Vascular aging and hypertension: Implications for the clinical application of central blood pressure

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 130/90 mmHg 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.