Is there any Additional Prognostic Value of Central Blood Pressure Wave Forms Beyond Peripheral Blood Pressure?

Miso      Sabovic; Michel   E.   Safar; Jacques      Blacher

Abstract

For a long time the consideration of blood pressure was based exclusively on measurements of peripheral (brachial) blood pressure. However, there is now a growing interest in the investigation of central (aortic) pressure. There is increasing awareness that the central hemodynamics, reflected by central pressure wave forms and arterial stiffness, can provide new and better insight into the pathophysiology of cardiovascular disorders associated with ageing, hypertension, diabetes, as well as end-stage renal disease. Understanding the concept of arterial stiffness, elevated central blood pressure and pulse pressure has given a new view on the mechanisms of target organ damage and their prevention and treatment. Hence, the measurements of arterial stiffness and central blood pressure, and not only peripheral pressure, have been performed in a few recent interventional trials. Not surprisingly, it was found that observed disparity in cardiovascular events obtained by different antihypertensive drugs might be attributed to their diverse effect on central pressure wave forms, despite similar control of peripheral blood pressure. Putting all currently available data together it appears certainly that there is an additional prognostic value of central pressure wave forms beyond peripheral blood pressure. The aim of this article is to provide the pathophysiology and predictive role for cardiovascular events of central pressure wave forms that are beyond peripheral blood pressure. Crucially, we will review data supporting the view that improvement of central blood pressure can result in reduction of cardiovascular events. Lastly, the future perspectives in this exciting and promising field will be presented.

Keywords: Central blood pressure, arterial stiffness, hemodynamics, pulse wave velocity, augmentation index, pulse pressure, cardiovascular events

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