Artery Research

Volume 9, Issue C, March 2015, Pages 8 - 13

Central pressure should not be used in clinical practice

Authors
Gary F. Mitchell*
Cardiovascular Engineering, Inc., 1 Edgewater Drive, Suite 201A, Norwood, MA 02062, United States
*Tel.: +1 781 255 6930; fax: +1 781 255 6931. E-mail address: GaryFMitchell@mindspring.com
Corresponding Author
Gary F. Mitchell
Received 20 November 2014, Accepted 21 November 2014, Available Online 8 December 2014.
DOI
https://doi.org/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.

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Journal
Artery Research
Volume-Issue
9 - C
Pages
8 - 13
Publication Date
2014/12
ISSN (Online)
1876-4401
ISSN (Print)
1872-9312
DOI
https://doi.org/10.1016/j.artres.2014.11.002How to use a DOI?
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.

Cite this article

TY  - JOUR
AU  - Gary F. Mitchell
PY  - 2014
DA  - 2014/12
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  - https://doi.org/10.1016/j.artres.2014.11.002
ID  - Mitchell2014
ER  -