S ystolic blood pressure (BP) and pulse pressure (PP) are known to be higher when assessed at the brachial artery compared with the aorta because of PP amplification across the arterial tree.1 From the physiological point of view, target organs, such as the heart and large arteries, are directly exposed to central rather than brachial BP, which could translate into superior predictive value of the former.1 A recent meta-analysis concluded that central PP is marginally superior to brachial PP in predicting clinical events. 2 Intense research has been recently performed on the clinical relevance of central BP assessed noninvasively using different techniques, and reference values have been recently estimated.1,3 A crucial remaining question is whether central BP offers significant improvement in cardiovascular risk assessment and stratification compared with brachial (peripheral) BP. Several studies showed superiority of central compared with brachial BP in terms of association with several indices of preclinical target-organ damage; yet these findings have not always been consistent (online-only Data Supplement).A systematic review and meta-analysis of the evidence on the relationship of central versus brachial BP with preclinical target-organ damage were performed. Methods Search StrategyA systematic literature search was performed in PubMed database to identify studies published until April 2014 providing comparative data on the association of central versus brachial BP and target-organ damage. Keywords for the search were: central pressure, target organ, left ventricular, carotid intima-media thickness, urine albumin, pulse wave velocity, or arterial stiffness. Data sources were also identified through manual search of references of articles. The study selection and data extraction were performed independently by 2 investigators (S.L. and M.E.Z.). Disagreements were resolved by consensus with a senior author (A.K.). Abstract-Accumulating Selection Criteria and Data ExtractionA systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations (http://www.prisma-statement.org). Eligible studies were full-text articles in English and presenting data from observational (cross-sectional or case-control), longitudinal, retrospective, and prospective studies in adults, which included assessment of central BP and evaluation of indices of preclinical target-organ damage. For the systematic review, all studies reporting any kind of relationship between central BP and target-organ damage (ie, bivariate correlations, univariate or multivariate regression analyses with the target variables or their log-transformed values) were included. Central BP was considered suitable if it was assessed noninvasively by recording pressure waveforms at the radial, carotid, or brachial arteries, using either applanation tonometry or oscillometry. Likewise, indices of target-organ damage that were considered appropriate for the analysis included (1) echocardiograph...

In the last two decades, considerable evidence on home blood pressure monitoring has accumulated and current guidelines recommend its wide application in clinical practice. First, several outcome studies have shown that the ability of home blood pressure measurements in predicting preclinical target organ damage and cardiovascular events is superior to that of the conventional office blood pressure measurements and similar to that of 24-hour ambulatory monitoring. Second, cross-sectional studies showed considerable agreement of home blood pressure measurements with ambulatory monitoring in detecting the white-coat and masked hypertension phenomena, in both untreated and treated subjects. Third, studies have shown larger blood pressure decline by using home blood pressure monitoring instead of office measurements for treatment adjustment. Fourth, in treated hypertensives, home blood pressure monitoring has been shown to improve long-term adherence to antihypertensive drug treatment and thus, has improved hypertension control rates. These data suggest that home blood pressure should no longer be regarded as only a screening tool that requires confirmation by ambulatory monitoring. Provided that an unbiased assessment is obtained according to current recommendations, home blood pressure monitoring should have primary role in diagnosis, treatment adjustment, and long-term follow-up of most cases with hypertension.

Objectives: To compare the association of home (HBP), ambulatory (ABP) and office blood pressure (OBP) measurements with preclinical organ damage in young individuals. Methods: Individuals referred for elevated blood pressure and healthy volunteers aged 6–25 years were evaluated with OBP (2–3 visits), 7-day HBP and 24-h ABP monitoring. Organ damage was assessed by echocardiographic left ventricular mass index (LVMI), carotid ultrasonography [intima--media thickness (IMT)] and pulse wave velocity (PWV) using piezo-electronic or oscillometric technique. Results: Analysis included 251 individuals (mean age 14 ± 3.9 years, 70.9% men: 31.1% children, 54.6% adolescents, 14.3% young adults) of whom 189 had LVMI, 123 IMT and 198 PWV measurements. Office, ambulatory and home hypertension was diagnosed in 29.5, 27.1 and 26.3% of participants. The agreement of OBP with ABP was 74.5% (kappa 0.37) and HBP 76.1% (kappa 0.41), with closer agreement between HBP and ABP (84.9%, kappa 0.61). LVMI gave comparable correlations with systolic OBP, 24-h ABP and HBP (r = 0.31/0.31/0.30, all P < 0.01). The same was the case for IMT (0.33/0.32/0.37, all P < 0.01) and piezo-electronic PWV (0.55/0.53/0.52, all P < 0.01), whereas oscillometric PWV gave stronger correlations with OBP than ABP or HBP. In linear regression analysis, the variation of LVMI was determined by night-time ABP, of IMT by HBP and of PWV by OBP and 24-h ABP. Conclusion: These data suggest that in young individuals, target organ damage is mainly determined by out-of-office rather than office BP. Home and ambulatory BP give comparable associations with preclinical organ damage.

Peripheral blood pressure (BP) is known to exhibit a typical diurnal variation with a 10%-20% fall during nighttime sleep compared to daytime values. 1 Alterations in the diurnal rhythm, such as the absence of nocturnal fall, namely the "non-dipping" status, or even a rising status, have been linked with increased cardiovascular risk in adults. 1-3 Relevant data in children and adolescents are scarce with most studies conducted in individuals with important underlying medical conditions like diabetes. 4,5 Several conditions and factors interfere and disrupt circadian BP variation, including increased sympathetic nervous system activity during the night, abnormal neurohormonal regulation, poor sleep quality, physical inactivity, obesity, smoking, chronic kidney disease, salt sensitivity, obstructive sleep apnea, and diabetes. 2,6,7 Although there is considerable evidence on the circadian variation of peripheral BP, 1-3,7,8 the diurnal variation of central BP (ceBP) remains largely unexplored. Moreover, there are still no reference