Borghi C, Acelajado M C, Gupta Y, Jain S
Cattedra di Medicina Interna, Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Ospedale Policlinico, S.Orsola-Malpighi, Via Albertoni 15, Bologna, Italy.
College of Medicine, University of South Alabama, Mobile, AL, USA.
J Hum Hypertens. 2017 Oct;31(10):605-610. doi: 10.1038/jhh.2017.26. Epub 2017 Apr 6.
Measurement of blood pressure (BP) using a brachial cuff sphygmomanometer is universally accepted for the diagnosis of hypertension and prediction of cardiovascular diseases. However, brachial systolic BP does not represent actual systolic BP in the central arteries which encounter cardiac load directly. Due to wave amplification from central to peripheral arteries, a significant difference exists between the two. Central BP measurements also account for arterial stiffness, vessel branching and vascular mechanics, unlike brachial BP. Emerging data suggests that hypertension can be diagnosed more accurately by central pressure indices as compared to brachial BP. Various non-invasive techniques are now available to measure central BP indices owing to recent technological advances. Recently, it has been reported that different classes of anti-hypertensive drugs display differential effects on brachial and central BPs. Nebivolol is a cardio-selective beta-blocker which targets central systolic BP and reduces it significantly along with brachial BP. In this article, we will review the current literature to evaluate the role of central BP to diagnose hypertension in detail. We will also assess the clinical evidence to evaluate the role of nebivolol in the management of elevated central systolic BP. Central BP indices offer better estimation of BP in central arteries and should be considered in routine clinical practice. Nebivolol has shown significant reduction in aortic pressure and wave reflection and improvements in endothelial dysfunction and arterial stiffness in hypertensive patients.
使用肱动脉袖带血压计测量血压（BP）在高血压诊断和心血管疾病预测方面已被广泛接受。然而，肱动脉收缩压并不代表直接承受心脏负荷的中心动脉的实际收缩压。由于从中心动脉到外周动脉的波放大，两者之间存在显著差异。与肱动脉血压不同，中心血压测量还考虑了动脉僵硬度、血管分支和血管力学。新出现的数据表明，与肱动脉血压相比，通过中心压力指数可以更准确地诊断高血压。由于最近的技术进步，现在有各种非侵入性技术可用于测量中心血压指数。最近，有报道称不同类别的抗高血压药物对肱动脉血压和中心血压有不同的影响。奈必洛尔是一种心脏选择性β受体阻滞剂，它以中心收缩压为靶点，在降低肱动脉血压的同时显著降低中心收缩压。在本文中，我们将回顾当前文献，详细评估中心血压在高血压诊断中的作用。我们还将评估临床证据，以评估奈必洛尔在管理升高的中心收缩压中的作用。中心血压指数能更好地估计中心动脉血压，应在常规临床实践中予以考虑。奈必洛尔已显示可显著降低高血压患者的主动脉压力和波反射，并改善内皮功能障碍和动脉僵硬度。
