Central hypertension is a non‐negligible cardiovascular risk factor

Abstract

High blood pressure (BP) confers cardiovascular risk. However, the clinical value of central BP remains debatable. In this article, we aim to briefly review the prognosis, diagnosis, and treatment of central hypertension. Central and brachial BPs are closely correlated. In most prospective investigations, elevated central and peripheral BPs were similarly associated with adverse outcomes. Outcome-driven thresholds of the central systolic BP estimated by the type I device were on average 10 mmHg lower than their brachial counterparts. Cross-classification based on the central and brachial BPs identified that nearly 10% of patients had discrepancy in their status of central and brachial hypertension. Irrespective of the brachial BP status, central hypertension was associated with increased cardiovascular risk, highlighting the importance of central BP assessment in the management of hypertensive patients. Newer antihypertensive agents, such as renin-angiotensin-aldosterone system inhibitors and calcium channel blockers, were more efficacious than older agents in central BP reduction. Clinical trials are warranted to demonstrate whether controlling central hypertension with an optimized antihypertensive drug treatment will be beneficial beyond the control of brachial hypertension.

The prediction of cardiovascular events by phenotype of central and peripheral blood pressure in subjects without hypertension

“…In the previous study, the cumulative CV events increased gradually from concordant central and brachial normotensive over isolated brachial hypertension to isolated central hypertension and onward to concordant central and brachial hypertension with no difference between isolated central hypertension and concordant hypertension, although 130 mmHg was the cut-off value for peripheral BP. Based on these results, isolated central hypertension should not be overlooked even if brachial BP is normal [17, 19].…”

Brachial and central hypertension in relation to coronary stenosis in patients with coronary angiography

“…Indeed, it was observed that the associations between brachial and aortic systolic BPs reduced significantly for borderline hypertensives 28 . From this point of view, central hypertension should not be ignored in the cardiovascular prevention 9 . The arising questions are therefore how many patients with central hypertension would be masked by and ignored due to brachial normotension according to our current management strategies, and whether these patients should be screened and intervened.…”

“…Central hypertension was a central SBP of ≥130 mmHg. The 130‐mmHg threshold was arbitrarily chosen considering it is the threshold proposed in previous publications 9,15,16 . Since theoretically it is the systolic but not diastolic BP different between brachial and central arteries, 17 central hypertension was defined based on systolic BP (SBP) only.…”

“…However, as central BP is not routinely measured in the clinic, central hypertension is often ignored. In addition, the clinical significance of central beyond brachial hypertension remains to be clarified, calling for more research efforts 9,10 . Up to now, data on the cross‐classification of brachial and central hypertension in patients with CAD is scarce.…”

Клінічне Значення Центрального Артеріального Тиску Та Переваги Його Корекції Комбінацією Олмесартану Та Амлодипіну

“…Потужний метааналіз індивідуальних, а не сукупних даних за допомогою Міжнародної бази даних властивостей центральної артерії для стратифікації ризику (International Database of Central Arterial Properties for Risk Stratification -IDCARS) також показали, що центральний і плечовий АТ пов'язані із серцевосудинними ускладненнями однаковою мірою. на його основі виділено групи пацієнтів, що потребували різних підходів до корекції антигіпертензивної терапії залежно від показників центрального тиску [10,11]. Ще один систематичний огляд та метааналіз 35 досліджень за участю осіб віком старше 60 років свідчить про сильний зв'язок між центральним АТ і показниками як серцево-судинної, так і загальної смертності серед населення літнього віку [12].…”