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Central Pressure Should be Used in Clinical Practice

Abstract

The original purpose for developing the technique to record brachial blood pressure (BP) more than 100 years ago was to estimate aortic (central) BP. While high brachial BP is an important cardiovascular risk factor, it is clear that major differences in central systolic BP (SBP; e.g. >30 mmHg) can occur among people with similar brachial SBP. It is also proven that central SBP responses to antihypertensive therapy can differ substantially from brachial SBP responses, such that true treatment effects cannot be gauged from conventional brachial BP. Importantly, assessment of central BP results in: 1) improved predictive accuracy of future cardiovascular events beyond brachial BP and other cardiovascular risk factors; 2) superior diagnostic accuracy over brachial BP and; 3) different patient management than usual care guided by brachial BP. Collectively the above data satisfy criteria for central BP being a better cardiovascular risk biomarker than brachial BP. As with all medical advances there are areas of research need and international consensus is required on issues such as standardization of techniques. However, central BP can now be accurately estimated (with appropriate waveform calibration) using brachial cuff methods in an approach that is familiar to clinicians, acceptable to patients and amenable to widespread use. In other words, this modern BP technique finally satisfies the original purpose for measuring BP as intended more than 100 years ago. Although the tipping point towards routine use is yet to be reached, the body of evidence continues to favour the view that central BP should be used in clinical practice.

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Sharman, J. Central Pressure Should be Used in Clinical Practice. Artery Res 8, 121 (2014). https://doi.org/10.1016/j.artres.2014.09.048

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  • DOI: https://doi.org/10.1016/j.artres.2014.09.048