Journal
AMERICAN JOURNAL OF HYPERTENSION
Volume 27, Issue 12, Pages 1433-1442Publisher
OXFORD UNIV PRESS
DOI: 10.1093/ajh/hpu135
Keywords
augmentation index; blood pressure; blood pressure measurement; blood pressure variability; central blood pressure; hypertension; measurement error; pulse pressure; pulse pressure amplification; systolic blood pressure
Categories
Funding
- Research for Health in Erie County Foundation
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This critique is intended to provide background for the reader to evaluate the relative clinical utilities of brachial cuff systolic blood pressure (SBP) and its derivatives, including pulse pressure, central systolic pressure, central augmentation index (AI), and pulse pressure amplification (PPA). The critical question is whether the newer indicators add sufficient information to justify replacing or augmenting brachial cuff blood pressure (BP) data in research and patient care. Historical context, pathophysiology of variations in pulse wave transmission and reflection, issues related to measurement and model errors, statistical limitations, and clinical correlations are presented, along with new comparative data. Based on this overview, there is no compelling scientific or practical reason to replace cuff SBP with any of the newer indicators in the vast majority of clinical situations. Supplemental value for central SBP may exist in defining patients with exaggerated PPA (spurious systolic hypertension), managing cardiac and aortic diseases, and in studies of cardiovascular drugs, but there are no current standards for these possibilities.
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