Clinical relevance of central blood pressure - a critical review

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.

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The Effect of Antihypertensive Medications on Testing for Primary Aldosteronism

Frontiers in Pharmacology ◽

10.3389/fphar.2021.684111 ◽

2021 ◽

Vol 12 ◽

Author(s):

Piotr Jędrusik ◽

Bartosz Symonides ◽

Jacek Lewandowski ◽

Zbigniew Gaciong

Keyword(s):

Blood Pressure ◽

Antihypertensive Drug ◽

Primary Aldosteronism ◽

Angiotensin Receptor Blockers ◽

Suboptimal Control ◽

Aldosterone Secretion ◽

Antihypertensive Medications ◽

Specific Patient ◽

Drug Classes ◽

Cardiovascular Morbidity And Mortality

Primary aldosteronism (PA) is a potentially curable form of secondary hypertension caused by excessive renin-independent aldosterone secretion, leading to increased target organ damage and cardiovascular morbidity and mortality. The diagnosis of PA requires measuring renin and aldosterone to calculate the aldosterone-to-renin ratio, followed by confirmatory tests to demonstrate renin-independent aldosterone secretion and/or PA subtype differentiation. Various antihypertensive drug classes interfere with the renin-angiotensin-aldosterone axis and hence evaluation for PA should ideally be performed off-drugs. This is, however, often precluded by the risks related to suboptimal control of blood pressure and serum potassium level in the evaluation period. In the present review, we summarized the evidence regarding the effect of various antihypertensive drug classes on biochemical testing for PA, and critically appraised the issue whether and which antihypertensive medications should be withdrawn or, conversely, might be continued in patients evaluated for PA. The least interfering drugs are calcium antagonists, alpha-blockers, hydralazine, and possibly moxonidine. If necessary, the testing may also be attempted during treatment with beta-blockers, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers but renin and aldosterone measurements must be interpreted in the context of known effects of these drugs on these parameters. Views are evolving on the feasibility of testing during treatment with mineralocorticoid receptor antagonists, as these drugs are now increasingly considered acceptable in specific patient subsets, particularly in those with severe hypokalemia and/or poor blood pressure control on alternative treatment.

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P42 24-HOUR CENTRAL BLOOD PRESSURE IS MORE STRONGLY ASSOCIATED TO TARGET ORGAN DAMAGE THAN BRACHIAL BLOOD PRESSURE: FIRST RESULTS OF THE VASOTENS REGISTRY

Artery Research ◽

10.1016/j.artres.2017.10.072 ◽

2017 ◽

Vol 20 (C) ◽

pp. 67

Author(s):

Stefano Omboni ◽

Igor N. Posokhov ◽

Gianfranco Parati ◽

Vitaliy S. Barkan ◽

Ernesto Cardona Muñoz ◽

...

Keyword(s):

Blood Pressure ◽

Target Organ Damage ◽

Organ Damage ◽

Target Organ ◽

Central Blood Pressure ◽

Brachial Blood Pressure ◽

First Results

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Is 24-Hour Central Blood Pressure Superior to 24-Hour Brachial Blood Pressure for Predicting Organ Damage?

Hypertension ◽

10.1161/hypertensionaha.117.10024 ◽

2017 ◽

Vol 70 (6) ◽

pp. 1082-1083 ◽

Cited By ~ 1

Author(s):

Aletta Elisabeth Schutte ◽

Stephane Laurent

Keyword(s):

Blood Pressure ◽

Organ Damage ◽

Central Blood Pressure ◽

Brachial Blood Pressure

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[OP.7D.07] 24-HOUR CENTRAL BLOOD PRESSURE IS BETTER ASSOCIATED WITH TARGET ORGAN DAMAGE OF HYPERTENSION THAN BRACHIAL BLOOD PRESSURE

Journal of Hypertension ◽

10.1097/01.hjh.0000523189.57049.80 ◽

2017 ◽

Vol 35 ◽

pp. e82-e83 ◽

Cited By ~ 1

Author(s):

S. Omboni ◽

I.N. Posokhov ◽

G. Parati ◽

V.S. Barkan ◽

E. Cardona Munoz ◽

...

Keyword(s):

Blood Pressure ◽

Target Organ Damage ◽

Organ Damage ◽

Target Organ ◽

Central Blood Pressure ◽

Brachial Blood Pressure

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Comparison of Brachial Blood Pressure and Central Blood Pressure in Attended, Unattended, and Unattended Standing Situations

Hypertension Research ◽

10.1038/s41440-021-00694-2 ◽

2021 ◽

Author(s):

Hiroyuki Mizuno ◽

Satoshi Hoshide ◽

Yuichiro Yano ◽

Ryoko Nozue ◽

Kazuomi Kario

Keyword(s):

Blood Pressure ◽

Central Blood Pressure ◽

Brachial Blood Pressure

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Antihypertensive drug classes have different effects on short-term blood pressure variability in essential hypertension

Hypertension Research ◽

10.1038/hr.2014.33 ◽

2014 ◽

Vol 37 (6) ◽

pp. 585-590 ◽

Cited By ~ 34

Author(s):

Natacha Levi-Marpillat ◽

Isabelle Macquin-Mavier ◽

Anne-Isabelle Tropeano ◽

Gianfranco Parati ◽

Patrick Maison

Keyword(s):

Blood Pressure ◽

Essential Hypertension ◽

Antihypertensive Drug ◽

Blood Pressure Variability ◽

Short Term ◽

Drug Classes

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The Emergence of Ambulatory Measurement of Arterial Stiffness and Central Blood Pressure. A Promising Novelty of Clinical Importance or Just Another Marker?

The Open Hypertension Journal ◽

10.2174/1876526201305010082 ◽

2013 ◽

Vol 5 (1) ◽

pp. 82-86

Author(s):

A. Lazaridis ◽

E. Gkaliagkousi ◽

M. Doumas ◽

A. Reklou ◽

A. Karagiannis

Keyword(s):

Blood Pressure ◽

Cardiovascular Risk ◽

Arterial Stiffness ◽

Integrated Assessment ◽

Pulse Wave ◽

Clinical Importance ◽

Organ Damage ◽

Brachial Blood Pressure ◽

Ambulatory Measurement ◽

The Everyday

Whereas brachial blood pressure (BP) is still considered the gold standard for the estimation of cardiovascular risk in all clinical trials and guidelines, scientific interest is shifting towards central hemodynamics and the scientific community is experiencing a whole new revolution with the emergence of novel cardiovascular markers such as the ambulatory measurement of central BP and arterial stiffness. Central BP has already started to demonstrate its superiority over peripheral BP as a better and more reliable predictor of end-organ damage in cardiovascular diseases. Furthermore, ambulatory measurement of central BP and pulse wave velocity are expected to add much more useful information towards a more integrated assessment of cardiovascular risk and profile. However, more research is required before these novel markers could be incorporated in the everyday practice of BP measurement.

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SAT-558 A Dedicated Endocrine Hypertension Service Increases the Timely Diagnosis of Primary Aldosteronism

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.1146 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Jun Yang ◽

Yin Y Lim ◽

Renata Libianto ◽

Jimmy Shen ◽

Morag Jennifer Young ◽

...

Keyword(s):

Blood Pressure ◽

Primary Care ◽

Primary Aldosteronism ◽

Pressure Control ◽

Organ Damage ◽

Antihypertensive Medications ◽

Endocrine Hypertension ◽

Treatment Naïve ◽

Hypertension Diagnosis ◽

The Impact

Abstract Background: Primary aldosteronism (PA) accounts for 3.2-12.7% of hypertension in primary care but is often diagnosed late, if at all. A delayed or missed diagnosis leads to poor blood pressure control and greater cardiovascular risk that could be averted with targeted treatment. An Endocrine Hypertension Service (EHS), encompassing an education program, streamlined diagnostic tests and dedicated PA clinic, was developed to address this issue. Aims: To analyse the impact of Victoria’s first dedicated EHS on the pattern of PA diagnoses. Methods: Socio-demographic and clinical data from all patients who attended the EHS since July 2016 (N=267) was collected prospectively. Patients were divided into Year 1 (Y1), Year 2 (Y2), and Year 3 (Y3), based on their first visit. Results: The proportion of referrals from primary care increased (20% in Y1 to 52% in Y3) with more referrals being made for treatment-naive hypertension (3% in Y1 to 19% in Y3). Patients with a hypertension diagnosis of 5 years or less at the time of referral to EHS increased from 34% in Y1 to 45% in Y3 whilst the percentage of patients with a hypertension diagnosis of more than 10 years decreased from 50% in Y1 to 35% in Y3. Consistent with an earlier presentation, the proportion of patients with end-organ damage at the time of referral decreased from 44% in Y1 to 29% in Y3. Almost a third of the PA patients had unilateral disease; all of those who underwent adrenalectomy had biochemical cure. Patients with bilateral PA were treated with spironolactone. Their systolic/diastolic blood pressure decreased by 15/12 mmHg in Y1, 17/13 mmHg in Y2 and 23/11 mmHg in Y3; while the mean number of antihypertensive medications decreased from 2.9 to 1.8 in Y1, 2.7 to 2.0 in Y2 and 2.2 to 1.6 in Y3 Conclusion: The EHS has facilitated an increase in referrals for PA screening from primary care, resulting in the earlier diagnosis of PA, when less complications are present, and optimised patient outcomes. A broader uptake of such a clinical service, integrated with education outreach, will bridge the gap between the reported high prevalence of PA and the actual low diagnostic rates.

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