Central BP guided therapy – a promising approach to antihypertensive treatment in patients with arterial hypertension, type 2 diabetes, and chronic kidney disease

Download in PDF


To compare two strategies of hypertension management based on either brachial (standard approach) or central aortic blood pressure (BP) (intervention) in patients with type 2 diabetes mellitus and chronic kidney disease G3.

Material and methods

Sixty patients were enrolled into the open-label prospective randomized study. We measured office brachial BP with a validated oscillometric device and conducted 24-hour ambulatory BP to monitor office central BP and 24-h brachial and central BP (BPLab Vasotens). All patients were treated with fixed-dose combinations of indapamide/perindopril arginine or amlodipine/indapamide/ perindopril arginine at different doses according to BP levels. Target brachial BP was <140/85 mmHg, whereas target aortic BP was determined according to ageand gender-specific reference values. The study duration was 6 months.


At month 1, up-titration of antihypertensive therapy was required in 93% of patients in both groups. At month 3, treatment was intensified in 37% of patients from standard approach group and in 13% patients from intervention group (p=0.07). Median systolic BP decrease in standard and intervention groups was 27 and 25 mmHg for brachial BP, and 26 and 28 mmHg for aortic BP, respectively (p>0.05). At the end of the study, target BP was achieved in 93% and 97% of patients, respectively.


Despite similar drop in office brachial and aortic BP, aortic BP guided approach was associated with a trend to a faster achievement of target BP and less frequent use of the highest doses of antihypertensive drugs.

Key words

Arterial hypertension, chronic kidney disease, type 2 diabetes mellitus, central aortic blood pressure, antihypertensive therapy, fixed-dose combination.