Central blood pressure: current evidence and clinical importance.
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.
Clinical Pharmacology Unit, University of Cambridge, Addenbrooke's Hospital, Box 110, Cambridge CB2 2QQ, UK cmm41@cam.ac.uk.
Carmel M
CM
McEniery
Department of Cardiology, Wales Heart Research Institute, Cardiff CF14 4XN, UK.
John R
JR
Cockcroft
Division of Cardiology, Weill Cornell Medical College, New York, NY 10021, USA.
Mary J
MJ
Roman
University of California, UCI School of Medicine, Irvine, CA 92697-4101, USA.
Stanley S
SS
Franklin
Clinical Pharmacology Unit, University of Cambridge, Addenbrooke's Hospital, Box 110, Cambridge CB2 2QQ, UK.
Ian B
IB
Wilkinson
D000959:Antihypertensive Agents / Q000627:therapeutic use; D001011:Aorta / Q000502:physiology*; D001794:Blood Pressure / Q000502:physiology*; D001795:Blood Pressure Determination / Q000379:methods; D001916:Brachial Artery / Q000502:physiology; D002318:Cardiovascular Diseases / Q000503:physiopathology / Q000517:prevention & control; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000503:physiopathology*; D018570:Risk Assessment / Q000379:methods; D019722:Sphygmomanometers
D000959:Antihypertensive Agents
Anti-hypertensive treatment; Blood pressure; Cardiovascular risk; Central pressure