Association between the direction of the blood pressure discrepancy and vascular aging in a large-scale screening population

OBJECTIVE: Recent guidelines recommend measuring blood pressure (BP) multiple times and averaging the results. The direction of the discrepancy between the first and second readings varies. This study aimed to examine whether directionality is associated with vascular aging indicators. METHODS: 43 807 participants who underwent health checkups were first stratified by average systolic BP (SBP < 120, 120-129, 130-139, or ≥140 mmHg) and diastolic BP (DBP < 80, 80-89, or ≥90 mmHg). They were then categorized into three groups based on the absolute difference between the first and second BP readings (ΔBP): ΔBP < 5 mmHg (group A), 5-9 mmHg (group B), and greater than or equal to 10 mmHg (group C). Clinical parameters and vascular aging markers were compared between groups. RESULTS: In participants with SBP less than 130 mmHg or DBP less than 80 mmHg, the first BP reading tended to be lower than the second. In contrast, among those with SBP greater than or equal to 130 mmHg or DBP greater than or equal to 90 mmHg, the first reading was often higher. Group C showed a significantly higher prevalence of hypertension, obesity, diabetes, and dyslipidemia, along with increased brachial-ankle pulse wave velocity and maximum carotid intima-media thickness. CONCLUSION: The direction and magnitude of the discrepancy between the first and second BP measurements may reflect the underlying vascular aging. BP discrepancy patterns could serve as simple, noninvasive indicators of subclinical atherosclerosis.