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1999年　OZパワーシリンジ（手動式造影剤注入器）

2001年　カルディオビュー（パソコン式12誘導心電計）

2007年　ラブテック　パソコン　心電計（ワイヤレス　ブルーツース式負荷心電用）

　　　　　当該ラインは、その後、

2008年　ラブテック　パソコン　ホルタ

2009年　ラブテック　血圧付　パソコン　ホルタ

2009年　ラブテック　血圧心電計

2014年　テンシオメド　脈波検査装置（ワイヤレス　動脈硬化指標解析　24時間から72時間使用可能　記憶式　携帯）

 

Central blood pressure: current evidence

 

and clinical importance

 

Carmel M. McEniery1*, John R. Cockcroft2, Mary J. Roman3,

 

Stanley S. Franklin4, and Ian B.Wilkinson1

 

1Clinical Pharmacology Unit, University of Cambridge, Addenbrooke’s Hospital, Box 110, Cambridge CB22QQ, UK; 2Department of Cardiology,Wales Heart Research Institute, Cardiff

 

CF14 4XN, UK; 3Division of Cardiology,Weill Cornell Medical College, New York, NY 10021, USA; and 4University of California, UCI School of Medicine, Irvine, CA 92697-4101, USA

 

Received 29 April 2013; revised 27 November 2013; accepted 17 December 2013; online publish-ahead-of-print 23 January 2014

 

and central pressure. Therefore, basing treatment decisions on central, rather than brachial pressure, is likely to have important implications

 

for the future diagnosis and management of hypertension. Such a paradigm shift will, however, require further, direct evidence that selectively

 

targeting central pressure, brings added benefit, over and above that already provided by brachial artery pressure.

 

Keywords Central pressure † Blood pressure † Anti-hypertensive treatment † Cardiovascular risk

 

Introduction

 

The brachial cuff sphygmomanometer was introduced into medical

 

practice well over 100 years ago, enabling the routine, non-invasive,

 

measurement of arterial blood pressure. Life insurance companies

 

were among the first to capitalize on the information provided by

 

cuff sphygmomanometry, by observing that blood pressure in

 

largely asymptomatic individuals relates to future cardiovascular

 

risk—observations that are nowsupported by a wealth of epidemiological

 

data.1 The most recent Global Burden of Disease report2

 

identified hypertension as the leading cause of death and disability

 

worldwide. Moreover, data from over 50 years of randomized controlled

 

trials clearly demonstrate that lowering brachial pressure,

 

in hypertensive individuals, substantially reduces cardiovascular

 

events.1,3 For these reasons, measurement of brachial blood pressure

 

has become embedded in routine clinical assessment throughout the

 

developed world, and is one of the most widely accepted ‘surrogate

 

measures’ for regulatory bodies.

 

The major driving force for the continued use of brachial blood

 

pressure has been its ease of measurement, and the wide variety of

 

devices available for clinical use. However, we have known for over

 

half a century that brachial pressure is a poor surrogate for aortic

 

pressure, which is invariably lower than corresponding brachial

 

values. Recent evidence suggests that central pressure is also more

 

strongly related to future cardiovascular events4 – 7 than brachial

 

pressure, and responds differently to certain drugs.8,9 Appreciating

 

this provides an ideal framework for understanding the much publicized

 

inferiority of atenolol and some other beta-blockers,10 compared

 

with other drug classes, in the management of essential

 

hypertension. Although central pressure can now be assessed noninvasively

 

with the same ease as brachial pressure, clinicians are unlikely

 

to discard the brachial cuff sphygmomanometer without

 

robust evidence that cardiovascular risk stratification, and monitoring

 

response to therapy, are better when based on central rather

 

than peripheral pressure. Central pressure assessment and accuracy

 

will also have to be standardized, as it has been for brachial pressure

 

assessment with oscillometric devices. This review will discuss our

 

current understanding about central pressure and the evidence

 

required to bring blood pressure measurement, and cardiovascular

 

risk assessment into the modern era.

 

Physiological concepts

 

Arterial pressure varies continuously over the cardiac cycle, but in

 

clinical practice only systolic and diastolic pressures are routinely

 

reported. These are invariably measured in the brachial artery

 

using cuff sphygmomanometry—a practice that has changed little

 

over the last century. However, the shape of the pressure waveform

 

* Corresponding author. Tel: +44 1223 336806, Fax: +44 1223 216893, Email: cmm41@cam.ac.uk

 

Published on behalf of the European Society of Cardiology. All rights reserved. &The Author 2014. For permissions please email: journals.permissions@oup.com

 

European Heart Journal (2014) 35, 1719–1725　doi:10.1093/eurheartj/eht565

 

 

 

Pressure measured with a cuff and sphygmomanometer in the brachial artery is accepted as an important predictor of future cardiovascular risk.However, systolic pressure varies throughout the arterial tree, such that aortic (central) systolic pressure is actually lower than corresponding　brachial values, although this difference is highly variable between individuals. Emerging evidence now suggests that central pressure is better　related to future cardiovascular events than is brachial pressure. Moreover, anti-hypertensive drugs can exert differential effects on brachial　and central pressure. Therefore, basing treatment decisions on central, rather than brachial pressure, is likely to have important implications　for the future diagnosis and management of hypertension. Such a paradigm shift will, however, require further, direct evidence that selectively　targeting central pressure, brings added benefit, over and above that already provided by brachial artery pressure.As discussed earlier, a full synthesis of the available evidence concerning

 

central pressure and the risk of future cardiovascular events is　now required. However, it will also be necessary to determine the　clinical relevance of differences between brachial and central pressure

 

for the individual patient, especially given the relatively high correlation　between the two. Emerging data support the prognostic　superiority of both 24-h ambulatory blood pressure monitoring

 

(ABPM)79 – 81 andhomemonitoring81 in comparison with office measurements.　Interestingly, a recent study82 demonstrated that 24-h　ambulatory cuff pressures were comparable with office central pressure

 

measurements in the prediction of risk, although the significance　of this study awaits confirmation.83 As yet, there are no data comparing　the predictive value ofhomemonitoring vs. central pressure in the

 

prediction of risk. Ultimately, it will be necessary to evaluate the prognostic　value of 24-h ambulatory central pressure.With the recent development　of ambulatory central pressure systems,84,85 this is now

 

possible and it may be reasonable to hypothesize that 24-h central,　rather than brachial ABPM would be superior in terms of risk prediction.

 

 

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Arteriograph- Comprehensive cardiovascular risk assessment in only 3 minutes! - A medical breakthrough in early diagnostics of atherosclerosis!  A big problem today is that many individuals with high risk of cardiovascular diseases otherwise have normal values; normal blood pressure, blood lipids and resting-EKG. The catastrophe strikes without any prior warning. The Arteriograph is an evidence based, fast, easy, noninvasive and user independent way of assessing cardiovascular risk. For the first time one have a good chance of finding high risk patient before it is too late. 1.       Screening of early atherosclerosis among ”healthy” individuals. Only the Arteriograph is useful for this. The Arteriograph gives an overall picture of the risk of assessing cardiovascular disease. 2.       Evaluating the effects of treatments (drugs, nutritional supplements and lifestyle changes etc) on the vascular functions among patients with established atherosclerosis (CAD, POST MI, STROKE, PAD) 3.       Is it not enough to check the blood lipids and blood pressure to prevent atherosclerosis and thereby strokes? No, 40-60% of patients with stroke or heart attacks do not have any know abnormal values such as high amount of blood lipids or high blood pressure (Johns Hopkins White Papers, Coronary Heart Disease - 1998, etc). They also have normal blood glucose values, resting-EKG, are non-smokers and have a healthy diet. Up until now it has been impossible to find there individuals. 4.       Todays metods of assessing cardiovascular risk (SCORE, Framingham) all have limits. They do not take into account important factors such as lack of physical activity, overweight, psychological factors or previous cardiovascular circumstances. (Simon, A. and Levenson, J.: May subclinical arterial disease helps to better detect and treat high-risk asymptomatic individuals? J Hypertension 2005, 23: 1939-1945) 5.       In most cases, lowering the blood pressure is not enough to avoid early death. Individuals who can lower both their arterial stiffness and blood pressure have a much greater chance of a longer life.Circulation 2001;103:987 6.       The Arteriograph is mobile and easy to use. The screening is fast, comfortable, harmless and user independent. It takes only a few minutes and can be described as a computerized blood pressure measurement. 7.       Today´s other available methods are hard to use, expensive, and requires an adequate educated staff. In the future, the Arteriograph may replace the regular blood pressure measurement as it is just as easy but gives much more information.    The Arteriograph is intended for DAILY USE at your clinic to measure AIx, PWV and Central blood pressure etc.

 Arteriograph- Comprehensive cardiovascular risk assessment in only 3 minutes!

 

- A medical breakthrough in early diagnostics of atherosclerosis!

 

A big problem today is that many individuals with high risk of cardiovascular diseases otherwise have normal values; normal blood pressure, blood lipids and resting-EKG. The catastrophe strikes without any prior warning.

The Arteriograph is an evidence based, fast, easy, noninvasive and user independent way of assessing cardiovascular risk. For the first time one have a good chance of finding high risk patients before it is too late .The Arteriograph is also used to evaluate the effect of different medications.