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(Hypertension. 2008;51:37.)
© 2008 American Heart Association, Inc.

Editorial Commentaries

Peripheral Augmentation Index

Shouldering the Central Pressure Load

Rupert A. Payne; David J. Webb

From the Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom.

Correspondence to David J. Webb, Centre for Cardiovascular Science, University of Edinburgh, Queen’s Medical Research Institute, 47 Little France Crescent, Edinburgh, EH16 4TJ, United Kingdom. E-mail d.j.webb@ed.ac.uk

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Peripheral blood pressure (BP) measurement has remained essentially unchanged over the last century, and many researchers believe that changes in such measurements fully account for the benefits of antihypertensive treatment in clinical trials.¹ Indeed, the wealth of data supporting a strong association between cuff measurements and adverse cardiovascular outcome may well have hindered the quest for alternative, and indeed potentially better, measures of arterial pressure. Over the last few years, however, advances in technology have enabled the routine assessment of BP in previously inaccessible central arteries. Central BP is not the same as peripheral BP. After cardiac contraction, a pressure wave propagates distally through the arterial tree. At points of impedance mismatch (arterial branch points), the wave is reflected, interacting with the incident wave and determining the overall measured pressure. The velocity and magnitude of the incident and reflected waves, and, hence, the nature of this interaction at different anatomic sites, are affected by various factors, including mean distending pressure, the intrinsic properties of the arterial wall, arterial path length, and the degree of impedance mismatch. From the pathophysiological perspective, central BP is likely to be more relevant than peripheral BP to the risk of left ventricular hypertrophy, heart failure, myocardial infarction, and stroke. Proximal aortic pressure determines left ventricular work and influences myocardial perfusion during diastole. Furthermore, degenerative changes characteristic of hypertension are observed in the wall of the large elastic arteries rather than in peripheral conduit vessels. There is increasing evidence that central pressure may be a stronger . . . [Full Text of this Article]

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				A. D. Hughes, J. E. Davies, D. Francis, J. Mayet, and K. H. Parker Peripheral Augmentation Index and Wave Reflection in the Radial Artery Hypertension, June 1, 2008; 51(6): e45 - e46. [Full Text] [PDF]