Role of Pulse Pressure Amplification in Arterial Hypertension

Abstract

Arterial hypertension is a major modifiable cardiovascular (CV) risk factor worldwide based on observational studies of brachial artery blood pressure (BP). In the latest guidelines of the European Society of Hypertension1 for the management of arterial hypertension, aortic stiffness was introduced as an index of target organ damage. Three additional cardinal features of BP were also acknowledged: (1) systolic BP and pulse pressure (PP) may differ between the brachial artery and central arteries (ie, the aorta and its proximal branches), (2) the effects of antihypertensive drug treatment on brachial BP does not invariably reflect those seen on central BP, and (3) central BP is significantly related to CV events. Moreover, the guidelines acknowledged that noninvasive methods exist for the assessment of central hemodynamic parameters, such as central PP, and highlighted the need for large scale interventional studies that will further confirm the prognostic importance of central BP.Two years ago, coincident with the 6th International Workshop on the “Structure and Function of the Vascular System,” in Paris, a consensus document on the role of central BP in arterial hypertension was published.2 It concluded that there is “mounting evidence suggesting that central BP and indices correlate more closely with intermediate markers of CV risk than brachial BP”. It was also suggested that clinicians and researchers need to become familiarized with the disparity between peripheral and central BPs, ie, the phenomenon of pressure wave amplification. The present document is designed to address this need.The left ventricle consumes energy by ejecting blood into the arterial system, thereby creating arterial blood flow and pressure. This phenomenon is easily conceived as a propagating pulse along the arterial bed. In daily clinical practice the arterial pulse, at a distinct site of the arterial tree (eg, at the brachial artery), is quantified as the …