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(Hypertension. 2005;45:e22.)
© 2005 American Heart Association, Inc.

Hypertension Electronic Pages

Can We Afford Crude Estimates of Central Pulse Pressure?

Service d’Explorations Fonctionnelles, Hôpital de Bicêtre-Université Paris Sud 11, Le Kremlin Bicêtre, France

Alain Nitenberg

Hôpital Jean-Verdier-Université Paris 13, Bondy, France

An extract of the first 250 words of the full text is provided, because this article has no abstract.

To the Editor:

The article by de Simone et al¹ in the April 2005 issue of Hypertension reports associations of high brachial pulse pressure (PP) with both arterial stiffness and left ventricular mass in 472 normotensive and 778 untreated hypertensive patients. Arterial stiffness was noninvasively estimated by the central PP-to-stroke volume ratio. Central PP was estimated from brachial PP "using age-adjusted equation previously generated in 230 normotensive and hypertensive subjects."¹ We think the following comments are needed.

Whereas the associations reported¹ are plausible on pathophysiological grounds, the calculations appear far less reliable because of potential bias in the estimation of central PP. Concerning the equation they used,¹ the authors make reference to their previous article² where we can read that brachial PP and age "explained 38% of variance of central PP (P<0.0001)" determined by carotid aplanation tonometry in 145 unmedicated hypertensive patients and 85 normotensive subjects.² How could the authors justify the use of an equation that ignores other factors responsible for nearly two-thirds of the variability of central PP? Further calculations of arterial stiffness and precise factorial analysis also appear especially hazardous. Finally, it is widely admitted that correlation is not estimation.³ Before applying this equation, one must have validated the accuracy and precision of the estimate on a new sample, and the pressure-dependence of the bias must be tested before applying the same equation in normotensive and hypertensive subjects. Have the investigators considered these issues?

Hypertension is a major public health challenge⁴ and there is increasing . . . [Full Text of this Article]

Giovanni de Simone

Department of Clinical and Experimental Medicine, Federico II University Hospital, Naples, Italy