0002-1583-8290, Roberts-Thomson, P, Chen, C-H, Cheng, H-M, Pucci, G, Wang, J-G and Sharman, JE ORCID: 0000-0003-2792-0811 2018 , 'Discovery of new blood pressure phenotypes and relation to accuracy of cuff devices used in daily clinical practice' , Hypertension, vol. 71 , pp. 1-9 , doi: 10.1161/HYPERTENSIONAHA.117.10696.

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Abstract

Cuff blood pressure (BP) is the reference standard for management of high BP, but the method is inaccurate andcan lead to BP misclassification. The aims of this study were to determine whether distinctive BP phenotypes exist basedon BP transmission (amplification) variability from central-to-peripheral arteries and whether applying one standard cuffBP measurement approach (eg, oscillometry) to all people could discriminate the BP phenotypes. Intra-arterial BP wasmeasured at the ascending aorta and brachial and radial arteries in 126 participants (61±10 years; 69% male) after coronaryangiography. Central-to-peripheral systolic BP (SBP) transmission (SBP amplification) was defined by ≥5 mm Hg SBPincrease between the aorta-to-brachial or brachial-to-radial arteries. Standard cuff BP was measured 4 different times using3 different devices. Three independent investigators also provided data (n=255 from 4 studies) using another 3 separatecuff BP devices. Four distinct BP phenotypes were discovered based on variability in SBP amplification: phenotype 1,both aortic-to-brachial and brachial-to-radial SBP amplification; phenotype 2, only aortic-to-brachial SBP amplification;phenotype 3, only brachial-to-radial SBP amplification; and phenotype 4, neither aortic-to-brachial nor brachial-to-radialSBP amplification. Aortic SBP was significantly higher among phenotypes 3 and 4 compared with phenotypes 1 and2 (P=0.00074), but this was not discriminated using any standard cuff BP measures (P=0.31). Data from independentinvestigators confirmed the key findings. This is the first-in-human discovery of BP phenotypes that have significantlydifferent BPs, but which are not discriminated by standard cuff BP devices used in daily clinical practice. Improved BPdevice accuracy may be achieved by considering individual phenotypic BP differences.

Item Type: Article
Authors/Creators:Picone, DS and Schultz, MG and Peng, X and Black, JA and Dwyer, N and Roberts-Thomson, P and Chen, C-H and Cheng, H-M and Pucci, G and Wang, J-G and Sharman, JE
Keywords: blood pressure, catheterization, hemodynamics, phenotype, sphygmomanometers
Journal or Publication Title: Hypertension
Publisher: Lippincott Williams & Wilkins
ISSN: 0194-911X
DOI / ID Number: 10.1161/HYPERTENSIONAHA.117.10696
Copyright Information:

Copyright 2018 American Heart Association, Inc.

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