Many people successfully manage their blood pressure but may still be unaware of underlying vascular pathological changes that could lead to life-threatening events such as myocardial and cerebral infarction. This lack of awareness underscores the need for more comprehensive monitoring beyond just blood pressure levels.
Besides hypertension, major risk factors for these events include diabetes, dyslipidemia, obesity, arrhythmia, and smoking. Simply monitoring blood pressure is insufficient for predicting the risk of vascular events.
The impact of high blood pressure on blood vessels varies among individuals. For example, a person with a blood pressure of 150/95 mmHg may be at high risk for myocardial infarction, while another with the same blood pressure level might be at a lower risk. This is analogous to glaucoma, where individuals with normal intraocular pressure can develop the disease, while others with higher pressures do not. Hence, like in glaucoma where visual field testing and OCT are essential, more comprehensive indicators are needed to monitor vascular changes and pathological abnormalities.
While catheter angiography, as well as MR and CT angiography, are available for checking vascular complications, their use is typically limited to cases with a strong suspicion of severe heart or brain problems. MR and CT angiography, though less invasive, are not routinely used for screening due to factors like cost and limited availability. Carotid artery ultrasound is a non-invasive test that can detect arteriosclerotic changes in the carotid arteries, but the US Preventive Services Task Force advises against its screening use in the general adult population due to high false-positive rates*. Pulse wave analysis offers insights into vascular health, especially for early arteriosclerosis and vascular aging detection. However, it is not commonly used in clinical practice since it does not directly reveal changes in coronary and cerebral arteries. This gap in our current vascular health monitoring approach highlights the urgent need for developing routine, non-invasive tests that could significantly improve our ability to predict and prevent major vascular events.
**Expert consensus on the clinical use of pulse wave velocity in Asia