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...

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Office blood pressure measurement has been the basis for hypertension evaluation for almost a century. However, the evaluation of blood pressure out of the office using ambulatory or self-home monitoring is now strongly recommended for the accurate diagnosis in many, if not all, cases with suspected hypertension. Moreover, there is evidence that the variability of blood pressure might offer prognostic information that is independent of the average blood pressure level. Recently, advancement in technology has provided noninvasive evaluation of central (aortic) blood pressure, which might have attributes that are additive to the conventional brachial blood pressure measurement. This position statement, developed by international experts, deals with key research and practical issues in regard to peripheral blood pressure measurement (office, home, and ambulatory), blood pressure variability, and central blood pressure measurement. The objective is to present current achievements, identify gaps in knowledge and issues concerning clinical application, and present relevant research questions and directions to investigators and manufacturers for future research and development (primary goal).

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