1. Comparison between Central and Peripheral Pulse Pressure as Determinants of Intermediate Cardiovascular Phenotypes C Delles, U Neisius, G Bilo, C Taurino, JD McClure, MP Schneider, K Kawecka-Jaszcz, K Stolarz-Skrzypek, Ł Klima, JA Staessen, T Kuznetsova, J Redon, F Martinez, E Agabiti Rosei, O Melander, F Zannad, P Rossignol, S Laurent, C Collin, L Lonati, A Zanchetti, AF Dominiczak BHF Glasgow Cardiovascular Research Centre Institute of Cardiovascular and Medical Sciences University of Glasgow

2. Cardiovascular Continuum Blood Pressure Determines Cardiovascular Risk Prospective Studies Collaboration. Lancet 2002

3. Cardiovascular Continuum Pulse Pressure Refines Cardiovascular Risk Franklin SS et al. Circulation 1999

4. Cardiovascular Continuum Franklin SS et al. Circulation 2001 Pulse Pressure Refines Cardiovascular Risk

5. Cardiovascular Continuum Central BP Causes Central Artery Damage Hypertension 2007; 50: 154-160

6. Cardiovascular Continuum Question Is central blood pressure a better predictor of cardiovascular risk than peripheral blood pressure in young to middle-aged people?

7. Cardiovascular Continuum Question Is central v pulse v pressure a better predictor of cardiovascular risk than peripheral v pulse v pressure in young to middle-aged people?

8. Cardiovascular Continuum Question Is central v pulse v pressure a better predictor of intermediate CV phenotypes than peripheral v pulse v pressure in young to middle-aged people?

9. Cardiovascular Continuum InGenious HyperCare

10. Index Patient Hypertension diagnosed < 50 years Caucasian Age 18-60 Index patient on treatment with ≥ 2 drugs or SBP ≥ 160 DBP ≥ 95 on two different occasions if untreated At least three 1st degree relatives of whom at least one should be affected (< 50 years ) and at least one from a different generation

11. Examples of Possible Family Structures affected unaffected index patient

12. Cardiovascular Continuum Patients

13. Cardiovascular Continuum Methods Blood pressure (Omron) Pulse wave analysis (mostly SphygmoCor) Pulse wave velocity (mostly SphygmoCor) Carotid intima-media thickness Echocardiography Urinary albumin:creatinine ratio

14. Cardiovascular Continuum Pulse Pressure and Age Hypertensives Normotensives

15. Cardiovascular Continuum Univariate Analysis Central Pulse PressurePeripheral Pulse Pressure

16. Cardiovascular Continuum Univariate Analysis Central Pulse PressurePeripheral Pulse Pressure

17. Cardiovascular Continuum Age and Intermediate Cardiovascular Phenotypes Age, years

18. Cardiovascular Continuum Multivariate Analysis

19. Cardiovascular Continuum Multivariate Analysis

20. Summary Central pulse pressure is more strongly correlated with intermediate cardiovascular phenotypes than peripheral pulse pressure. In a young to middle-aged cohort of normotensive and well-controlled hypertensive subjects, age is the major determinant of intermediate cardiovascular phenotypes. When adjusted for relevant cofactors including age, models containing either cPP or pPP predict intermediate cardiovascular phenotypes equally well. Limitations: cross-sectional design, case-control design and family structure.

21. Perspective and Clinical Relevance Assessment of central haemodynamic parameters provides an integrated view on blood pressure and other determinants of cardiovascular phenotypes. Our data do not support the notion that central blood pressure is a superior determinant of risk than peripheral blood pressure if age is taken into account. Large and prospective studies on the use of central haemodynamic parameters in clinical practice are still required – and under way.

24. Cardiovascular Continuum Results by Study Centre

25. Cardiovascular Continuum Results by Gender age (years) cPP (mmHg) pPP (mmHg) PWV (dm/s) C-IMT (10 -2 mm) LVMI (g/m 2.7 )4

26. Cardiovascular Continuum Blood Pressure and Cardiovascular Risk Prospective Studies Collaboration. Lancet 2002

27. Central BP and Antihypertensive Treatment Williams B et al. Circulation 2006 Atenolol based Amlodipine based

28. Local Pulse Pressure and Large Arteries Circulation 1999: 100:1387-1393