Cheng Hao-Min, Park Sungha, Huang Qifang, Hoshide Satoshi, Wang Ji-Guang, Kario Kazuomi, Park Chang-Gyu, Chen Chen-Huan
Department of Medical Education, Taipei Veterans General Hospital, Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
Division of Cardiology, Cardiovascular Hospital, Yonsei Health System, Seoul, South Korea.
Int J Cardiol. 2017 Mar 1;230:209-213. doi: 10.1016/j.ijcard.2016.12.170. Epub 2016 Dec 27.
Vascular aging may be responsible for the high residual lifetime risk for hypertension in the middle-aged and elderly individuals. Increased arterial stiffness and wave reflection has been recognized as the dominant hemodynamic manifestations of vascular aging, and both are major determinants of central blood pressure (BP) and independent predictors for incident hypertension. Because central BP is strongly linearly associated with age, it can be regarded as an integrated marker for vascular aging. Central BP can be measured noninvasively using various techniques, including the convenient cuff-based oscillometric central BP monitors. Noninvasive central BP is likely better than the conventional brachial BP in association with target organ damages and long term cardiovascular outcomes. Based on the analysis of the long-term events of derivation and validation cohorts, the central BP threshold of 130/90mmHg for defining hypertension has been proposed. Recent studies suggest that the central BP strategy for confirming a diagnosis of hypertension may be more cost-effective than the conventional brachial BP strategy, and guidance of hypertension management with central BP may result in less use of medications to achieve BP control. Vascular aging-related hypertension is expected to become the dominant phenotype in many countries, especially in the Asian regions. Although noninvasive measurement of brachial BP is inaccurate and central BP has been shown to carry superior prognostic value beyond brachial BP, the use of central BP should be justified by studies comparing central blood pressure-guided therapeutic strategies with classic guidelines-guided strategies for preventing cardiovascular events. Future randomized control trials are required to support that the diagnosis and monitoring of vascular aging-related hypertension is best managed with the central BP strategy.
血管老化可能是导致中老年人高血压终生残留风险较高的原因。动脉僵硬度增加和波反射已被公认为血管老化的主要血流动力学表现，二者均是中心血压（BP）的主要决定因素以及高血压发病的独立预测指标。由于中心血压与年龄呈强线性相关，因此可将其视为血管老化的综合标志物。中心血压可通过多种技术进行无创测量，包括便捷的基于袖带的示波法中心血压监测仪。在与靶器官损害及长期心血管结局的关联方面，无创中心血压可能优于传统肱动脉血压。基于对推导队列和验证队列长期事件的分析，已提出将130/90mmHg作为定义高血压的中心血压阈值。近期研究表明，用于确诊高血压的中心血压策略可能比传统肱动脉血压策略更具成本效益，且以中心血压指导高血压管理可能会减少药物使用以实现血压控制。血管老化相关的高血压预计将在许多国家，尤其是亚洲地区成为主要的表型。尽管肱动脉血压的无创测量不准确，且已证明中心血压比肱动脉血压具有更高的预后价值，但中心血压的应用应通过比较中心血压指导的治疗策略与经典指南指导的预防心血管事件策略的研究来证明其合理性。未来需要进行随机对照试验，以支持血管老化相关高血压的诊断和监测采用中心血压策略最为适宜。
