Central aortic blood pressure and pulse wave velocity as tools in the hemodynamic assessment of hypertension

The effects of age on arteries are associated with stiffening of the artery wall, and this phenomenon is a major determinant of the age-related increase in isolated systolic hypertension. Arterial stiffness affects the speed of the arterial pulse which can be readily measured noninvasively. Alterations in arterial stiffness also affect the relationship between the conventionally measured blood pressure in the brachial artery and the pressure in the central aorta, which characterizes the pressure load on the ejecting ventricle. Central aortic systolic pressure is lower than peripheral systolic pressure and is affected by a range of hemodynamic factors, including heart rate. Devices are now available that can estimate central aortic pressure from the calibrated peripheral pulse waveform. Studies have shown that arterial stiffness, as measured by pulse wave velocity, and central aortic pressure can enhance the characterization of cardiovascular risk beyond the conventional measurement of brachial blood pressure. Although measurements of central aortic pressure and pulse wave velocity have provided a wealth of research and epidemiological data, there has been limited entry of these techniques in the routine clinical setting as well as in guidelines for treatment and management of hypertension. This review will address the current evidence of the use of central aortic pressure and pulse wave velocity for assessment of hypertension as a major cardiovascular risk.