SCIENTISTS have recently found a non-invasive way to measure the central aortic systolic pressure. This new technology takes pulse wave measurements which, combined with systolic and diastolic readings from the conventual cuff method, can compute central aortic systolic pressure readings, giving Doctors valuable information enabling them to make informed decisions regarding treatment.
CENTRAL AORTIC BLOOD PRESSURE AND PULSE WAVE VELOCITY (Note 01)
Technological advances in non-invasive measurement of vascular structure and function have generated considerable interest in the use of central aortic blood pressure and pulse wave velocity as predictors of cardiovascular risk. Recent articles detail the technical aspects of measurement, and predictive value of these measures in the general population and in chronic kidney disease. These devices allow measurement of large artery stiffness represented by pulse wave velocity, and measures of central pressure including the augmentation index,
central systolic pressure and central pulse pressure which measures the difference between the diastolic and systolic blood pressure.
The central blood pressure equipment requires modest training and time, and can be implemented in a clinical setting. During a cross-sectional analysis of patients with Chronic Kidney Disease from the Chronic Renal Insufficiency
Cohort Study (CRIC) Study, it was reported that central pulse pressures are positively and independently compared with increasing brachial pulse pressure, older age, female sex, and the presence of diabetes mellitus
These measures independently predict risk of cardiovascular disease in the general population, though the measure of systemic arterial stiffness added predictive value to conventional measures of blood pressure. Recently, measures of arterial stiffness estimated on home blood pressure readings have also been shown to have a future significance.
The role of centrally measured blood pressure in treating high blood pressure is less well defined. In a study of participants enrolled in the Anglo-Scandinavian Cardiac Outcomes Trial, there was no difference in brachial systolic BPs between treatment groups. However, compared to atenolol (which is a Beta Blocker that affects the heart and circulation) therapy, Amlodipine, (a calcium channel blocker that dilates (widens) blood vessels) therapy, resulted in significantly lower central aortic systolic pressure and central aortic pulse pressure. Additionally, elevated central pulse pressure was associated with increased risk for the composite outcome that included cardiovascular events and kidney failure.
Other studies have shown that ACE (Angiotensin-converting-enzyme inhibitors) and ARB (Angiotensin II receptor blockers) based therapy, may be more effective in lowering central aortic pressure than other antihypertensive drug therapies.