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(Hypertension. 2007;50:154.)
© 2007 American Heart Association, Inc.

Sixth International Workshop on Structure and Function of the Vascular System

Central Blood Pressure Measurements and Antihypertensive Therapy

A Consensus Document

Enrico Agabiti-Rosei; Giuseppe Mancia; Michael F. O’Rourke; Mary J. Roman; Michel E. Safar; Harold Smulyan; Ji-Guang Wang; Ian B. Wilkinson; Bryan Williams; Charalambos Vlachopoulos

From the Clinica Medica and Department of Medicine (E.A-R.), University Hospital, Brescia, Italy; Clinica Medica and Department of Medicine (G.M.), University of Milano-Bicocca, St Gerardo Hospital, Monza, Milan, Italy; St Vincent’s Clinic/University of New South Wales (M.F.O.), Darlinghurst, Australia; Weill Medical College (M.J.R.), Cornell University, Ithaca, NY; Centre de Diagnostic (M.E.S.), Hopital Hotel-Dieu, Paris, France; Department of Medicine (H.S.), Upstate Medical University, Syracuse, NY; Centre for Epidemiological Studies and Clinical Trials (J.G.W.), Ruijin Hospital Shanghai Jiaotong, University School of Medicine, Shanghai, China; University of Cambridge Addenbrooke’s Hospital (I.B.W.), Cambridge, United Kingdom; the Department of Cardiovascular Sciences (B.W.), School of Medicine, University of Leicester, Leicester, United Kingdom; and the First Department of Cardiology (C.V.), Athens Medical School, Hippokration Hospital, Athens, Greece.

Correspondence to Charalambos Vlachopoulos, Kerassoundos 17, Athens 11528, Greece. E-mail cvlachop@otenet.gr

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

	Introduction

 
The 2003 European Society of Hypertension/European Society of Cardiology guidelines for the management of arterial hypertension¹ included 2 important novel recommendations: assessment of the total cardiovascular risk should be taken into account in the management of the hypertensive patient, and quantification of risk should include subclinical target organ damage.

These guidelines acknowledged that central (aortic) blood pressure (BP), which is the pressure exerted on the heart and brain, may be different from the pressure that is measured at the arm. They also recognized that central pressure may be predictive of outcome in specific populations² and differently affected by antihypertensive drugs. However, although these guidelines accepted that central augmentation index and pulse wave velocity may be important as measures of subclinical organ damage, they also stressed the need for prospective trials to establish their predictive values given that such studies were lacking at that time (2003).

After publication of these guidelines, additional data have strengthened the pathophysiological importance of central BP. Clinical studies have indicated that central BP may have predictive value independent of the corresponding peripheral (brachial) BP. More importantly, recent large-scale trials have shown that central hemodynamics may provide a worthwhile treatment target. In addition, central hemodynamics can now be reliably assessed noninvasively with a number of devices. Accordingly, because arterial stiffening and central hemodynamics are markers and manifestations of organ damage, the pertinent key question is whether the balance of evidence on their importance and issues related to clinical practice allows for implementation in patient management.

	Pathophysiological Significance of Central Pressures

 
Central (aortic . . . [Full Text of this Article]

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