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Central blood pressure in the management of hypertension: soon reaching the goal?

Journal of Human Hypertension volume 27, pages 405–411 (2013)Cite this article

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Abstract

Blood pressure (BP) is conventionally measured by cuff at the brachial artery as an indication of pressure experienced by the organs. However, individual variation in pulse pressure amplification means that brachial cuff BP may be a poor representation of true central BP. Estimation of central BP is now possible using non-invasive methods that are amenable for widespread use. This paper reviews the evidence regarding the potential value of central BP in hypertension management. The major lines of evidence that support the use of central BP as a clinical tool include the: (1) major discrepancies in central BP among people with similar brachial BP; (2) independent relationship of central BP with end-organ damage; (3) independent relationship of central BP with cardiovascular (CV) events and mortality; (4) differential central and brachial BP responses to antihypertensive medications and; (5) improvements in end-organ damage after therapy more strongly relate to central than brachial BP. Despite all this, important evidence gaps relating to clinical use of central BP need fulfilling. These include the lack of central BP reference values and randomized, controlled studies to determine if: (1) central BP can help with diagnostic/therapeutic decisions and; (2) CV outcome is improved by targeting therapy towards lowering central BP levels. Additional challenges such as standardization of central BP methods, and understanding which patients are most likely to benefit from central BP monitoring also need to be determined. Overall, the future for central BP as a worthwhile clinical instrument appears positive, but there is much to be done.

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Acknowledgements

Dr Sharman was supported by a National Health and Medical Research Council of Australia Career Development Award (reference 569519).

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Authors and Affiliations

  1. Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia

    J E Sharman

  2. Pharmacology Department Hôpital Européen Georges Pompidou, Assistance Publique Hopitaux de Paris, Université Paris-Descartes, INSERM U 970, Paris, France

    S Laurent

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Correspondence to J E Sharman.

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Competing interests

Both authors have received equipment or grants from companies that manufacture central blood pressure devices. These include; AtCor Medical, PulseCor, Alam Medical, EIM, Hemo Sapiens, and OMRON.

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Sharman, J., Laurent, S. Central blood pressure in the management of hypertension: soon reaching the goal?. J Hum Hypertens 27, 405–411 (2013). https://doi.org/10.1038/jhh.2013.23

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