{"id":"46009","type":"article","url":"https://hartvaat.nl/2026/04/29/centrale-versus-brachiale-ambulante-bloeddruk-brachiaal-volstaat-voor-mortalitei/","title":"Centrale versus brachiale ambulante bloeddruk: brachiaal volstaat voor mortaliteit-stratificatie (n=36.594)","title_en":"Mortality in Relation to Brachial Versus Central Ambulatory Blood Pressure","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"Hypertension","doi":"https://www.ahajournals.org/doi/abs/10.1161/HYPERTENSIONAHA.126.26778","source_url":"https://doi.org/https://www.ahajournals.org/doi/abs/10.1161/HYPERTENSIONAHA.126.26778","authors":[],"significance":7,"published":"2026-07-12","source_date":"2026-04-29","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/bloeddrukmeting-thuismeting-abpm/","https://hartvaat.nl/kennis/hypertensie/cardiovasculaire-risicoschatting-score2/"],"congress":"","summary_en":"Analysis of 36,594 patients from the Shanghai Ruijin Ambulatory BP Monitoring Registry (2017-2023) who underwent 24-hour ambulatory blood pressure monitoring with an oscillometric cuff monitor, measuring both brachial (bSBP) and central systolic BP (cSBP, calibrated on brachial or on mean arterial pressure). Median age 53.4 years; 52.8% female. During 4 years of follow-up, 505 participants died, including 174 from cardiovascular causes. Non-linear Cox models fitted better than linear (p<0.001) for both endpoints, regardless of time-of-day or calibration. Adding 24-hour SBP to the base model improved C-statistics for all-cause and cardiovascular mortality (0.003≤p≤0.06). Adding cSBP on top of bSBP did not yield statistically significant improvement (0.054≤p≤0.22). Central BP measurement on top of brachial ambulatory monitoring therefore adds little value for mortality stratification — simple brachial ambulant measurement suffices.","created":"2026-07-03T20:27:05Z","updated":"2026-07-04T19:27:05Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van 36.594 patiënten uit het Shanghai Ruijin Ambulatory BP Monitoring Registry (2017-2023) die 24-uurs ambulante bloeddrukmeting met oscillometrische manchet-monitor ondergingen, met meting van zowel brachiale (bSBP) als centrale systolische bloeddruk (cSBP, gekalibreerd op brachiaal of op mean arterial pressure). Mediane leeftijd 53,4 jaar; 52,8% vrouw. Tijdens 4 jaar follow-up overleden 505 deelnemers, waaronder 174 cardiovasculair. Niet-lineaire Cox-modellen pasten beter dan lineaire (p<0,001) voor beide eindpunten, ongeacht dagdeel of kalibratie. Toevoeging van 24-uurs SBP aan het basismodel verbeterde de C-statistiek voor totale en cardiovasculaire sterfte (0,003≤p≤0,06). Toevoegen van cSBP bovenop bSBP gaf geen statistisch significante verbetering (0,054≤p≤0,22). Centrale bloeddrukmeting bovenop brachiale ambulante meting voegt dus weinig waarde toe voor mortaliteit-stratificatie — eenvoudige brachiale ambulante meting volstaat.","abstract_original":"BACKGROUND:Whether central systolic blood pressure (cSBP) compared with brachial systolic blood pressure (bSBP) improves risk stratification remains debated. This study investigated whether cSBP is more closely associated with total and cardiovascular mortality than bSBP when recorded by 24-hour ambulatory BP monitoring with an arm cuff-based oscillometric monitor.METHODS:Consecutive patients referred for ambulatory BP monitoring and enrolled in the Shanghai Ruijin Ambulatory BP Monitoring Registry (2017–2023) were analyzed. bSBP and cSBP were recorded over 24 hours. cSBP was calibrated on brachial systolic and diastolic BP (cSBPc1) or on mean arterial pressure and brachial diastolic BP (cSBPc2). Total and cardiovascular mortality up to December 31, 2024, was assessed by record linkage withInternational Classification of Diseases, Tenth Revision,coded death certificates. Linear and nonlinear Cox proportional hazard regression was applied with age as the underlying time-scale and adjusted for established cardiovascular risk factors.RESULTS:Over 4.0 years of follow-up, 505 of 36 594 participants (52.8% women; median age, 53.4 years) died, 174 from cardiovascular disease. With multivariable adjustment applied, the nonlinear compared with linear Cox models provided a better model fit for both end points (P&amp;lt;0.001), irrespective of the period of the day and the calibration method of cSBP. Adding any 24-hour SBP to the base model increased the C statistics for total and cardiovascular mortality (0.003≤P≤0.06). Adding cSBPc1 or cSBPc2 to the base model extended by bSBP also increased the C statistics, but not by a statistically significant amount (0.054≤P≤0.22).CONCLUSIONS:cSBP compared with bSBP did not improve the associations with mortality. Measurement of the ambulatory bSBP is adequate for BP-based risk stratification."}