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Updated: Jul 7, 2026
Ultrasound Assessment of Endothelial-Dependent Flow-Mediated Vasodilation of the Brachial Artery in Clinical Research
Published on: October 22, 2014
Brachial arterial pressure to assess cardiovascular structural damage: an overview and lessons from clinical trials
1Department of Nephrology and Hemodialysis, Manhès Hospital, Fleury-Mérogis, France. glondon@club-internet.fr
Insights
Systolic blood pressure (BP) measured peripherally differs from central aortic pressure. Central artery pressure is a stronger predictor of cardiovascular outcomes and end-organ damage than brachial BP.
Area of Science:
- Cardiovascular Physiology
- Hypertension Research
- Arterial Biomechanics
Background:
- Epidemiological studies link blood pressure (BP) to cardiovascular disease incidence.
- Historically, hypertension severity was based on diastolic BP, but systolic BP is now recognized as a better mortality predictor.
- Conventional BP measurement in peripheral arteries (brachial artery) assumes uniform pressure throughout the arterial system.
Purpose of the Study:
- To highlight the discrepancy between peripheral and central (aortic) systolic blood pressure.
- To emphasize the importance of central artery pressure in predicting cardiovascular outcomes and end-organ damage.
- To discuss the influence of arterial properties on pressure amplification and the differential effects of antihypertensive drugs.
Main Methods:
- Review of epidemiological studies and recent research on blood pressure measurement.
- Analysis of arterial hemodynamics, including wave reflections and pressure amplification.
- Comparison of peripheral and central BP measurements in relation to cardiovascular outcomes and drug efficacy.
Main Results:
- Systolic BP and pulse pressure are amplified from the aorta to peripheral arteries due to arterial stiffness and wave reflections.
- Peripheral systolic BP (e.g., brachial) only indirectly reflects central systolic BP.
- Central aortic pressure and its determinants are stronger predictors of end-organ damage and cardiovascular outcomes than brachial BP.
Conclusions:
- Central artery pressure measurement offers a more accurate assessment of cardiovascular risk than traditional peripheral BP.
- Understanding arterial properties is crucial for interpreting BP readings and optimizing antihypertensive treatment.
- Future research should focus on central BP monitoring for improved cardiovascular disease management.
Abstract:
Epidemiological studies have emphasized the relationship between blood pressure (BP) and the incidence of cardiovascular diseases. Severity of hypertension was in the past judged on the basis of diastolic BP. More recent epidemiological studies have directed attention to systolic pressure as a better guide to cardiovascular and all-cause mortality. Traditionally, hypertension was appreciated by measures of BP recorded in peripheral arteries, usually brachial artery which was assumed to reflect pressures in all parts of arterial system. All these studies neglected that peripheral systolic BP differs from pressure recorded in the aorta and central arteries. While mean and diastolic pressures are almost constant along the arterial tree, due to the stiffness and geometric heterogeneity of large arteries and the timing and magnitude of wave reflections systolic BP and pulse pressure are amplified from the aorta to peripheral arteries, and brachial systolic BP only indirectly reflects the systolic BP in the aorta and central arteries. Several recent studies have shown that the effects of antihypertensive drugs are not the same in peripheral and central arteries, fact which could account for different effects of various drugs on end-organ damage, such as regression of left ventricular hypertrophy. Moreover, it has been shown that aortic and central artery pressure (or their determinants) are stronger predictors of end-organ damage and cardiovascular outcome than conventionally measured brachial pressure. These studies have focused the attention on the physical properties of large arteries and on the way they influence the level of systolic and pulse pressures along the arterial tree.
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