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Closer to Noninvasive Out-of-Office Aortic Blood Pressure Assessment: A Time to Think and Act

See related article, pp 825–832

The noninvasive assessment of central (aortic or carotid) blood pressure (BP) is a challenge to the clinical investigation of arterial hypertension. The importance of central BP was recognized decades ago on the basis of invasive hemodynamic studies1 but has become widely acknowledged during the last 15 years.2 This is largely attributed to the work of highly respected pioneers, like Michael O'Rourke's team, who created the first commercial device (SphygmoCor, AtCor, Sydney, Australia), enabling the wide application of the noninvasive assessment of aortic BP.3

In this issue of Hypertension , Weber et al4 present the validation of a novel BP recording device that noninvasively assesses aortic BP based on the brachial cuff oscillometric method and the application of mathematical transformation. The present invasive and noninvasive validation is of importance because it is a straightforward demonstration of the strengths and disadvantages of a new generation of BP devices that opens the way to out-of-office aortic BP self-assessment. After briefly reviewing the reasons for estimating central BP, we discuss the novelty of this device, the findings, and limitations of this study.4 and some of the major issues that should arise in future clinical research and practice.

### Why Assess Central Pressure?

The reasons have been extensively addressed in recent expert opinions and reviews1,5 and are only summarized here. Normally, central systolic BP (SBP) and pulse pressure (PP) are lower than peripheral SBP and PP (from 1 to 30 mm Hg). This PP disparity, defined as PP amplification,1 is an undisputable physiological phenomenon and depends on the individual's hemodynamic and pathophysiological characteristics.1,6 Notably, PP amplification exhibits substantial within-subject time variability (eg, from 5 to 20 mm Hg; Figure) that is mainly attributed to variations in heart rate, pressure wave reflections, and arterial …