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Central Blood Pressure Management in the Case of Arterial Hypertension

John Drummond

Published Date: 2021-10-30

John Drummond *

Division of Cardiology, Weill Cornell Medical College, New York, USA.

*Corresponding Author:
John Drummond
Division of Cardiology
Weill Cornell Medical College
New York, USA

Received Date: October 09, 2021; Accepted Date: October 23, 2021; Published Date: October 30, 2021

Citation: Drummond J (2021) Central Blood Pressure Management in the Case of Arterial Hypertension.Insights Blood Press Vol.7 No.5:1.

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Commentary

Obesity is linked to a number of factors that cause arterial hypertension. Central Blood Pressure (BP) appears to be more closely linked to future cardiovascular risk than peripheral BP. In people with extreme obesity, bariatric surgery is an efficient way to lower blood pressure while also losing weight. The link between weight loss after bariatric surgery and ambulatory BP measurement, including both peripheral and central BP, could provide insight into the mechanisms of organic damage associated with high blood pressure in obesity. In this study, we look at the data for the link between central BP and obesity, as well as how it changes following bariatric surgery. Central blood pressure is a new cardiovascular risk predictor that can be evaluated in the clinic with currently available technologies. The present state of central blood pressure monitoring, as well as its implications in cardiac and renal disease, will be discussed in this paper. Cardiovascular mortality and major cardiac events are linked to both aortic and carotid systolic blood pressure. Furthermore, studies demonstrate that systolic aortic blood pressure, as opposed to brachial blood pressure, is a better predictor of cardiovascular disease.

Inhibitors of the renin-angiotensin axis may lower blood pressure in the central nervous system; Long-term studies examining the influence of reducing central blood pressure on clinical outcomes, on the other hand, are scarce. A good predictor of cardiovascular risk is central blood pressure. As more research show the efficacy of central blood pressure as a therapeutic target, it's feasible that targeting central blood pressure may become a key part of the armamentarium for reducing cardiovascular risk. There are times during surgery when it is necessary or inevitable to reduce Mean Arterial Pressure (MAP) to levels substantially below those seen in non-anesthetized people. In these circumstances, doctors are understandably concerned about the brain's tolerance for hypotension. In discussions about safe MAP limits, the phenomena of cerebral blood flow autoregulation are commonly mentioned. However, popular notions of cerebral blood flow autoregulation may be incorrect or wrong in numerous ways. The main conclusions of this review are that: (1) the average lower limit of cerebral blood flow autoregulation in normotensive adult humans is not less than 70 mm Hg; and (2) there is significant intersubject variability in both the lower limit and the efficiency of cerebral blood flow autoregulation; (3) that the normal central nervous system has a significant blood flow reserve that protects it from critical blood flow reduction in the face of hypotension; (4) that there are several common clinical phenomena that have the potential to compromise that buffer and should be considered when deciding on minimum acceptable MAPs; and (5) that the average threshold for the occlusion of the occlusion of the occlusion of the occlusion of the occlusion of the occlusion of the occlusion. However, these MAPs should usually only be used when the surgical circumstance really demands it. Aging causes structural changes in large conducting arteries, which leads to increased vascular stiffness.

As a result, cardiovascular hemodynamic alterations occur as a result of increased central blood pressure, which may be linked to the remodelling of peripheral resistance arteries, which contributes to an increase in central vascular stiffness and blood pressure. These changes are similar to those seen in essential hypertension, prompting the term "early vascular ageing" to be applied to hypertensive individuals. Because the heart and other hypertension-related target organs are exposed to aortic blood pressure rather than brachial blood pressure, it has recently been suggested that central blood pressure and other stiffness parameters of large arteries, such as Pulse Wave Velocity (PWV), may better correlate with subclinical organ damage and may be useful to assess the cardiovascular risk of patients beyond hypertension.

Different technologies for measuring central blood pressure and PWV have been verified and are now available for clinical use. By better diagnosing cardiovascular risk and addressing antihypertensive medicine, the increased use of these measures in clinical practise could enhance hypertension patient management. SBP, DBP, and mean arterial pressure all decrease with isometric resistance training. The amplitude of the effect is greater than that seen in dynamic aerobic or weight training. Our findings imply that this type of training has the potential to result in considerable and clinically important blood pressure reductions, and that it might be used as a supplement to other forms of exercise. Blood Pressure (BP) self-monitoring appears to lower BP in hypertension, but critical issues remain about how to apply it effectively and which populations may benefit the most. This IPD meta-analysis was conducted to better understand the effectiveness of BP self-monitoring in lowering blood pressure and controlling hypertension.

The pressure in the brachial artery, measured with a cuff and sphygmomanometer, is widely acknowledged as an essential predictor of future cardiovascular risk. However, systolic pressure varies across the arterial tree, therefore aortic (central) systolic pressure is actually lower than equivalent brachial values, albeit this difference varies greatly between individuals. According to new findings, central pressure is more closely linked to future cardiovascular events than brachial pressure. Antihypertensive medications can also have differing effects on brachial and central pressure. As a result, basing treatment decisions on central pressure rather than brachial pressure is anticipated to have significant consequences for future hypertension diagnosis and management. Such a paradigm shift, however, will necessitate more concrete evidence that preferentially targeting central pressure provides additional benefit over and beyond what brachial artery pressure presently provides.

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