Medscape designates this educational activity for a maximum of 1 AMA PRA Category 1 Credits™. Please note that the course is accredited only for physicians (MD, DO, or equivalent). All other participants receive a certificate of completion.

INTRODUCTION
High blood pressure, or hypertension, is a major risk factor for coronary heart disease and is one of the most treatable forms of cardiovascular disease. Historically, blood pressure (BP) has been measured at the periphery in the brachial artery and is considered an accurate measure of diastolic BP. However, peripherally measured BP may not accurately reflect systolic BP, as this measure does not take into account the duration of systole or the shape of the systolic wave. More importantly, this measure provides a poor estimate of central aortic systolic pressure, an important factor for determining cardiac function and work.

Central aortic pressure can be derived noninvasively by examining the shape of the pulse wave at the wrist. Interestingly, different classes of antihypertensive drugs produce different BP effects peripherally (brachial BP) vs centrally (aortic BP). Data from the Conduit Artery Function Evaluation (CAFE) trial, a substudy of the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT), suggested that certain drug classes may be more effective than others at reducing central aortic pressure and that the reduction of central aortic pressure may lead to important clinical outcomes.

A better understanding of the importance of central aortic pressure, including the differential effects that antihypertensive drugs have on this measure and the clinical relevance of these data, is therefore essential.

Intended Audience The goal of this CME activity is to provide an educational opportunity to enhance the professional development of clinicians and researchers in all aspects of cardiovascular health. Release Date November 1, 2006 Expiration Date January 8, 2008 Term of Offering This CME activity has a release date of November 1, 2006, and is valid for 1 year. Requests for credit must be received no later than January 8, 2008. After reviewing all of the presentations and completing both the course test and the course evaluation, participants will receive further instruction regarding instantaneous online receipt of credit. For inquiries regarding technical issues with CME/CE or registration, email eMedicine at CME/CE Support. Please direct CME content–related questions to Medscape at CME@medscape.net.

Estimated Completion Time 1 hour Faculty Stanley S. Franklin, MD, FACC, FACP Clinical Professor of Medicine University of California at Irvine Associate Medical Director UCI Heart Disease Prevention Program Irvine, California Ian B. Wilkinson, MA, DM, MRCP Clinical Pharmacology Unit University of Cambridge Addenbrooke's Hospital Cambridge, United Kingdom Richard B. Devereux, MD Department of Medicine New York-Presbyterian Hospital Weill Cornell Medical Center New York, New York

Learning Objectives

After completing this activity, participants should be able to

• describe the scientific basis of central aortic blood pressure as a measure for cardiovascular outcomes;
  
  
• discuss the clinical importance of measuring central blood pressure in hypertension and heart failure;
  
  
• review the normal physiologic range of central pressure, including how central pressure changes with age and/or disease; and
  
  
• discuss recent clinical outcomes related to central pressure along with the differential effects of hypertension drugs on central pressure.

Medscape, LLC, is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Medscape, LLC, designates this educational activity for a maximum of 1 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Disclosure Policy

As an organization accredited by the ACCME, Medscape, LLC, requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest.

Medscape, LLC, encourages authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration at first mention and where appropriate in the content.

Faculty Disclosure

Stanley S. Franklin, MD, FACC, FACP
Sources of Funding for Research: None
Consulting Agreements: AtCor Medical (USA)
Speakers Bureau/Honorarium Agreements: None
Financial Interests/Stock Ownership: None
Discussion of Off-label, Investigational, or Experimental Drug Use: None

Ian B. Wilkinson, MA, DM, MRCP
Sources of Funding for Research: None
Consulting Agreements: None
Speakers Bureau/Honorarium Agreements: None
Financial Interests/Stock Ownership: None
Discussion of Off-label, Investigational, or Experimental Drug Use: None

Richard B. Devereux, MD
Sources of Funding for Research: Merck & Co, Inc.
Consulting Agreements: Merck & Co, Inc.; Novartis
Speakers Bureau/Honorarium Agreements: Merck & Co, Inc.; Novartis
Financial Interests/Stock Ownership: None
Discussion of Off-label, Investigational, or Experimental Drug Use: None

Instructions to Participants

Course participants must view all presentations and complete both the course test and the course evaluation in order to receive CME credit. No fees are charged to participate in the program or to receive the certificate. Full instructions are available on the user instructions page.

Disclaimer

The material presented here does not necessarily reflect the views of Medscape or companies that support educational programming on www.medscape.com. These materials may discuss therapeutic products that have not been approved by the US Food and Drug Administration and off-label uses of approved products. A qualified health care professional should be consulted before using any therapeutic product discussed. Readers should verify all information and data before treating patients or using any therapies described in this educational activity.

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