ABSTRACT
The gold standard for measuring blood pressure (BP) and diagnosing hypertension is the brachial cuff, thus favoring a distal site accessible to noninvasive measurement. However, two concepts have gained an important audience these past years: pressure amplification between central and peripheral arteries and higher damaging effect of local BP than brachial BP on target organs in hypertensive patients. An increasing number of physiological studies, as well as pathophysiological, epidemiological, and pharmacological studies, have underlined the importance of measuring not only brachial systolic pressure and pulse pressure (PP) but also central systolic pressure and PP. The aims of this chapter are (i) to detail the hemodynamic characteristics of the arterial circulation to explain why it is important to measure central BP, (ii) to describe the various noninvasive methods currently available to measure central BP, (iii) to discuss the concepts of intermediate and surrogate end points to determine if they are applicable to central BP, and (iv) to describe how drugs can reduce abnormally high central BP.
