Hypertension. 2001;38:932-937
doi: 10.1161/hy1001.096106
doi: 10.1161/hy1001.096106
(Hypertension. 2001;38:932.)
© 2001 American Heart Association, Inc.
Fourth Workshop on Structure and Function of Large Arteries |
Prospective Evaluation of a Method for Estimating Ascending Aortic Pressure From the Radial Artery Pressure Waveform
From the Anesthesiology Department (A.L.P) and Cardiothoracic Surgery (N.D.K.), Wake Forest University School of Medicine, Winston-Salem, NC; St. Vincent’s Clinic/University of New South Wales (M.F.O.), Sydney, Australia.
Correspondence to Michael F. O’Rourke, Professor of Medicine, Medical Professorial Unit, St. Vincent’s Hospital, Victoria St, Darlinghurst, NSW 2010, Australia. E-mail M.ORourke{at}unsw.edu.au
Abstract
Abstract—— Pressure wave reflection in the upper limb causes amplification of the arterial pulse so that radial systolic and pulse pressures are greater than in the ascending aorta. Wave transmission properties in the upper limbs (in contrast to the descending aorta and lower limbs) change little with age, disease, and drug therapy in adult humans. Such consistency has led to use of a generalized transfer function to synthesize the ascending aortic pressure pulse from the radial pulse. Validity of this approach was tested for estimation of aortic systolic, diastolic, pulse, and mean pressures from the radial pressure waveform. Ascending aortic and radial pressure waveforms were recorded simultaneously at cardiac surgery, before initiation of cardiopulmonary bypass, with matched, fluid-filled manometer systems in 62 patients under control conditions and during nitroglycerin infusion. Aortic pressure pulse waves, generated from the radial pulse, showed agreement with the measured aortic pulse waves with respect to systolic, diastolic, pulse, and mean pressures, with mean differences <1 mm Hg. Control differences in Bland-Altman plots for mean±SD in mm Hg were systolic, 0.0±4.4; diastolic, 0.6±1.7; pulse, -0.7±4.2; and mean pressure, -0.5±2.0. For nitroglycerin infusion, differences respectively were systolic, -0.2±4.3; diastolic, 0.6±1.7; pulse, -0.8±4.1; and mean pressure, -0.4±1.8. Differences were within specified limits of the Association for the Advancement of Medical Instrumentation SP10 criteria. In contrast, differences between recorded radial and aortic systolic and pulse pressures were well outside the criteria (respectively, 15.7±8.4 and 16.3±8.5 for control and 14.5±7.3 and 15.1±7.3 mm Hg for nitroglycerin). Use of a generalized transfer function to synthesize radial artery pressure waveforms can provide substantially equivalent values of aortic systolic, pulse, mean, and diastolic pressures.
Key Words: aorta • blood pressure monitoring • hemodynamics • nitroglycerin
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M. J. Haller, M. Samyn, W. W. Nichols, T. Brusko, C. Wasserfall, R. F. Schwartz, M. Atkinson, J. J. Shuster, G. L. Pierce, and J. H. Silverstein Radial Artery Tonometry Demonstrates Arterial Stiffness in Children With Type 1 Diabetes Diabetes Care, December 1, 2004; 27(12): 2911 - 2917. [Abstract] [Full Text] [PDF]
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A. P. Avolio, J. R. Cockcroft, and M. F. O'Rourke Use of Arterial Transfer Functions for the Derivation of Central Aortic Waveform Characteristics in Subjects With Type 2 Diabetes and Cardiovascular Disease: Response to Hope et al. Diabetes Care, October 1, 2004; 27(10): 2564 - 2565. [Full Text] [PDF]
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B. A. Mullan, C. N. Ennis, H. J. P. Fee, I. S. Young, and D. R. McCance Protective effects of ascorbic acid on arterial hemodynamics during acute hyperglycemia Am J Physiol Heart Circ Physiol, September 1, 2004; 287(3): H1262 - H1268. [Abstract] [Full Text] [PDF]
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 A. L. Pauca, N. D. Kon, and M. F. O'Rourke The second peak of the radial artery pressure wave represents aortic systolic pressure in hypertensive and elderly patients Br. J. Anaesth., May 1, 2004; 92(5): 651 - 657. [Abstract] [Full Text] [PDF]
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Yasmin, C. M. McEniery, S. Wallace, I. S. Mackenzie, J. R. Cockcroft, and I. B. Wilkinson C-Reactive Protein Is Associated With Arterial Stiffness in Apparently Healthy Individuals Arterioscler Thromb Vasc Biol, May 1, 2004; 24(5): 969 - 974. [Abstract] [Full Text]
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 A. Covic, D. J. A. Goldsmith, P. Gusbeth-Tatomir, and M. Covic Haemodialysis acutely improves endothelium-independent vasomotor function without significantly influencing the endothelium-mediated abnormal response to a {beta}2-agonist Nephrol. Dial. Transplant., March 1, 2004; 19(3): 637 - 643. [Abstract] [Full Text] [PDF]
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M. T. Schram, R. M.A Henry, R. A.J.M van Dijk, P. J. Kostense, J. M. Dekker, G. Nijpels, R. J. Heine, L. M. Bouter, N. Westerhof, and C. D.A. Stehouwer Increased Central Artery Stiffness in Impaired Glucose Metabolism and Type 2 Diabetes: The Hoorn Study Hypertension, February 1, 2004; 43(2): 176 - 181. [Abstract] [Full Text] [PDF]
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T. Weber, J. Auer, M. F. O'Rourke, E. Kvas, E. Lassnig, R. Berent, and B. Eber Arterial Stiffness, Wave Reflections, and the Risk of Coronary Artery Disease Circulation, January 20, 2004; 109(2): 184 - 189. [Abstract] [Full Text] [PDF]
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C. Vlachopoulos, K. Hirata, and M. F O'Rourke Effect of sildenafil on arterial stiffness and wave reflection Vascular Medicine, November 1, 2003; 8(4): 243 - 248. [Abstract] [PDF]
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M. F. O'Rourke, A. Avolio, A. Qasem, S. C. Millasseau, J. M. Ritter, and P. J. Chowienczyk Clinical Assessment of Wave Reflection * Response: Augmentation Index and the Radial-to-Aortic Transfer Function Hypertension, November 1, 2003; 42 (5): e15 - e16. [Full Text] [PDF]
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H. Smulyan, D. S. Siddiqui, R. J. Carlson, G. M. London, and M. E. Safar Clinical Utility of Aortic Pulses and Pressures Calculated From Applanated Radial-Artery Pulses Hypertension, August 1, 2003; 42(2): 150 - 155. [Abstract] [Full Text] [PDF]
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J. R. Greenfield, K. Samaras, L. V. Campbell, A. B. Jenkins, P. J. Kelly, T. D. Spector, and C. S. Hayward Physical activity reduces genetic susceptibility to increased central systolic pressure augmentation: a study of female twins J. Am. Coll. Cardiol., July 16, 2003; 42(2): 264 - 270. [Abstract] [Full Text] [PDF]
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P.-S. Tsai, C. B. Yucha, W. W. Nichols, and H. Yarandi Hemodynamics and Arterial Properties in Response to Mental Stress in Individuals with Mild Hypertension Psychosom Med, July 1, 2003; 65(4): 613 - 619. [Abstract] [Full Text] [PDF]
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J. C. Smith, H. Lane, N. Davies, L. M. Evans, J. Cockcroft, M. F. Scanlon, and J. S. Davies The Effects of Depot Long-Acting Somatostatin Analog on Central Aortic Pressure and Arterial Stiffness in Acromegaly J. Clin. Endocrinol. Metab., June 1, 2003; 88(6): 2556 - 2561. [Abstract] [Full Text] [PDF]
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 R Klocke, J R Cockcroft, G J Taylor, I R Hall, and D R Blake Arterial stiffness and central blood pressure, as determined by pulse wave analysis, in rheumatoid arthritis Ann Rheum Dis, May 1, 2003; 62(5): 414 - 418. [Abstract] [Full Text] [PDF]
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S. C. Millasseau, S. J. Patel, S. R. Redwood, J. M. Ritter, and P. J. Chowienczyk Pressure Wave Reflection Assessed From the Peripheral Pulse: Is a Transfer Function Necessary? Hypertension, May 1, 2003; 41(5): 1016 - 1020. [Abstract] [Full Text] [PDF]
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M. Tamminen, J. Westerbacka, S. Vehkavaara, and H. Yki-Jarvinen Insulin-Induced Decreases in Aortic Wave Reflection and Central Systolic Pressure Are Impaired in Type 2 Diabetes Diabetes Care, December 1, 2002; 25(12): 2314 - 2319. [Abstract] [Full Text] [PDF]
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K. Obuobie, J. Smith, L. M. Evans, R. John, J. S. Davies, and J. H. Lazarus Increased Central Arterial Stiffness in Hypothyroidism J. Clin. Endocrinol. Metab., October 1, 2002; 87(10): 4662 - 4666. [Abstract] [Full Text] [PDF]
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K. E. North, J. W. MacCluer, R. B. Devereux, B. V. Howard, T. K. Welty, L. G. Best, E. T. Lee, R. R. Fabsitz, and M. J. Roman Heritability of Carotid Artery Structure and Function: The Strong Heart Family Study Arterioscler Thromb Vasc Biol, October 1, 2002; 22(10): 1698 - 1703. [Abstract] [Full Text] [PDF]
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J. R. Cockcroft and I. B. Wilkinson reliability of transfer function in determining central pulse pressure and augmentation index: Reply J. Am. Coll. Cardiol., September 18, 2002; 40(6): 1196 - 1197. [Full Text] [PDF]
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S. A. Hope, I. T. Meredith, and J. D. Cameron Reliability of transfer functions in determining central pulse pressure and augmentation index J. Am. Coll. Cardiol., September 18, 2002; 40(6): 1196 - 1196. [Full Text] [PDF]
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S. A. Hope, D. B. Tay, I. T. Meredith, and J. D. Cameron Comparison of generalized and gender-specific transfer functions for the derivation of aortic waveforms Am J Physiol Heart Circ Physiol, September 1, 2002; 283(3): H1150 - H1156. [Abstract] [Full Text] [PDF]
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X J Jiang, M F O'Rourke, W Q L Jin, L S Liu, C W Li, P C Tai, X C Zhang, and S Z Liu Quantification of glyceryl trinitrate effect through analysis of the synthesised ascending aortic pressure waveform Heart, August 1, 2002; 88(2): 143 - 148. [Abstract] [Full Text] [PDF]
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I. B. Wilkinson, K. Prasad, I. R. Hall, A. Thomas, H. MacCallum, D. J. Webb, M. P. Frenneaux, and J. R. Cockcroft Increased central pulse pressure and augmentation index in subjects with hypercholesterolemia J. Am. Coll. Cardiol., March 20, 2002; 39(6): 1005 - 1011. [Abstract] [Full Text] [PDF]
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M. E. Safar, J. Blacher, B. Pannier, A. P. Guerin, S. J. Marchais, P.-M. Guyonvarc'h, and G. M. London Central Pulse Pressure and Mortality in End-Stage Renal Disease Hypertension, March 1, 2002; 39(3): 735 - 738. [Abstract] [Full Text] [PDF]
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