Pulsatile blood pressure (BP) confers cardiovascular risk. Whether associations of cardiovascular endpoints are tighter for central than peripheral systolic or pulse pressure (cSBP, pSBP, cPP, pPP) is uncertain. Among 5608 participants (54.1% women; mean age, 54.2 years) enrolled in nine studies, median follow-up was 4.1 years. cSBP and cPP, estimated tonometrically from the radial waveform, averaged 123.7 and 42.5 mm Hg, and pSBP and pPP 134.1 and 53.9 mm Hg. The primary composite cardiovascular endpoint occurred in 255 participants (4.5%). Across fourths of the cPP distribution, rates increased exponentially (4.1, 5.0, 7.3, and 22.0 per 1000 person-years) with comparable estimates for cSBP, pSBP and pPP. The multivariable-adjusted hazard ratios, expressing the risk per 1-SD increment in BP (HR), were 1.50 (95% confidence interval, 1.33–1.70) for cSBP, 1.36 (1.19–1.54) for cPP, 1.49 (1.33–1.67) for pSBP, and 1.34 (1.19–1.51) for pPP (P < 0.001). Further adjustment of cSBP and cPP, respectively for pSBP and pPP, and vice versa, removed the significance of all HRs. Adding cSBP, cPP, pSBP, pPP to a base model including covariables increased the model fit (P < 0.001) with generalized R2 increments ranging from 0.37 to 0.74%, but adding a second BP to a model including already one did not. Analyses of the secondary endpoints, including total mortality (204 deaths), coronary endpoints (109) and strokes (89), and various sensitivity analyses produced consistent results. In conclusion, associations of the primary and secondary endpoints with SBP and pulse pressure were not stronger if BP was measured centrally compared with peripherally.
