Central blood pressure: A new vital sign?

72-9312/$e seefrontmattera2009A i:10.1016/j.artres.2009.10.179 The ongoing development of non-invasive technology to perform sophisticated pulse wave analysis and accurately determine central blood pressure has facilitated study of central blood pressure as a physiologic parameter or biomarker. It is now possible to systematically compare the magnitude of differences in central and brachial systolic and pulse pressures. Furthermore, the relative importance of central and brachial pressures in relation to both subclinical and clinical cardiovascular disease can now be assessed. Central systolic and pulse pressures are systematically lower than their brachial counterparts due to pulse wave amplification. The major determinants of central systolic pressure include wave reflections, vascular stiffness, left ventricular contractility and heart rate. In theory, central pressure should provide a more accurate representation of the load imposed on the left ventricle and coronary and cerebral vasculature than brachial pressure due to its closer proximity. Arterial stiffening will result in higher central systolic pressure and thereby impose a greater afterload on the left ventricle whereas associated lower diastolic pressure may reduce coronary perfusion pressure. This article