Central blood pressure for the management of hypertension: Is it a practical clinical tool in current practice?

women were clearly in the peri-and post-menopausal age bracket at the time of enrollment. The potential overlap between obesity and early atherosclerosis is a key point of the study. Since CSBP is an estimated value contingent on the behavior of the vessels, it may not be entirely independent of other anthropometric features. Similarly, the BPro 10 device was probably not validated for the full spectrum of obesity. Assessment of early atherosclerosis 11 by other emerging technologies, such as pulse wave velocity or aortic augmentation index, would be desirable. 10 These reviewers also found some features described in the paper noteworthy. First of all, while the authors state that BP was measured with mercury sphygmomanometers, these are now obsolete and phased out in most places in North America and Europe. It is uncertain whether the study results would be confirmed using different manual devices, or in other populations, or by using a different brand device estimating CSBP. 11 Additionally, income status does not equal insurance status and the type of insurance may affect clinical outcomes beyond income, education, and socioeconomic status.At least in patients with end-stage renal failure, a difference in clinical outcomes has been demonstrated based on the type of insurance in China. 12 Yet, the nagging question remains-do the outcomes described in the paper by Dong and his co-workers 7 truly infer differences of BP, or rather reflect differences in vascular physiology in some of the enrollees? When one reviews original studies examining the correlation between central SBP during cardiac catheterization (itself a rather major event) and non-invasive, cuff-based BPs, a highly significant but imperfect correlation (r = .893, P < .001) is detected with only some of the individual measurements falling within 5 mm Hg of agreement during Bland-Altman plotting of the observations. 13Pulse pressure ratio also appeared to be a measure of central-to-brachial pressure amplification. We agree with a recent review in the Journal that "it is arguable that the inconsistent superiority of central BP over brachial BP may reflect a true pathophysiological issue or is potentially biased by methodological weakness". 6 Thus, we think it is still too early for central BP measurement to be a routine assessment.

supporting

confidence: 65%

“…To state it differently, it would be desirable to separate the effect of hypertensive atherosclerosis from the BP‐induced damage to the organs themselves. A state of the art review on central BP has recently been published by Chang et al in this Journal …”

mentioning

confidence: 99%

Blood pressure measurements—Shifting the focus from periphery to center

Fülöp

Salim

Herberth

et al. 2020

“…The HOPE Asia Network has published a number of papers on important Asia‐specific topics in hypertension . This Asia‐specific issue of the Journal of Clinical Hypertension provides an important resource including original research and review articles on the management of hypertension from a variety of Asian viewpoints, including topics such as central BP, environmental factors, comorbidities such as diabetes, atrial fibrillation, heart failure, and dementia, recent Asian guidelines and so forth . This issue also includes reports from twelve countries/regions in Asia to help define and highlight the current status of hypertension, its management, and their initiatives.…”

Section: Resultsmentioning

confidence: 99%

“…The “perfect 24‐hour BP control” strategy taking Asian characteristics into account is essential for achievement of the “zero” cardiovascular event goal . Considerable work has already been done on the journey to achieving this goal . Practically, a staged approach to the 24‐hour management of hypertension should be considered, first targeting morning hypertension, then nocturnal hypertension, followed by daytime hypertension .…”

Section: Perspectivesmentioning

confidence: 99%

The HOPE Asia Network activity for “zero” cardiovascular events in Asia: Overview 2020

Kario

2020

Self Cite

The impact of hypertension-related cardiovascular disease and target organ damage, and therefore the benefits of blood pressure (BP) control, is greater in Asian than in Western countries. Asia-specific features of hypertension and its effective management are important and active areas of research. The Hypertension Cardiovascular Outcome Prevention and Evidence in Asia (HOPE Asia) Network was formed in 2016and is now a member of the World Hypertension League. The main goal of the HOPE Asia Network is to improve the management of hypertension and organ protection toward achieving "zero" cardiovascular events in Asia. Considerable work has already been done on the journey to achieving this goal. We have shown that BP control status in Asia differs between countries, and even between regions within the same country. Several expert panel consensus recommendations and clinical guidance papers are available to support the use of home and ambulatory BP monitoring in the region. In addition, the AsiaBP@Home study prospectively investigated home BP control status across 15 specialist centers using the same validated device and measurement schedule. We have also proposed the concept of systemic hemodynamic atherothrombotic syndrome (SHATS), a vicious cycle of BP variability and vascular disease on cardiovascular events and organ damage, and suggested a SHATS score for risk stratification for clinical practice. This special issue of the journal collates Asia-specific resources and data, contributing to advances in hypertension management and cardiovascular disease prevention in the region.

“…Current guidelines recommend out‐of‐office BP measures for the diagnosis and management of hypertension, 1 but this approach may be hindered by limited availability of devices and patients’ adherence issues, 14 raising the need for identification of preferential targets for out‐of‐office BP measures. Given the increasing availability of techniques that allow feasible and simultaneous brachial and central BP measures, 3,9 the diagnosis of discordant elevations of central or brachial BP at the office could be used to identify preferential targets for out‐of‐office BP measures. Conversely, in services that routinely perform ambulatory BP monitoring, the presence of masked hypertension could be used to recognize individuals at higher risk of having elevation of central BP among those with normal brachial BP at the office.…”

Section: Discussionmentioning

confidence: 99%

Ambulatory blood pressure phenotypes and isolated elevation of office central or brachial blood pressure

Feitosa

Paiva

Mota‐Gomes

et al. 2020

Hypertension is defined based on brachial blood pressure (BP) levels. 1 However, BP measured at the central aorta (central BP) is reported to be superior to brachial BP in predicting cardiovascular events, and central BP values of 130/90 mm Hg have been proposed as thresholds to define hypertension. 2,3 Disagreements in brachial and central BP measured at the office have resulted in the identification of novel hypertension phenotypes, namely isolated central hypertension (ICH) and isolated brachial hypertension (IBH), 3 but the clinical significance of these phenotypes is not established. 4,5 Although conflicting data have been reported, 6 previous studies have suggested that young individuals with elevated brachial systolic BP might have high rates of normal central BP and high prevalence of white coat hypertension, 7,8 raising the assumption that divergences in office brachial and central BP may be coupled with office and out-of-office brachial BP discrepancies. Therefore, the present study aimed at investigating the