Clinical relevance of central blood pressure - a critical review

Kostapanos, Michael S.; McEniery, Carmel M.; Wilkinson, Ian B.

doi:10.1024/0301-1526/a000565

Cited by 6 publications

(2 citation statements)

References 59 publications

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“…It has been shown in non-critically ill patients that the greater the ratio between systolic central and peripheral pressure, the poorer the outcome. Moreover, several factors have been reported to be associated with increased ratios, including comorbid diabetes, hypertension and cardiovascular disease [9, 26–29], although conflicting results exist [30]. In our sample of stable patients, we could not determine whether the bias was related to the severity of the patients’ acute condition, to an underlying chronic vascular disease or to a combination of both.…”

Section: Discussionmentioning

confidence: 88%

Estimation of central arterial pressure from the radial artery in patients undergoing invasive neuroradiological procedures

et al. 2019

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Backgrounds Central arterial pressure can be derived from analysis of the peripheral artery waveform. The aim of this study was to compare central arterial pressures measured from an intra-aortic catheter with peripheral radial arterial pressures and with central arterial pressures estimated from the peripheral pressure wave using a pressure recording analytical method (PRAM). Methods We studied 21 patients undergoing digital subtraction cerebral angiography under local or general anesthesia and equipped with a radial arterial catheter. A second catheter was placed in the ascending aorta for central pressure wave acquisition. Central (AO) and peripheral (RA) arterial waveforms were recorded simultaneously by PRAM for 90–180 s. During an off-line analysis, AO pressures were reconstructed (AO rec ) from the RA trace using a mathematical model obtained by multi-linear regression analysis. The AO rec values obtained by PRAM were compared with the true central pressure value obtained from the catheter placed in the ascending aorta. Results Systolic, diastolic and mean pressures ranged from 79 to 180 mmHg, 47 to 102 mmHg, and 58 to 128 mmHg, respectively, for AO, and 83 to 174 mmHg, 47 to 107 mmHg, and 60 to 129 mmHg, respectively, for RA. The correlation coefficients between AO and RA were 0.86 (p < 0.01), 0.83 (p < 0.01) and 0.86 (p < 0.01) for systolic, diastolic and mean pressures, respectively, and the mean differences − 0.3 mmHg, 2.4 mmHg and 1.5 mmHg. The correlation coefficients between AO and AO rec were 0.92 (p < 0.001), 0.87 (p < 0.001) and 0.92 (p < 0.001), for systolic, diastolic and mean pressures, respectively, and the mean differences 0.01 mmHg, 1.8 mmHg and 1.2 mmHg. Conclusions PRAM can provide reliable estimates of central arterial pressure. Electronic supplementary material The online version of this article (10.1186/s12871-019-0844-1) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 88%

Estimation of central arterial pressure from the radial artery in patients undergoing invasive neuroradiological procedures

et al. 2019

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“…In a small (n = 30) randomized, double-blind, placebo-controlled trial, ACEI attained a significant decrease in central SBP than BB (average decrease of 5.2 mmHg, p < 0.0001) compared to brachial BP 29 . Moreover, the earlier small studies, meta-analysis, and a recent Japanese cross-sectional study have demonstrated that the vasodilatory antihypertensives (CCB, ARB, ACEI, alpha-blockers) lower CBP more than any non-vasodilatory class (diuretics and BB), but the brachial BP was lowered to the same level 30, 31. In the CAFE trial, conducted in 2199 patients with hypertension and receiving anti-hypertensive drugs (beta-blocker + LCD, CCB + ACEI) for 4 years in a controlled manner, despite similar brachial SBP between treatment groups (difference, 0.7 mmHg), there was substantial reduction in central SBP with ACEI + DHP-CCB versus beta-blocker + LCD (difference, 4.3 mmHg, p < 0.0001) 32 .…”

Section: Discussionmentioning

confidence: 95%

Prevalence and real-world assessment of central aortic blood pressure in adult patients with essential hypertension uncontrolled on single anti-hypertensive agents

Verma

Tiwari

Joshi

et al. 2018

Indian Heart Journal

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ObjectiveTo assess the prevalence of high central aortic pressure (CAP) in Indian patients with uncontrolled essential hypertension while on anti-hypertensive monotherapy. Also, to determine correlation between brachial blood pressure (BBP) and CAP, and ascertain if it is impacted by anti-hypertensive drug class and patients’ age.MethodsIn this real-world, observational, prospective study, patients (30–70 years) with uncontrolled BBP (systolic BP [SBP] ≥140 mmHg or diastolic BP [DBP] ≥90 mmHg) were enrolled. Treatment was adjusted at Visit 1 (baseline), based on BBP and at treating physicians’ discretion. Primary endpoint was proportion of patients with uncontrolled central aortic SBP (>125 mmHg) at baseline. Secondary endpoints were comparison of BBP and CAP across drugs classes and age groups at baseline and Visit 2 (End-of-study, ∼8 weeks post-baseline), and proportion of patients with uncontrolled central SBP at end-of-study.ResultsOf 2030 patients screened, 1949 patients reported at baseline and 1740 patients completed end-of-study visit. Central SBP was >125 mmHg for 84.3% patients at baseline, and 48% patients at end-of-study. Interestingly, at end-of-study, 6.6% patients still had uncontrolled brachial SBP and controlled central SBP, while 13.6% patients had uncontrolled central SBP and controlled brachial SBP. At both visits, brachial SBP and central SBP showed positive correlation across most drug classes and age groups. At baseline, ACE inhibitors showed better efficacy than other drug classes. At end-of-study, BP control was better with fixed-dose combinations, though free–drug combinations were more frequently prescribed.ConclusionMeasurement of CAP along with BBP can be vital in management of hypertension.Ctri registration numberCTRI/2015/10/006302.

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