Central pressure should not be used in clinical practice

DOI

10.1016/j.artres.2014.11.002How to use a DOI?

Keywords

Central pressure; Arterial stiffness; Aorta

Abstract

The heart, brain and kidneys are key targets of pulsatile damage in older people and in patients with longstanding hypertension. These central organs are exposed to central systolic and pulse pressures, which may differ from the corresponding peripheral pressures measured in the brachial artery. Studies employing the generalized transfer function as a means to estimate central pressure have demonstrated a large difference between central and peripheral systolic and pulse pressure that diminishes with age but remains substantial even in octogenarians. As a result of this persistent difference, some have advocated that central pressure may represent a more robust indicator of risk for target organ damage and major cardiovascular disease events. From the perspective of risk prediction, it is important to acknowledge that a new technique must add incremental predictive value to what is already commonly measured. Thus, in order to justify the added complexity and expense implicit in the measurement, central pressure must be shown to add significantly to a risk factor model that includes standard cardiovascular disease risk factors. A limited number of studies have shown marginally better correlations between central pressure pulsatility and continuous measures of target organ damage in the heart. A similarly limited number of prospective studies in unique cohorts have suggested that central pressure may provide marginally better risk stratification, although no reclassification analysis has been published. Thus, currently available evidence does not provide sufficient justification for widespread adoption and routine use of central pressure measurements in clinical practice.

Copyright

© 2014 Association for Research into Arterial Structure and Physiology. Published by Elsevier B.V. All rights reserved.

Open Access

This is an open access article distributed under the CC BY-NC license.

Download article (PDF)
View full text (HTML)

TY  - JOUR
AU  - Gary F. Mitchell
PY  - 2014
DA  - 2014/12/08
TI  - Central pressure should not be used in clinical practice
JO  - Artery Research
SP  - 8
EP  - 13
VL  - 9
IS  - C
SN  - 1876-4401
UR  - https://doi.org/10.1016/j.artres.2014.11.002
DO  - 10.1016/j.artres.2014.11.002
ID  - Mitchell2014
ER  -