View More View Less
  • 1 Semmelweis University, Hungary
  • | 2 Health Service of Zugló (ZESZ), Hungary
  • | 3 Semmelweis University, Hungary
  • | 4 University College London, UK
  • | 5 Semmelweis University, Hungary
  • | 6 Klinikum Klagenfurt, Austria
Restricted access

Purchase article

USD  $25.00

1 year subscription (Individual Only)

USD  $752.00

Background and aims

The aim of this study was to develop an integrated central blood pressure–aortic stiffness (ICPS) risk score to predict cardiovascular events.

Methods

It was a retrospective cohort study. A total of 100 chronic kidney disease (CKD) patients on conservative therapy were included. Pulse wave velocity (PWV), central systolic blood pressure (cSBP), and central pulse pressure (cPP) were measured. A score was assigned to tertiles of PWV (0–2), cPP (0–2), and cSBP (0 to the first and second and 1 to the third tertile) based on each parameter’s ability to individually predict cardiovascular outcome. The sum of these scores and three ICPS risk categories as predictors were studied. Finally, we compared discrimination of the ICPS risk categories with PWV, cSBP, and cPP.

Results

Adjusted for age and sex, patients in high and very high ICPS risk categories had increased cardiovascular risk (HR: 3.52, 95% CI: 1.65–7.49; HR: 7.56, 95% CI: 3.20–17.85, respectively). High and very high ICPS risk categories remained independent predictors in a model adjusted for multiple CV risk factors (HR: 4.58, 95% CI: 1.65–7.49; HR: 8.56, 95% CI: 3.09–23.76, respectively). ICPS risk categories (Harrell’s C: 0.723, 95% CI: 0.652–0.795) showed better discrimination than PWV (Harrell’s C: 0.659, 95% CI: 0.586–0.732, p = 0.028) and cSBP (Harrell’s C: 0.660, 95% CI: 0.584–0.735, p = 0.008) and there has been a tendency of significance in case of cPP (Harrell’s C: 0.691, 95% CI: 0.621–0.761, p = 0.170).

Conclusion

The ICPS score may clinically importantly improve the identification of CKD patients with elevated cardiovascular risk.

  • 1.

    Cseprekal O , Egresits J , Tabak A , Nemcsik J , Jarai Z , Babos L , Fodor E , Farkas K , Godina G , Karpathi KI , Kerkovits L , Marton A , Nemcsik-Bencze Z , Nemeth Z , Sallai L , Kiss I , Tisler A : The significance of micro- and macrovascular biomarkers on cardiovascular outcome in chronic kidney disease: a prospective cohort study. J. Hum. Hypertens. 30, 449455 (2016)

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2.

    Fagard RH : Predicting risk of fatal cardiovascular disease and sudden death in hypertension. J. Hypertens. 35, 21652167 (2017)

  • 3.

    Holewijn S , den Heijer M , Kiemeney LA , Stalenhoef AF , de Graaf J : Combining risk markers improves cardiovascular risk prediction in women. Clin. Sci. (Lond). 126, 139146 (2014)

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4.

    Kavousi M , Elias-Smale S , Rutten JH , Leening MJ , Vliegenthart R , Verwoert GC , Krestin GP , Oudkerk M , de Maat MP , Leebeek FW , Mattace-Raso FU , Lindemans J , Hofman A , Steyerberg EW , van der Lugt A , van den Meiracker AH , Witteman JC : Evaluation of newer risk markers for coronary heart disease risk classification: a cohort study. Ann. Intern. Med. 156, 438444 (2012)

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5.

    Lagerweij GR , de Wit GA , Moons KG , van der Schouw YT , Verschuren WM , Dorresteijn JA , Koffijberg H : A new selection method to increase the health benefits of CVD prevention strategies. Eur. J. Prev. Cardiol. 25, 642650 (2018)

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6.

    London GM , Blacher J , Pannier B , Guerin AP , Marchais SJ , Safar ME : Arterial wave reflections and survival in end-stage renal failure. Hypertension 38, 434438 (2001)

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7.

    McEniery CM , Cockcroft JR , Roman MJ , Franklin SS , Wilkinson IB : Central blood pressure: current evidence and clinical importance. Eur. Heart J. 35, 17191725 (2014)

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8.

    Mitchell GF , Hwang SJ , Vasan RS , Larson MG , Pencina MJ , Hamburg NM , Vita JA , Levy D , Benjamin EJ : Arterial stiffness and cardiovascular events: the Framingham Heart Study. Circulation 121, 505511 (2010)

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9.

    Nambi V , Chambless L , Folsom AR , He M , Hu Y , Mosley T , Volcik K , Boerwinkle E , Ballantyne CM : Carotid intima-media thickness and presence or absence of plaque improves prediction of coronary heart disease risk: the ARIC (atherosclerosis risk in communities) study. J. Am. Coll. Cardiol. 55, 16001607 (2010)

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10.

    Nemcsik J , Cseprekal O , Egresits J , Kielstein J , Kumpers P , Lukasz A , Tabak A , Marton A , Nemeth ZK , Jarai Z , Godina G , Sallai L , Farkas K , Kiss I , Tisler A : The role of laser doppler flowmetry tests, serum angiopoietin-2, asymmetric and symmetric dimethylarginine to predict outcome in chronic kidney disease. J. Hypertens. 35, 11091118 (2017)

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11.

    Nemcsik J , Egresits J , El Hadj Othmane T , Fekete BC , Fodor E , Szabo T , Jarai Z , Jekkel C , Kiss I , Tisler A : Validation of arteriograph – a new oscillometric device to measure arterial stiffness in patients on maintenance hemodialysis. Kidney Blood. Press. Res. 32, 223229 (2009)

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12.

    Piepoli MF , Hoes AW , Agewall S , Albus C , Brotons C , Catapano AL , Cooney MT , Corra U , Cosyns B , Deaton C , Graham I , Hall MS , Hobbs FD , Lochen ML , Lollgen H , Marques-Vidal P , Perk J , Prescott E , Redon J , Richter DJ , Sattar N , Smulders Y , Tiberi M , van der Worp HB , van Dis I , Verschuren WM : 2016 European guidelines on cardiovascular disease prevention in clinical practice: the Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts) developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur. Heart J. 37, 23152381 (2016)

    • Search Google Scholar
    • Export Citation
  • 13.

    Taal MW : Arterial stiffness in chronic kidney disease: an update. Curr. Opin. Nephrol. Hypertens. 23, 169173 (2014)

  • 14.

    Verwoert GC , Elias-Smale SE , Rizopoulos D , Koller MT , Steyerberg EW , Hofman A , Kavousi M , Sijbrands EJ , Hoeks AP , Reneman RS , Mattace-Raso FU , Witteman JC : Does aortic stiffness improve the prediction of coronary heart disease in elderly? The Rotterdam Study. J. Hum. Hypertens. 26, 2834 (2012)

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15.

    Vlachopoulos C , Xaplanteris P , Aboyans V , Brodmann M , Cifkova R , Cosentino F , De Carlo M , Gallino A , Landmesser U , Laurent S , Lekakis J , Mikhailidis DP , Naka KK , Protogerou AD , Rizzoni D , Schmidt-Trucksass A , Van Bortel L , Weber T , Yamashina A , Zimlichman R , Boutouyrie P , Cockcroft J , O’Rourke M , Park JB , Schillaci G , Sillesen H , Townsend RR : The role of vascular biomarkers for primary and secondary prevention. A Position Paper from the European Society of Cardiology Working Group on Peripheral Circulation: Endorsed by the Association for Research into Arterial Structure and Physiology (ARTERY) Society. Atherosclerosis 241, 507532 (2015)

    • Search Google Scholar
    • Export Citation
  • 16.

    Wang KL , Cheng HM , Chuang SY , Spurgeon HA , Ting CT , Lakatta EG , Yin FC , Chou P , Chen CH : Central or peripheral systolic or pulse pressure: which best relates to target organs and future mortality? J. Hypertens. 27, 461467 (2009)

    • Crossref
    • Search Google Scholar
    • Export Citation

Monthly Content Usage

Abstract Views Full Text Views PDF Downloads
Jan 2021 10 0 0
Feb 2021 15 1 0
Mar 2021 9 0 0
Apr 2021 15 1 1
May 2021 14 0 0
Jun 2021 5 0 0
Jul 2021 0 0 0