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Published on: May 3, 2018
Clinical relevance of central blood pressure - a critical review
Michael Kostapanos1, Carmel M McEniery1, Ian B Wilkinson1
11 Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, United Kingdom.
Insights
Central blood pressure is a better predictor of organ damage than brachial blood pressure. Further research is needed to confirm its role in cardiovascular outcomes and guide new antihypertensive medication development.
Area of Science:
- Cardiology
- Hypertension Research
- Pharmacology
Background:
- Vital organs are primarily influenced by central blood pressure, not brachial.
- Noninvasive methods for assessing central blood pressure are available.
- Central blood pressure measurement is increasingly recognized for its clinical relevance.
Purpose of the Study:
- To critically review the clinical relevance of central blood pressure assessment.
- To evaluate central blood pressure as a predictor of end-organ damage and cardiovascular outcomes.
- To discuss the impact of antihypertensive drug classes on central blood pressure.
Main Methods:
- Review of existing clinical studies and data.
- Critical discussion of the evidence regarding central blood pressure.
- Comparative analysis of antihypertensive drug effects on central and brachial blood pressure.
Main Results:
- Central blood pressure is a stronger predictor of end-organ damage than brachial blood pressure.
- Existing studies are underpowered to definitively establish central blood pressure's predictive value for cardiovascular outcomes.
- Beta-blockers may lower central blood pressure less effectively than other antihypertensive classes, potentially impacting cardiovascular outcome efficacy.
Conclusions:
- Further synthesis of data is required to clarify the role of central blood pressure in predicting cardiovascular outcomes.
- Newer vasodilating beta-blockers might not exhibit the same differential effect on central blood pressure.
- Future research should focus on appropriately powered trials, central blood pressure variability, and developing medications targeting central blood pressure.
Abstract:
Vital organs are exposed to the central rather than the brachial blood pressure. To date, central blood pressure can be assessed noninvasively through the use of several devices. In this review, we critically discuss the clinical relevance of central blood pressure assessment. Considerable evidence suggests that central blood pressure is a better predictor of end-organ damage than brachial blood pressure. However, there is still uncertainty concerning the value of central pressure for predicting cardiovascular outcomes, as the existing studies are underpowered to address this issue. A full synthesis of the available data is needed in this regard. Among the different antihypertensive drug classes, beta-blockers appear to lower central blood pressure less than brachial blood pressure. This difference may, at least in part, explain the reduced efficacy of beta-blockers in the prevention of cardiovascular outcomes compared with the other antihypertensive drug classes, which may lower central and brachial blood pressure to a similar extent. Nevertheless, this differential effect might not be relevant to the newer beta-blockers with vasodilating properties, including nebivolol, celliprolol and carvedilol. However, whether a preferential reduction of central blood pressure results in better outcomes should be further assessed by appropriately powered clinical trials. Other emerging challenges include the assessment of the potential predictive value of central blood pressure variability and the development of new antihypertensive medications based on central blood pressure rather than brachial blood pressure.
