Carotid pressure is a better predictor of coronary artery disease severitythan brachial pressure

The mechanisms relating pulse pressure to cardiovascular outcome may includ e surrogacy for coronary disease severity. Although pulse pressure is typic ally measured at the brachial artery, central pulse pressure and its princi pal determinant, large-artery stiffness, may relate more closely to disease severity. This study aimed to determine the relationships between large-ar tery stiffness and carotid and brachial blood pressures and coronary artery disease severity. One hundred fourteen male patients with coronary artery disease (age 60 +/- 8 years, mean SD) and 57 age-matched healthy male contr ols (age 59 +/- 9 years) were recruited. Patients were classified into 2 gr oups based on the magnitude of their maximum coronary stenosis: moderate (5 0% to 89%) and severe (greater than or equal to 90%). Large-artery stiffnes s was assessed as systemic arterial compliance and carotid-femoral pulse wa ve velocity. Mean pressure was not different between the 3 groups. Systemic compliance and carotid pulse pressure were significantly different between all 3 groups, with compliance lowest and pressure highest in the severe gr oup (P<0.05). Pulse wave velocity was higher in patients with severe stenos is than in those with moderate stenosis (P<0.01) and those in the control g roup (P<0.001). Brachial pulse pressure was higher in patients than in cont rols (P<0.05), but there was no difference between the 2 disease groups. In separate multivariate analyses, carotid pressures and systemic arterial co mpliance were determinants of coronary artery disease severity, independent of age, smoking status, body mass index, mean arterial pressure, heart rat e, cholesterol levels (total, LDL, and HDL), triglycerides, and beta -antag onist and lipid-lowering therapy (P<0.001), whereas brachial pressures and pulse wave velocity were not. In conclusion, central blood pressures and sy stemic arterial compliance are more sensitive markers of coronary artery di sease severity than brachial pressures.