Central blood pressure:

what do we really know today?

Significant and highly variable differencebetween aortic and brachial systolic pressure at all ages

Published online: Eur Heart J. 2014;doi:10.1093/eurheartj/eht565.

Difference between brachial and aortic systolic blood pressure (SphygmoCor) in healthy men (dark blue bars;n=2779) and women (light blue bars; n=2869). The data represent means plus standard deviation.

Techniques for assessing central blood pressure

(A) Invasive cardiac catheterization; (B) direct applanation tonometry of the carotid artery; (C) applanation tonometry of the radial artery; (D) cuff-based oscillometry at the brachial artery.

Published online: Eur Heart J. 2014;doi:10.1093/eurheartj/eht565.

Predictive value of central pressure has been investigated in a variety of patient cohorts

First author

Year, country

N, Population Duration Parameter End-point Outcome

 Safar

 2002, France 

 180, ESRD 

 1 year 

 Carotid PP 

 All-cause (including CV mortality) 

Carotid PP but not carotid SBP or brachial SBP/PP remained independently associated with all-cause mortality after adjustment. Not mutually adjusted for brachial pressure. 

Chirinos 2005, USA 

324, Men with CAD 

4 years  Aortic SBP and PP 

All-cause mortality and MACE

Aortic PP independently associated with all-cause mortality after adjustment 

 Williams

 2006, UK 

 2199, Hypertensives 

 4 years 

 Aortic PP 

 CV events and procedures

Aortic PP independently associated with CV events and procedures after adjustment. Not mutually adjusted for brachial pressure. 

 Pini  2008, Italy 

 173, Geriatrics

 8 years   Carotid SBP and PP 

 CV mortality and events

Carotid SBP and PP independently associated with cardiovascular events and carotid SBP with fatal cardiovascular events. Association remained after adjusting for brachial BP. 

 Wang  2009, Taiwan 

 1272, community

 10 years   Carotid SBP and PP 

 All-cause and CV mortality

Only carotid SBP predicted CV mortality after adjustment. No adjustment for brachial pressure.

Published online: Eur Heart J. 2014;doi:10.1093/eurheartj/eht565. Abbreviations: CV, cardiovascular; PP, pulse pressure; SBP, systolic blood pressure

Comparative effect of antihypertensive drugson central systolic pressure

Published online: Eur Heart J. 2014;doi:10.1093/eurheartj/eht565.

ASCOT trial: difference in central aortic pressure is an important explanation for better outcomes in amlodipine-perindopril regimen

Williams B, Lacy PS, Thom SM, et al. Circulation. 2006;113:1213-1225.

“By demonstrating that amlodipine-perindopril therapy is associated with substantially lower central aortic pressure than atenolol-thiazide therapy, the results of the CAFE study provide a plausible and novel

mechanism to explain the effects of the different treatment arms in ASCOT.”