Central Blood Pressure: Part 1, Pathophysiology
“Central arterial blood pressure” is the term commonly used to describe blood pressure in the ascending aorta, on leaving the left ventricle.
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Central Blood Pressure: Part 1, Pathophysiology
“Central arterial blood pressure” is the term commonly used to describe blood pressure in the ascending aorta, on leaving the left ventricle. At the beginning of the new millennium, some studies had already pointed out the importance of central systolic blood pressure and of central pulse pressure (central systolic blood pressure—diastolic blood pressure) as cardiovascular prognostic factors, much more significant than peripheral blood pressure values measured in the brachial artery by means of traditional sphygmomanometers. However, it was only after the Conduit Artery Functional Evaluation (CAFE) study published its outcomes that central systolic blood pressure started to be in the spotlight. The Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) had stressed a greater reduction in cardiovascular events in patients treated with calcium channel blockers (amlodipine) compared with patients treated with β-blocker (atenolol), without any difference being noted in the reduction of brachial systolic blood pressure values between the groups treated. The CAFE study, a branch of the ASCOT study, supplied reasonable arguments to explain this more marked reduction in cardiovascular events in subjects treated with vasodilators (Fig. 4.1) [1]. More than 2000 subjects, taking part in the ASCOT study, were measured for central blood pressure. The CAFE study showed that the decrease in central systolic blood pressure and in central pulse pressure was greater in subjects taking some vasodilators with respect to those treated with non-vasodilator drugs (diuretic or β-blocker), despite similar brachial systolic blood pressures (Fig. 4.1). On the basis of the same brachial blood pressure, in the group treated with amlodipine, central systolic blood pressure was much lower compared with the group treated with atenolol. Therefore, the authors concluded that the greater reduction in cardiovascular events in the group treated with vasodilators could be caused by a greater effect of these drugs in lowering central systolic blood pressure, with respect to β-blockers. In conclusion, it is reasonable to infer, from the outcomes of the CAFE study, that peripheral blood pressure is not always the best method to assess the effects of drugs on blood pressure and that central systolic blood pressure and # Springer International Publishing 2017 P. Salvi, Pulse Waves, DOI 10.1007/978-3-319-40501-8_4
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Central Blood Pressure: Part 1, Pathophysiology
1031 patients treated with atenolol ± thiazide 1042 patients treated with amlodipine ± perindopril
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Fig. 4.1 Outcomes of the CAFE study [1]. The two upper lines refer to systolic blood pressure values recorded in the brachial artery; the two lower lines refer to central systolic blood pressure values
central pulse pressure are able to evaluate the real load imposed on the left ventricle much better than peripheral systolic blood pressure and peripheral pulse
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