Predictive Value Of Central Arterial Pressure For Cardiovascular Events And All-Cause Mortality:a Systematic Review And Meta-Analysis

Objective:Central arterial pressure (CAP) is supposed to be more relevant to the occurrence of cardiovascular (CV) disease compared with peripheral blood pressure. We performed a meta-analysis of longitudinal studies to calculate robust quantitative estimates on the predictive value of central pressure for cardiovascular outcome and all-cause mortality.Method:Longitudinal studies that reported associations of CAP with the risk of future clinical events were drawn from Embase, PubMed, Cochrane, CBMdisc, and reference list of relevant articles up until March 2015. Meta-analysis was performed using the Comprehensive Meta Analysis version 2. The publication bias were estimated with fail-safe number test and evaluated the robustness of the results with sensitivity analyses.Results:Data from 7324 patients in 10 observational studies were included, the pooled Hazard ratio (HR) of total CV outcome was 1.166 (95% CI 1.054-1.290) for a 10 mmHg increase of central systolic pressure(SBP),1.144 (95% CI 1.093-1.198) for a 10 mmHg increase of central pulse pressure (PP), and 1.721 (95% CI 1.146-2.583) for a 0.1 absolute increase of central fractional pulse pressure (PPf, calculated as PP divided by mean blood pressure), respectively. We also obtained the results that a 1 SD (standard deviation) increasement of central SBP or PP were associated with a HR (Hazard ratio) of 1.449 (95% CI 1.291-1.626) and 1.615 (95% CI 1.463-1.783) for all-cause mortality, respectively. The pooled Hazard ratio of clinical outcome was 1.208 (95%CI 1.051-1.388) vs 1.094 (95%CI 1.000-1.198) for central vs. brachial SBP(P=241); and 1.211 (95%CI 1.143-1.282) vs 1.143 (95%CI 1.083-1.207) for central vs brachial PP(P=0.151). Results of fail-safe number test showed that the apparent publication bias was insufficient to affect our results, sensitivity analysis showed that the results were stable and reliable.Conclusion:Central arterial pressure is independent predictor for future CV events and all-cause mortality. While central SBP and PP have a marginally but not significantly better predictive ability when compared with brachial SBP and PP, clinical assessment of blood pressure still should be based on peripheral blood pressure.