1. Specific guidelines on the use of arterial measurements Jiguang WANG, MD, PhD Professor of Cardiovascular Medicine The Shanghai Institute of Hypertension, China jiguangwang@aim.com

2. Current guidance documents Single technology Multiple techniques Guidance in guidelines for the management of hypertension Why do we need specific guidelines on the use of arterial measurements ?

3. L Carotid-femoral PWV (applanation tonometry) the“foot-to-foot method” 5 4 3 2 1 10 9 8 7 6 tt

4. Van Bortel L, et al. J Hypertens. 2012;30(3):445-8.

5. 150 100 50 150 100 50 150 100 50 (mmHg) Age 68 years Age 54 years Age 24 years Renal artery aorta Thoracic aorta Ascending aorta Abdominal lliac artery Femoral artery (mmHg)

6. Central BP measurements and antihypertensive therapy: a consensus document Enrico Agabiti-Rosei et al. Hypertension. 2007;50:154-160. At left, pressure is the brachial measured, whereas at right, pressure is the estimated central pressure allowed for the decrease over brachial pressure of 3 mm Hg when the active therapy was a drug that reduces peripheral wave reflection (CCB, ACEI, or ARB).

7. Stoner L, Lambrick DM, Faulkner J, Young J. Guidelines for the use of pulse wave analysis in adults and children. J Atheroscler Thromb. 2013;20(4):404-6.

8. Brachial FMD as a measure of endothelial function Celermajer DS et al. The Lancet 1992; 340: 1111-1115.

9. Guidelines for FMD Corretti MC. et al. JACC 2002; 39: 257-265.

10. Japanese guidance on FMD Hypertens Res 2008;31: 2105–2113.

11. Expert consensus document on arterial stiffness: methodological issues and clinical applications Laurent S, et al. Eur Heart J. 2006;27(21):2588-605.

12. Current guidance documents Single technology Multiple techniques Guidance in guidelines for the management of hypertension Why do we need specific guidelines on the use of arterial measurements ?

13. ESH guidelines: CV measurements J Hypertens 2013;31:1281-1357.

14. 2014 JSH hypertension guidelines Hypertension Research 2014;37, 254–392.

15. ESH and JSH recommendations on PWV ESH 2013 (J Hypertens 2013;31:1281-1357 ) cfPWV  10 m/s (asymptomatic organ damage) JSH 2014 (Hypertens Res 2014;37, 254–392 ) cfPWV; baPWV  18 m/s (organ damage) Cardio-ankle vascular index (biomarker of angiopathy)

16. Current guidance documents Single technology Multiple techniques Guidance in guidelines for the management of hypertension Why do we need specific guidelines on the use of arterial measurements ?

17. Huang QF, et al. Am J Hypertens 2013; 26:754-761. The relationship between cfPWV and AGEs according to age

18. Total mortality according to the decile distributions of baPWV Adjusted for age, sex, body mass index, current smoking and alcohol intake, SBP and DBP, use of antihypertensive drugs, diabetes mellitus, and serum total cholesterol. Sheng CS, et al. 2014; 64(5):1124-1130.

19. Central prehypertension (110-129/80-89) or hypertension (  130/90) vs. normotension (n=2501) Cheng HM, et al. J Am Coll Cardiol. 2013;62:1780-7. Total deathCV deathStroke death Number of endpoints (%) 185 (7.4)34 (1.36)18 (0.72) Pre-hypertension vs. optimal BP 1.31 (0.87–3.35)1.59 (0.57–4.43)1.93 (0.45–8.31) Hypertension vs. optimal BP 2.14 (1.36–3.35)3.08 (1.05–9.05)6.12 (1.43–26.21)

20. Overall ELSA (2002) ASCOT-BPLA (2005) LIFE (2002) HAPPHY (1987) INVEST (2003) Study (Year) 1.26 (1.14, 1.38, P < 0.001) 1.59 (0.69, 3.69) 1.31 (1.13, 1.51) 1.36 (1.14, 1.62) 0.77 (0.49, 1.23) 1.14 (0.93, 1.40) OR (95% CI) 100.0 1.2 41.6 28.8 5.4 23.1 Weight, % 0.2713.69 (I-squared = 38.0%, P = 0.17) Favors β-blockersFavors other drugs Effects of β-blockers vs other classes drugs on stroke Ding FH, et al. Am J Hypertens 2013; 26:118-125. Heart rate, beat/min pSBP, mm Hg Derived cSBP, mm Hg 1209.6 100.28.0 5.91.14.7 3.60.32.9 10.72.7 (0.7) 8.5 (observed 4.3) 7.41.05.9

21. There are some guidance documents for single and multiple techniques of arterial measurements. There are also recommendations on the use of arterial measurements for assessing organ damages in hypertension. These current documents are more technical and less clinical. In the past few years, a large body of evidence has been accumulated on the clinical use of arterial measurements. It is probably high time for the Pulse of Asia Society and other regional societies, such as ARTERY and North America ARTERY to establish a task force to work on a guidance document for the clinical use of arterial measurements.

22. Thank you very much ！