دانلود رایگان مقاله استفاده از فشار مرکزی در عمل بالینی

Abstract

The original purpose for recording brachial blood pressure (BP) more than 100 years ago was to estimate central (aortic) BP. While high brachial BP is an important cardiovascular risk factor, it is clear that major differences in central systolic BP (SBP; e.g. >30 mmHg) can occur among people with similar brachial SBP. It is also proven that central SBP responses to antihypertensive therapy can differ substantially from brachial SBP responses, such that true treatment effects cannot be gauged from conventional brachial BP. Importantly, assessment of central BP results in: 1) improved predictive accuracy of future cardiovascular events beyond brachial BP and other cardiovascular risk factors; 2) superior diagnostic accuracy over brachial BP and; 3) different patient management than usual care guided by brachial BP. Collectively, the above illustrates that central BP is a better cardiovascular risk biomarker than brachial BP. As with all medical advances there are areas of research need and international consensus is required on issues such as standardization of techniques. However, central BP can now be accurately estimated (with appropriate waveform calibration) using brachial cuff methods in an approach that is familiar to clinicians, acceptable to patients and amenable to widespread use. In other words, this modern BP technique can finally satisfy the original purpose for measuring central aortic BP as intended more than 100 years ago. Although the tipping point towards routine use is yet to be reached, the body of evidence continues to favour the view that central BP should be used in clinical practice.

Conclusions

More than one century ago the original invention to noninvasively measure brachial BP had the main goal of obtaining a clinically meaningful value that represented the pressure loading within the aorta (now commonly referred to as central BP). This important advancement opened the way for widespread use and elaborated understanding on the relation between BP and CV risk. Yet in recent decades, unassailable evidence has shown that the brachial BP method does not necessarily produce BP values that are representative of the true underlying central BP. Development of non-invasive methods to more accurately estimate central BP (and other indices from waveform analysis) has led to a consistent and growing volume of data indicating that central BP is a stronger CV risk determinant than brachial BP, and there is nothing to suggest a risk for harm (only advantage) by using central BP in clinical practice. The identification of some methodological and technical issues could jeopardise progression of the discipline and underscores the imperative for international collaboration to provide guidance. Altogether, it is clear that central BP techniques will help refine clinical decision making for doctors and enhance patient care above and beyond conventional brachial BP.