Central blood pressure: current evidence and clinical importance

Abstract

Pressure measured with a cuff and sphygmomanometer in the brachial artery is accepted as an important predictor of future cardiovascular risk. However, systolic pressure varies throughout the arterial tree, such that aortic (central) systolic pressure is actually lower than corresponding brachial values, although this difference is highly variable between individuals. Emerging evidence now suggests that central pressure is better related to future cardiovascular events than is brachial pressure. Moreover, anti-hypertensive drugs can exert differential effects on brachial and central pressure. Therefore, basing treatment decisions on central, rather than brachial pressure, is likely to have important implications for the future diagnosis and management of hypertension. Such a paradigm shift will, however, require further, direct evidence that selectively targeting central pressure, brings added benefit, over and above that already provided by brachial artery pressure.

Keywords: Anti-hypertensive treatment; Blood pressure; Cardiovascular risk; Central pressure.

Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.

Figures

Figure 1

Amplification of the pressure waveform moving from the aorta to the radial artery.

Figure 2

Difference between brachial and aortic systolic blood pressure (SphygmoCor) in healthy men (dark blue bars; n = 2779) and women (light blue bars; n = 2869). The data represent means ± SD.

Figure 3

Overlap in aortic systolic blood pressure despite no overlap in brachial systolic pressure, in healthy men and women (n = 5648). Over 70% of individuals with high-normal blood pressure had aortic systolic pressures in common with individuals with stage 1 hypertension.

Figure 4

Techniques for assessing central blood pressure. (A) Invasive cardiac catheterization; (B) direct applanation tonometry of the carotid artery; (C) applanation tonometry of the radial artery; (D) cuff-based oscillometry at the brachial artery.