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(Hypertension. 2008;51:819.)
© 2008 American Heart Association, Inc.

Editorial Commentaries

Central Blood Pressure and Hypertension

Michel E. Safar; Harold Smulyan

From the Paris Descartes University (M.E.S.), Hospital Hotel-Dieu, Diagnosis Center, Paris, France; and the Upstate Medical University (H.S.), State University of New York, Syracuse.

Correspondence to Prof Michel Safar, Diagnosis Center, Hotel-Dieu, 1, Place du parvis Notre-Dame, 75181 Paris Cedex 04, France. E-mail michel.safar@htd.aphp.fr

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

During the 20th century, the brachial artery auscultatory method of blood pressure (BP) measurement has been the major basis for our understanding of clinical hypertension. First, the height of systolic (S) and diastolic (D) BP was used to define cardiovascular (CV) risk. Second, BP reduction by drug treatment was shown to be associated with a substantial decrease of CV risk in several varieties of high BP, including systolic hypertension in the elderly.^1,2 However, drug treatment often reduced DBP more than SBP, resulting in increased pulse pressures (PP) and the related arterial stiffness. An associated increase in coronary risk was also observed.^1,3 Because PP and arterial stiffness did not respond readily to drug treatment and was made even less responsive by aging, it has been suggested and shown that mechanical factors such as PP, arterial stiffness, and wave reflections, preferably measured by central (aortic or carotid) BP, should be fully investigated. Because the majority of the studies used noninvasive peripheral BPs the need arose for invasive methods to verify and validate central BP measurement in the evaluation of CV risk.⁴

In the present issue of this journal, Jankowski et al⁵ established, in a 4.5-year follow-up of 1109 patients undergoing coronary angiography, that central BP was a significant and independent predictor of CV risk, as potent as cardiac ejection fraction and more powerful than brachial sphygmomanometric measurements. For these coronary patients, the pulsatile component of BP was the most important factor for CV risk prediction and was more closely related to CV . . . [Full Text of this Article]

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Pulsatile but Not Steady Component of Blood Pressure Predicts Cardiovascular Events in Coronary Patients

Piotr Jankowski, Kalina Kawecka-Jaszcz, Danuta Czarnecka, Malgorzata Brzozowska-Kiszka, Katarzyna Styczkiewicz, Magdalena Loster, Malgorzata Kloch-Badelek, Jerzy Wilinski, Adam M. Curylo, Dariusz Dudek on behalf of the Aortic Blood Pressure and Survival Study Group
Hypertension 2008 51: 848-855. [Abstract] [Full Text] [PDF]