Hypertension and SphygmaCor

Central arterial pressure waveform analysis provides clinicians with better prognostic and diagnostic information to help determine the need for and type of interventions. Antihypertensive therapy is a key component in the management of hypertensive patients and there is a large body of evidence documenting the effects of pharmacological treatment on arterial stiffness, the central arterial pressure and wave reflection.  Central aortic pressure waveform guidance has been shown to positively inform hypertension management, resulting in reduced medications to achieve blood pressure control with no adverse effects on left ventricular mass, cardiac function, aortic stiffness, or quality of life.

Central arterial pressure waveform analysis using the SphygmoCor® system may provide individualized and improved therapy selection for borderline hypertensive patients or those near blood pressure goal (for example, individuals with a brachial systolic blood pressure of 130-140mmHg), as well as improve therapy guidance in resistant hypertensive patients.

Renal Disease and SphygmaCor

Arterial stiffness and measures of wave reflection are well-established in the field of chronic kidney disease and have been shown to be strong independent risk factors for morbidity and mortality in all stages of chronic kidney disease, including end-stage renal disease (ESRD) with dialysis and kidney transplantation. Furthermore, these measures also provide prognostic ability for identifying patients at risk of CKD progression.

CKD has a number of significant co-morbidities that present additional cardiovascular risk, such as diabetes and hypertension. Each of these brings additional treatment considerations.

Antihypertensive therapy is important in CKD patients, as well as dialysis timing and composition and immunosuppressant agents for kidney transplant recipients. There is a growing body of research highlighting the effects each of these has on arterial stiffness and measures of wave reflection. The wider application of using arterial stiffness and central hemodynamic measures to evaluate and guide treatment is now emerging.

Arterial stiffness and measures of wave reflection have been well established as a factor in ESRD, but more recently the degree of arterial stiffness has also been shown to be important in the pre-dialysis group of CKD. In addition, increases in aortic PWV and AIx are commonly associated with other conditions highly prevalent in CKD patients, such as hypertension and diabetes.

The most recent European guidelines for the management of arterial hypertension recommend evaluation of aortic PWV for asymptomatic organ damage in hypertensive patients. Furthermore, two key position papers have also recommended the clinical use of aortic PWV for primary and secondary disease prevention and to provide additional information beyond traditional risk factors for prediction of CV events.