This document discusses pulse wave analysis and central blood pressure. It explains that pulse wave velocity analysis can provide information about arterial stiffness and wave reflections that influence central blood pressure, which may be a better indicator of cardiovascular risk than brachial blood pressure. A study at Bahrain Specialist Hospital found that central systolic blood pressure was significantly lower than brachial systolic pressure, with a lower central pulse pressure, indicating increased pulse pressure amplification. Central blood pressure and measures of arterial stiffness like augmentation pressure were more strongly correlated with age and showed the effects of antihypertensive drugs better than brachial pressure measurements.
18. 20
Key Central pressure parameters.
S P
AP
PP
DP
Systolic pressure (SP)
Diastolic pressure (DP)
Central Pulse Pressure (PP)
Augmented pressure (AP)
“measure of the energy “wasted”
by the heart due to the reflected
wave”
AIx (= AP/PP)
“composite measure of the
magnitude of wave reflection and
arterial stiffness”
26. Central Pressure shows the effects of Drug therapy masked by
31
In the CAFE study of over 2,000
patients, brachial blood
pressure was controlled in both
study arms
But the ACE/ CCB arm had up
lower central BP and 30% less
CV events than the beta blocker
arm.
Augmented Pressure was
reduced by the ACE/ CCB but
not by the beta blocker.
Brachial pressure does not
measure arterial stiffness
Brachial Pressure
Williams B et al., Circulation 2006; 113: 1213-25
40. BSH study on PWA and Central BP
Pressure Brachial (SE) Central (SE) p
Systolic 136 (1.2) 121.8(1.10 <0.0001
Diastolic 83(0.8) 84(0.8) < 0.0001
MAP 100.9 (0.8) 100(0.9) < 0.0001
Pulse pressure 52.7(1) 37.2(0.8) <0.0001