Although the clinical relevance of brachial blood pressure (BP) measurement for cardiovascular (CV) risk stratification is
nowadays widely accepted, this approach can nevertheless present several limitations. Pulse pressure (PP) amplification accounts for the
notable increase in PP from central to peripheral arterial sites. Target organs are more greatly exposed to central hemodynamic changes
than peripheral organs. The pathophysiological significance of local BP pulsatility, which has a role in the pathogenesis of target organ
damage in both the macro- and the microcirculation, may therefore not be accurately captured by brachial BP as traditionally evaluated
with cuff measurements. The predictive value of central systolic BP and PP over brachial BP for major clinical outcomes has been demonstrated
in the general population, in elderly adults and in patients at high CV risk, irrespective of the invasive or non-invasive methods
used to assess central BP. Aortic stiffness, timing and intensity of wave reflections, and cardiac performance appear as major factors influencing
central PP. Great emphasis has been placed on the role of aortic stiffness, disturbed arterial wave reflections and their intercorrelation
in the pathophysiological mechanisms of CV diseases as well as on their capacity to predict target organ damage and clinical
events. Comorbidities and age-related changes, together with gender-related specificities of arterial and cardiac parameters, are known to
affect the predictive ability of central hemodynamics on individual CV risk.
Keywords: Cardiovascular risk prediction, central pulse pressure, aortic stiffness, wave reflections, atherosclerosis, microcirculatory damage.
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