Non-Invasive Aortic Pressure Monitoring in Hypertension Management
Non-Invasive Aortic Pressure Monitoring in Hypertension Management
Viewpoint: The Case for Non-Invasive Central Aortic Pressure Monitoring in the Management of Hypertension
“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). Lowering elevated brachial arterial pressures through lifestyle modification and pharmacotherapy reduces the risk of cardiovascular events and improves survival. Central aortic systolic pressure is correlated to brachial systolic pressures; however, central systolic pressures cannot be reliably inferred from brachial pressures in individual measurements. 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 as 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 published data on prediction of risk, it is clinically appropriate to consider that lowering of elevated central systolic pressures may reduce the risk of cardiovascular events and mortality. 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, particularly considering the availability of dual arterial pressure devices that can provide both brachial and central aortic pressures in the same clinic setting.”
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Viewpoint: The Case for Non-Invasive Central Aortic Pressure Monitoring in the Management of Hypertension
“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). Lowering elevated brachial arterial pressures through lifestyle modification and pharmacotherapy reduces the risk of cardiovascular events and improves survival. Central aortic systolic pressure is correlated to brachial systolic pressures; however, central systolic pressures cannot be reliably inferred from brachial pressures in individual measurements. 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 as 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 published data on prediction of risk, it is clinically appropriate to consider that lowering of elevated central systolic pressures may reduce the risk of cardiovascular events and mortality. 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, particularly considering the availability of dual arterial pressure devices that can provide both brachial and central aortic pressures in the same clinic setting.”