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Arm cuff blood pressure measurements may fall short for predicting heart disease risk in some people with resistant high blood pressure

September 07, 2019

NEW ORLEANS, Sept. 7, 2019 -- A measurement of central blood pressure in people with difficult-to-treat high blood pressure could help reduce risk of heart disease better than traditional arm cuff readings for some patients, according to preliminary research presented at the American Heart Association's Hypertension 2019 Scientific Sessions.

Central blood pressure, also called blood pressure amplification, is measured at the aorta, the artery closest to the heart. Researchers found this measurement can more accurately reflect heart disease risk in people with treatment-resistant high blood pressure based on findings from their study.

"We found that higher differences in blood pressure between the arm and the aorta are associated with increased incidence of heart disease in the general population," said Badhma Valaiyapathi, M.B.B.S., M.P.H., lead study author and a postdoctoral fellow in vascular biology at the hypertension clinic at the University of Alabama at Birmingham. "We looked specifically at people whose high blood pressure is resistant to treatment, meaning patients' arm blood pressure readings remain out of control despite the patient being on high blood pressure medications."

The researchers studied adult patients with high blood pressure including some with difficult-to-treat high blood pressure. Blood pressure and pulse pressure were measured using the traditional arm cuff as well as with pulse wave analysis, to measure central blood pressure when the heart is pumping. Based on the measurements, patients were categorized into three groups: controlled nonresistant blood pressure; controlled resistant blood pressure; and uncontrolled resistant blood pressure. Blood pressure amplification was calculated as the difference between the two measures.

The highest blood pressure amplification was found in patients with uncontrolled resistant high blood pressure. The lowest blood pressure amplification was noted among patients who were in the controlled non-resistant category, explaining why risk severity tends to be highest among some adults who have uncontrolled high blood pressure and are resistant to certain medications, according to Valaiyapathi.

"The findings imply that amplification of blood pressure and pulse pressure remains high in patients with resistant hypertension regardless of blood pressure control," he said. "This means their arteries are stiffer than patients with controlled blood pressure, and they're having problems in their vessels that are leading to heart disease even though they are on medications and even though their blood pressure is under control."

Valaiyapathi suggested doctors should tailor blood pressure treatment for treatment-resistant high blood pressure patients by taking into consideration central blood pressure, amplification and reinforcing the importance of lifestyle modifications to patients -- not only medications -- to reduce heart disease risk.

Among the limitations of the study are its small size and that it was done in the southern U.S., so the results might not be reproducible in the general U.S. population.
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Co-authors are Tanja Dudenbostel, M.D.; Mohammed Siddiqui, M.D.; Bin Zhang, Ph.D.; Maria El Hachem, M.D.; Suzanne Oparil, M.D.; and David A. Calhoun, M.D. Author disclosures are in the abstract. The National Institutes of Health and the American Heart Association-funded Strategically Focused Research Networks initiative funded this research. Additional Resources:

Available multimedia is on the right column of the release link https://newsroom.heart.org/news/arm-cuff-blood-pressure-measurements-may-fall-short-for-predicting-heart-disease-risk-in-some-people-with-resistant-high-blood-pressure?preview=ebe52c82f03bd50e1733e3d4a0cf6e18

NOTE: Actual presentation time is 3:45 p.m. CT/4:45 p.m. ET on Saturday, Sept. 7, 2019.

Statements and conclusions of study authors that are presented at American Heart Association scientific meetings are solely those of the study authors and do not necessarily reflect Association policy or position. The Association makes no representation or warranty as to their accuracy or reliability. The Association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations are available at https://www.heart.org/en/about-us/aha-financial-information.

About the American Heart Association


The American Heart Association is a relentless force for a world of longer, healthier lives. We are dedicated to ensuring equitable health in all communities. Through collaboration with numerous organizations, and powered by millions of volunteers, we fund innovative research, advocate for the public's health and share lifesaving resources. The Dallas-based organization has been a leading source of health information for nearly a century. Connect with us on heart.org, Facebook, Twitter or by calling 1-800-AHA-USA1.

American Heart Association

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