Central blood pressure
Each contraction of the left ventricle generates a pulse wave. Stiffening in the arterial vessel walls leads to early wave reflection in the systole and is associated with an increase in pressure in the central aorta. Increased central blood pressure means an unfavorable rise in cardiac afterload as well as a reduction in diastolic coronary flow and myocardial microcirculation. Other organs such as the kidneys and brain may be damaged by this.
In the event of increased central blood pressure an increased cardiovascular risk may be assumed, even if the peripherally measured blood pressure is within the normal range.
Pulse wave velocity (PWV)
Pulse wave velocity describes the speed at which the pressure wave emitted by the left ventricle runs via the vascular tree to the periphery. The arterial stiffness is quantified using aortal pulse wave velocity (PWV) with m/s as a measuring unit.
Its prognostic value has been proven in a number of studies and is more important than the classic risk factors such as high blood pressure and hypercholesterolemia.
All antihypertensive classes of substances reduce blood pressure in a similar way. However, their hemodynamic features differ in terms of heart rate, stroke volume, and peripheral resistance. The pulse wave analysis gives information about the individually measured stroke volume. Certain antihypertensives lead to a reduction in the peripheral vascular resistance which leads to the heart function easing (afterload) and the stroke volume improving at the same time. The randomized intervention study by R.D. Smith et al. shows that therapy decisions based on measured hemodynamics (stroke volume and peripheral resistance) achieve up to 69% better accuracy in the blood pressure adjustment with the initial prescription.