Published online before print April 30, 2007, doi: 10.1161/HYPERTENSIONAHA.107.089953
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(Hypertension. 2007;49:1210.)
© 2007 American Heart Association, Inc.
Editorial Commentaries |
Pulsology Reloaded
Commentary on Similar Effects of Treatment on Central and Brachial Blood Pressure in Older Hypertensive Subjects
From the Department of Clinical and Experimental Medicine (V.P.), "Federico II" University Hospital, Naples, Italy; and the Department of Critical Care Medicine and Surgery (R.P., M.C.C.), University of Florence and Azienda Ospedaliero-Universitaria "Careggi," Florence, Italy.
Correspondence to Vittorio Palmieri, Department of Clinical and Experimental Medicine, "Federico II" University Hospital, via Pansini 5, Edificio 1A, Naples, 80131, Italy. E-mail vpalmier@med.cornell.edu
An extract of the first 250 words of the full text is provided, because this article has no abstract. |
The Losartan Intervention For Endpoint reduction in hypertension (LIFE) Study,1 the Second Australian National Blood Pressure Trial (ANBP2),2 and the Anglo-Scandinavian Cardiovascular Outcome Trials3 have shown that different antihypertensive treatments may have different impacts on the rate of events in hypertension while achieving comparable brachial blood pressure (BP) reduction. Thus, although brachial BP estimation by classic Riva–Rocci cuff sphygmomanometer and the Korotkoff auscultatory technique have provided almost all of our knowledge on epidemiology, prognosis, and treatment of hypertension,4,5 recent trials1–3 are revealing intrinsic limitations of the conventional approach, because the real goal of treatment in hypertension is the reduction in the number and the rate of untoward events.
More recently, the Conduit Artery Function Evaluation (CAFE) Study6 described higher central BP as a key factor explaining the greater number and rate of events with atenolol than with amlodipine plus perindopril. Central pressure waveform and BP values can be estimated by applanation tonometry, a method supported by solid theoretical principles and modeling studies in experimental settings.7 Analysis of the systolic portion of the carotid pressure waveform allows for obtaining indices of the arterial viscous-elastic properties that correlate with end-organ damage and clinical outcomes in hypertension.8 Therefore, the indices of arterial waveform reflection and mechanics and central BP assessed by applanation tonometry have the potential to add significant information for risk stratification beyond and above brachial BP. In fact, the conclusions of the CAFE Study were well received.9 In addition, applanation tonometry has also been associated with 2D-guided M-mode vascular ultrasonography to
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