Aortic pressure

Central aortic pressure (CAP), central aortic blood pressure (CABP), or central aortic systolic pressure (CASP) is the blood pressure at the root of aorta. Studies have shown the importance of central aortic pressure, especially as compared to peripheral blood pressure, and its implications in assessing the efficacy of antihypertensive treatment with respect to cardiovascular risk factors, kidney disease, and mortality.^[1] There is an emerging movement for clinicians to begin using central aortic blood pressure, instead of peripheral blood pressure, as a guide for clinical decisions.^[2][3][4]

Measurement

In the past, central aortic blood pressure could only be measured by invasive means, such as heart catheterization, but there now exist, or are in late stages of development, noninvasive methods of accurately measuring it indirectly.^[5][6][7]

Relationship to disease

Elevated central aortic blood pressure has generally been found to be a greater predictor of cardiovascular disease-related mortality, structural changes in the heart, and chronic kidney disease than elevated peripheral blood pressure (such as measured in the brachial artery, the main artery in the upper arm where blood pressure is most commonly measured).^[3][1][2]

Different medications for lowering blood pressure have different effects on the central aortic pressure and blood flow characteristics, despite producing similar peripheral blood pressure readings. The traditional method of measuring blood pressure in peripheral arteries, such as the brachial artery (the main artery in the upper arm) has been shown to underestimate the efficacy of medications such as amlodipine (a calcium channel blocker) and overestimate the efficacy of those like atenolol (a beta blocker).^[2][8]

Central aortic blood pressure is a better independent predictor of negative cardiovascular (such as heart attack or stroke) and kidney (such as chronic kidney disease) outcomes than is peripheral blood pressure.^[2][8][9]

References

1. Avolio, Alberto (2008). "Central Aortic Blood Pressure and Cardiovascular Risk: A Paradigm Shift?". Hypertension. 51 (6): 1470–1471. doi:10.1161/HYPERTENSIONAHA.107.108910. ISSN 0194-911X.
2. McEniery, Carmel M.; Cockcroft, John R.; Roman, Mary J.; Franklin, Stanley S.; Wilkinson, Ian B. (23 Jan 2014). "Central blood pressure: current evidence and clinical importance". European Heart Journal. 35 (26). Oxford University Press (OUP): 1719–1725. doi:10.1093/eurheartj/eht565. ISSN 1522-9645. PMC 4155427.
3. Kesten, Steven; Qasem, Ahmad; Avolio, Alberto (2022-10-20). "Viewpoint: The Case for Non-Invasive Central Aortic Pressure Monitoring in the Management of Hypertension". Artery Research. 28 (4): 128–139. doi:10.1007/s44200-022-00023-z. ISSN 1876-4401.
4. Middeke, Martin (2017). "Zentraler aortaler Blutdruck: Bedeutender Parameter für Diagnostik und Therapie". Deutsche Medizinische Wochenschrift (in German). 142 (19). Georg Thieme Verlag KG: 1430–1436. doi:10.1055/s-0043-113212. ISSN 0012-0472.
5. O’Rourke, Michael F.; Adji, Audrey (15 Nov 2011). "Noninvasive Studies of Central Aortic Pressure". Current Hypertension Reports. 14 (1). Springer Science and Business Media LLC: 8–20. doi:10.1007/s11906-011-0236-5. ISSN 1522-6417.
6. Liu, Wenyan; Du, Shuo; Zhou, Shuran; Mei, Tiemin; Zhang, Yuelan; Sun, Guozhe; Song, Shuang; Xu, Lisheng; Yao, Yudong; Greenwald, Stephen E. (2022). "Noninvasive estimation of aortic pressure waveform based on simplified Kalman filter and dual peripheral artery pressure waveforms" (PDF). Computer Methods and Programs in Biomedicine. 219. Elsevier BV: 106760. doi:10.1016/j.cmpb.2022.106760. ISSN 0169-2607.
7. Mariscal-Harana, Jorge; Charlton, Peter H.; Vennin, Samuel; Aramburu, Jorge; Florkow, Mateusz Cezary; van Engelen, Arna; Schneider, Torben; de Bliek, Hubrecht; Ruijsink, Bram; Valverde, Israel; Beerbaum, Philipp; Grotenhuis, Heynric; Charakida, Marietta; Chowienczyk, Phil; Sherwin, Spencer J.; Alastruey, Jordi (1 Feb 2021). "Estimating central blood pressure from aortic flow: development and assessment of algorithms". American Journal of Physiology. Heart and Circulatory Physiology. 320 (2). American Physiological Society: H494–H510. doi:10.1152/ajpheart.00241.2020. hdl:10261/265391. ISSN 0363-6135.
8. Williams B, Lacy PS, Thom SM, et al. (March 2006). "Differential impact of blood pressure-lowering drugs on central aortic pressure and clinical outcomes: principal results of the Conduit Artery Function Evaluation (CAFE) study". Circulation. 113 (9): 1213–25. doi:10.1161/CIRCULATIONAHA.105.595496. PMID 16476843.
9. "Benefits of Older Blood Pressure Drugs May be Overestimated While Benefits of Newer Drugs are Underestimated". University of Leicester (Press release). 2006.

Further reading

• CAFE - The Conduit Artery Functional Endpoint Study
• Lehmann ED (February 2001). "Where is the evidence that radial artery tonometry can be used with a generalised transfer function to accurately and non-invasively predict central aortic blood pressure?". Journal of Human Hypertension. 15 (2): 145–6. doi:10.1038/sj.jhh.1001126. PMID 11317196.
• Williams B, Lacy PS, Thom SM, et al. (March 2006). "Differential impact of blood pressure-lowering drugs on central aortic pressure and clinical outcomes: principal results of the Conduit Artery Function Evaluation (CAFE) study". Circulation. 113 (9): 1213–25. doi:10.1161/CIRCULATIONAHA.105.595496. PMID 16476843.
• Roman MJ, Devereux RB, Kizer JR, et al. (July 2007). "Central pressure more strongly relates to vascular disease and outcome than does brachial pressure: the Strong Heart Study". Hypertension. 50 (1): 197–203. CiteSeerX 10.1.1.486.1588. doi:10.1161/HYPERTENSIONAHA.107.089078. PMID 17485598.
• McGhee BH, Bridges EJ (April 2002). "Monitoring arterial blood pressure: what you may not know". Critical Care Nurse. 22 (2): 60–4, 66–70, 73 passim. PMID 11961944.