Central Aortic Pressure Monitoring as an Essential Component of Hypertension Management



Central Aortic Pressure Monitoring as an Essential Component of Hypertension Management


Central Aortic Pressure Monitoring

Hypertension is common and responsible for continued morbidity, mortality and high socioeconomic costs despite the widespread availability and use of cuff brachial artery measurements for diagnosis and monitoring. Elevated brachial arterial pressures predict CV events and mortality in addition to structural changes (e.g., left ventricular hypertrophy, carotid intima-media thickness and reduced glomerular filtration rate). Central aortic systolic pressure is correlated to brachial systolic pressures; however, central systolic pressures cannot be reliably inferred from brachial pressures. Elevated central aortic pressure predicts cardiovascular events and mortality in addition to structural changes (e.g., left ventricular hypertrophy, carotid intima-media thickness and reduced glomerular filtration rate). The risk of adverse CV outcomes is associated with elevated central pressures and these risks have been shown in multiple studies to be superior, and in others, at least as high than that associated with brachial pressures. A recent meta-analysis, which incorporated multiple baseline factors including brachial systolic pressure, demonstrated that central systolic pressure is independently predictive of cardiovascular events and therefore provides additional risk information. Based on the extensive published data on prediction of risk, the correlations of central and brachial systolic pressures, the improvement of health outcomes resulting from lowering elevated brachial systolic pressure, it is clinically appropriate to conclude that lowering of elevated central systolic pressures will reduce the risk of cardiovascular events and morality. In addition, threshold values for the diagnosis of elevated central arterial pressures have been defined and have been referenced to the threshold values for the diagnosis of hypertension based on brachial pressures and for target goals of treatment. Measurements of central arterial pressures can be incorporated into the current approaches to hypertension management as the dual arterial pressure SphygmoCor® XCEL device, the only FDA cleared medical device for non-invasive central arterial pressure waveform analysis for all adults, can provide both brachial and central aortic pressures in the same clinic setting.


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