Central pressure should not be used in clinical practice

Area of Science:

• Cardiovascular Physiology
• Hypertension Research
• Clinical Risk Prediction

Background:

• Pulsatile damage affects the heart, brain, and kidneys in older adults and hypertensive patients.
• Central systolic and pulse pressures, differing from brachial artery measurements, impact these organs.
• The generalized transfer function estimates central pressure, revealing significant age-related differences.

Purpose of the Study:

• To evaluate if central pressure offers superior risk prediction for target organ damage and cardiovascular events compared to peripheral pressure.
• To determine if central pressure measurements provide incremental predictive value beyond established cardiovascular risk factors.

Main Methods:

• Utilized the generalized transfer function to estimate central systolic and pulse pressures.
• Reviewed existing studies correlating central pressure with target organ damage and cardiovascular events.
• Assessed the potential for central pressure to add predictive value to standard risk factor models.

Main Results:

• A substantial difference exists between central and peripheral pressures, persisting even in advanced age.
• Limited studies show marginally improved correlations between central pressure pulsatility and organ damage.
• Prospective studies suggest potential for marginally better risk stratification, but reclassification analysis is lacking.

Conclusions:

• Current evidence is insufficient to support the widespread adoption of central pressure measurements in routine clinical practice.
• Further research, including reclassification analysis, is needed to justify the added complexity and cost of central pressure monitoring.
• Central pressure's role in enhancing cardiovascular risk prediction requires more robust validation.