Association of Central Versus Brachial Blood Pressure With Target-Organ Damage

Abstract

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...

Impaired Muscle Oxygenation and Elevated Exercise Blood Pressure in Hypertensive Patients

“…The finding that muscle oxygenation indices were correlated with central aortic systolic and PP and arterial stiffness indices rather than with visit brachial pressure is also noteworthy as central BP has been more strongly associated with preclinical organ damage. 44 Our data also suggest that microvascular stiffness contributes to limitations of muscle oxygenation and to the exaggerated BP during exercise, in hypertension. Future studies should explore whether lifestyle (ie, exercise) or pharmacological interventions could enhance skeletal muscle oxidative capacity and microvascular function and improve hypertensive patient outcomes.…”

Isolated Systolic Hypertension in Young People Is Not Spurious and Should Be Treated

“…[19][20][21][22][23] CBp values in the aortic root, calculated from the pulse wave recorded in peripheral arteries using a transfer function, are lower than those obtained in the brachial artery. Central aortic Bp and central pulse pressure are more reflective of the Bp experienced by major organs, such as the brain, heart, and kidneys, and therefore may have a stronger association with cardiovascular risk.…”

“…[19][20][21][22][23] Los valores de la PAc en la raíz aór-tica, calculados a partir de la onda de pulso registrada en las arterias periféricas utilizando una función de transferencia, son inferiores a los obtenidos en la arteria braquial. Los valores de la PA aórtica y la presión de pulso central reflejan mejor la PA experimentada por los órganos principales, como el cerebro, el corazón y los riñones, y, por ende, pueden tener una relación más sólida con el riesgo cardiovascular.…”

Daily Physical Activity Improves Vascular Function and Motor Skills in Children

“…In adults, central BP, the pressure in the aorta, has been shown to be more strongly related to preclinical organ damage, vascular disease, left ventricular hypertrophy and carotid atherosclerosis as markers of hypertensive end-organ damage and future cardiovascular events than the traditional upper arm BP [12,13,28]. The CAFE-study demonstrated better clinical outcome with comparable peripheral BP but with lower central BP due to medical therapy [29].…”

“…Emerging evidence now suggests that in contrast to pressure measured in the brachial artery, central pressure is more strongly associated with preclinical organ damage such as left ventricular hypertrophy, carotid intima-media thickness and pulse wave velocity [11] and is better related to future cardiovascular events as well [12]. Antihypertensive therapy can exert differential effects on brachial and central pressures [13].…”