Is 24-Hour Central Blood Pressure Superior to 24-Hour Brachial Blood Pressure for Predicting Organ Damage?

Abstract

See related article, pp 1157–1164 For over a century, office brachial blood pressure (BP) measurements have formed the cornerstone of clinical practice—which is still the case in most parts of the world. In the hands of healthcare practitioners, office systolic blood pressure (SBP) measured at the brachial artery (bOSBP) remains the most widely used and best predictor of cardiovascular outcome.1,2 However, in recent decades, the pros of conventional BP measurement—being ease of use, low cost, and noninvasiveness—have been challenged by its cons. The introduction of 24-hour ambulatory BP measurements highlighted the weaknesses of conventional measurements to overcome observer measurement errors, and the inability to detect white-coat and masked hypertension. More importantly, 24-hour ambulatory brachial systolic blood pressure (bASBP) was shown to be superior to bOSBP in predicting preclinical damage3 and cardiovascular outcome.4 Another advancement in understanding cardiovascular risk represented by BP was the acknowledgment that SBP differs throughout the arterial tree, with higher pressures in the periphery (brachial) than central (aortic) arteries. With technological developments, it is also possible to measure central pressure noninvasively and accurately, albeit not cheaply, and to determine normal …