Abstract
The sphygmomanometer is one of the few medical devices that can be truly said to have stood the test of time. This is in part testament to its simplicity and ease of use, but also that 100 years of careful epidemiological observation and large-scale intervention trials have placed the predictive value of brachial blood pressure beyond question. Despite this, over the last 30 years a few visionaries, or ‘heretics’, depending on one’s viewpoint, have fought for greater recognition of the potential clinical importance of aortic (central) pressure. Their rationale stemmed from the observation, first made at the time of invasive cardiac catheterization, that aortic and brachial systolic pressures vary considerably, and, more recently, that surrogate markers of cardiovascular risk are better related to central systolic pressure than the corresponding brachial artery values. Since then, evidence has accrued that central pressure may actually be an independent predictor of future cardiovascular risk, supporting the visionaries. However, central pressure measurement and its use in risk stratification are yet to enter the clinical arena for two main reasons:
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