Title:Central Hemodynamics for Risk Reduction Strategies: Additive Value Over and Above Brachial Blood Pressure
Volume: 21
Issue: 6
Author(s): Elisa R. Rinaldi, Alexandra Yannoutsos, Claudio Borghi, Michel E. Safar and Jacques Blacher
Affiliation:
Keywords:
Cardiovascular risk reduction, central pulse pressure, aortic stiffness, anti-hypertensive treatment.
Abstract: Reduction strategies of blood pressure, as a modifiable cardiovascular risk, are currently based on office assessment of brachial
artery blood pressure. However, antihypertensive treatment based on brachial BP values reduces cardiovascular risk but cannot
completely reverse the hypertension-induced risk of morbidity events. As is well known, BP varies in different arterial systems and invasive
and non-invasive studies have demonstrated that brachial BP does not necessarily reflect central aortic BP. Emerging evidences now
suggest that central pressure may predict cardiovascular diseases better than brachial BP; moreover, it may differently respond to certain
antihypertensive drugs. The potential effects beyond peripheral BP control may be due to specific protective properties of different antihypertensive
drugs in affecting central aortic pressure and arterial stiffness. Although data on direct cardiovascular benefit impact of central
blood pressure treatment in randomized clinical trials are still lacking, it is likely that the improvement of quality of care and the individualized
assessment of the hypertension-associated cardiovascular risk are achievable with the use of central hemodynamics. Therefore,
basing antihypertensive treatment guidance on central pressures rather than on peripheral blood pressure may be the key for future antihypertensive
strategies.
