Measuring central or peripheral blood pressure levels? That is the question in the modern clinical practice of Hypertension

Over the last decades, blood pressure (BP) levels have been measured at brachial level by conventional sphygmomanometers and, more recently, by validated and accurate automated devices. This method has been systematically applied in observational studies and in large randomized controlled clinical trials for both diagnostic and therapeutic purposes in the clinical management of essential hypertension. As an example, data from the Framingham cohort of individuals have demonstrated the strong and independent relationship between BP levels, mostly systolic, and increased risk of major cardiovascular outcomes, including myocardial infarction, stroke, renal disease, congestive heart failure and cardiovascular death [1]. Similar findings have been observed in various epidemiological surveys in almost all countries all over the world, including Italy [2]. On the other hand, pharmacological and non pharmacological interventions aimed at reducing high peripheral (brachial) BP levels have convincingly and independently demonstrated the beneficial effects of antihypertensive therapies in different clinical settings and across the whole spectrum of cardiovascular continuum. On the basis of these assumptions, current definition of hypertension has been founded on the assessment of peripheral BP levels, and therapeutic targets in hypertension have been set on clinic BP measurements, recorded at the brachial artery level. More recently, however, several other techniques for measuring BP in other conditions and different arteries have been progressively becoming available. These techniques provided additional BP data compared to conventional assessment. Indeed, innovative and comfortable devices for 24-h ambulatory BP monitoring, home BP measurement, intra-arterial or cuff-less assessment of beat-to-beat BP levels have made available for the clinical management of hypertensive outpatients and gradually adopted not only in randomized clinical trials, but also in real world practice of hypertension.