Central haemodynamics and clinical outcomes: going beyond brachial blood pressure?

This editorial refers to ‘Prediction of cardiovascular events and all-cause mortality with central haemodynamics: a systematic review and meta-analysis’, by C. Vlachopoulos et al. doi: 10. 1093/eurheartj/ehq024 It is remarkable that despite considerable advances in methods and technologies to assess the function and integrity of the cardiovascular (CV) system, the technique for measuring blood pressure (BP) has changed little over 100 years. We still rely on routine brachial BP recordings via sphygmomanometry for much of our clinical decision making with regard to circulatory pressures. There is good reason for this—the measurement of brachial BP has stood the test of time as a robust predictor of CV risk and the benefits of treatment. Moreover, the recording of brachial BP is a familiar and relatively simple procedure, albeit often performed badly. It is noteworthy that before blood pressure was ever routinely measured, in the 19th century the sphygmograph was used non-invasively to record the characteristics of the arterial pulse wave to gain information about the health of the circulation. 1 There has been much recent interest in pulse wave analysis, reinvigorating the concept of ‘pulsology’ in an endeavour to go beyond conventional BP measurement in the assessment of arterial disease and central aortic pressures and haemodynamics. The word ‘central’ in this context is used to emphasize the estimation of aortic root pressures and haemodynamic indices as opposed to ‘peripheral’, i. e. brachial, pressures. This is important because brachial pressures are not always a perfect surrogate for central aortic pressures because of a variable degree of amplification of the pulse pressure wave from the aortic root to the peripheral circulation. This amplification process can be profoundly influenced by many factors, including the effects of ageing and disease on aortic stiffness, heart rate, height, gender, and, importantly, drug therapies. 2 This has led to the hypothesis that … *Corresponding author. Tel: +44 (0) 116 252 3182, Fax: +44 (0) 116 252 5847, Email: bw17atle. ac. uk