eCite Digital Repository

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

Citation

Sharman, JE and Laurent, S, Central blood pressure in the management of hypertension: soon reaching the goal?, Journal of Human Hypertension, 27, (7) pp. 405-411. ISSN 0950-9240 (2013) [Substantial Review]


Preview
PDF
Pending copyright assessment - Request a copy
697Kb
  

DOI: doi:10.1038/jhh.2013.23

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.Journal of Human Hypertension advance online publication, 28 March 2013; doi:10.1038/jhh.2013.23.

Item Details

Item Type:Substantial Review
Keywords:haemodynamics; cardiovascular; risk therapy
Research Division:Medical and Health Sciences
Research Group:Cardiorespiratory Medicine and Haematology
Research Field:Cardiology (incl. Cardiovascular Diseases)
Objective Division:Health
Objective Group:Clinical Health (Organs, Diseases and Abnormal Conditions)
Objective Field:Cardiovascular System and Diseases
Author:Sharman, JE (Professor James Sharman)
ID Code:87469
Year Published:2013
Web of Science® Times Cited:31
Deposited By:Menzies Institute for Medical Research
Deposited On:2013-11-20
Last Modified:2013-11-20
Downloads:0

Repository Staff Only: item control page