Central blood pressure and its amplification: a final breakthrough or do we need more?

Blood pressure is one of the cardinal risk factors for atherosclerosis and cardiovascular diseases. Systolic and diastolic blood pressures are measured at the level of the brachial artery, positioned at a midthoracic level with an adequately sized cuff and bladder. Treatment of arterial hypertension with lifestyle and drugs has become one of the cornerstones of contemporary cardiology. Subjects and patients should all have office blood pressures ,140/90 mmHg. Office blood pressure measurements have to be complemented by out-of-office measurements in order to rely on frequent rather than punctual measurements.1 These non-invasive cuff brachial pressures underestimate invasively measured blood pressures,2 but nevertheless are the firm ground of evidence-based medicine, while invasive pressures are not. During the last decades,we have witnessed important research on properties of the arterial tree and on distortion of the pressurewaveform from the central aorta to the brachial and radial artery. This distortion was attributed to wave travel and wave reflection.3 This explains why the radial pressure wave is much more peaked than the central aortic or carotid pressure wave, and has a higher systolic pressure. Overall, the minimum (diastolic) and mean blood pressure values change little from one location to the other. On this physiological basis, researchers compute central-to-peripheral pressure amplification and central systolic pressure.

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