CHL 01-2 CENTRAL HYPERTENSION

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Abstract

Blood pressure (BP) is conventionally measured with a pressure cuff over an upper arm and a cutoff of 140/90 mmHg in the office is the current criteria for diagnosing hypertension. Recently, out of office BP has been suggested as the reference standard for the management of hypertension, due to its better prognostic value over office BP.

However, the above BP parameters are all measured at brachial arteries and may be different from the central blood pressure (CBP) measured in the ascending aorta or carotid arteries. The individual discrepancies between CBP and peripheral BP may be substantial and highly variable, and may magnify during hemodynamic changes or after pharmacological interventions. Growing evidence suggests that central BP may be more relevant than peripheral BP in predicting target organ damage and cardiovascular outcomes, central and peripheral BP may respond differently to antihypertensive medication in randomized controlled trials, and end-organ changes after antihypertensive medication are more strongly related to changes in central BP than peripheral BP.

Currently,_ENREF_2_ENREF_5 non-invasive CBP can be obtained with either tonometry-based or cuff-based techniques. Using an outcome-driven approach to examine the discriminatory ability of CBP for long-term cardiovascular outcomes, an operational threshold for CBP has been derived and validated in two independent Taiwanese cohorts. A CBP cutoff, 130/90 mmHg, was characterized by a greater discriminatory power for long-term events, and can be considered to be implemented for the management of hypertension in routine daily clinical practice. CBP may have greater sensitivity and negative predictive value than peripheral BP in the diagnosis of hypertension. In the recently updated hypertension management guidelines, we have made a Level IIb recommendation that Measurement of CBP with a cutoff of 130/90 mmHg is recommended when a diagnosis of hypertension is clinically suspected but cannot be established by current conventional BP criteria. The new recommendation is expected to increase the detection rate of hypertension and decrease the cardiovascular risk associated with hypertension.

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