Central arterial pressure: a necessary parameter for assessment of cardiovascular risk and efficacy of antihypertensive therapy?

Most of large controlled randomized trials have not revealed superiority of "new" over "old" anti hypertensive drugs and posed a question of value of surrogate criteria for comparison of various treatment regimes. Data of ASCOT-CAFE trials allow to assume that estimation of central blood pressure (BP) opens novel perspectives in this direction. Most affordable methods of noninvasive measurement of central BP are radial artery applanation tonometry with subsequent computer transformation of peripheral to central pulse wave, and carotid artery applanation tonometry. Contrary to peripheral BP central BP level is modulated by elastic properties of major arteries and structural-functional state of medium caliber arteries and microcirculatory vascular bed, and thus is an index indirectly reflecting the state of the whole cardiovascular bed. Differences between central and peripheral BP levels are most clearly expressed in young age and diminish in the elderly. Effects of anti hypertensive drugs on central BP may vary at the account of difference of points of application of their effects in vascular bed. Prognostic and clinical value of the central BP requires further investigation.