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(Hypertension. 2006;47:1203.)
© 2006 American Heart Association, Inc.

Original Articles

Validation of a Generalized Transfer Function to Noninvasively Derive Central Blood Pressure During Exercise

James E. Sharman; Richard Lim; Ahmad M. Qasem; Jeff S. Coombes; Malcolm I. Burgess; Jeff Franco; Paul Garrahy; Ian B. Wilkinson; Thomas H. Marwick

From the Department of Medicine (J.E.S., M.I.B., T.H.M.), School of Human Movement Studies (J.E.S., J.S.C.), and Department of Cardiology (R.L., J.F., P.G.), University of Queensland, Princess Alexandra Hospital, Queensland, Australia; Department of Engineering (A.M.Q.), University of New South Wales, Sydney, Australia; and Clinical Pharmacology Unit (I.B.W.), University of Cambridge, Addenbrooke’s Hospital, Cambridge, United Kingdom.

Correspondence to James E. Sharman, Department of Medicine, The University of Queensland, Princess Alexandra Hospital, Ipswich Rd Woolloongabba, Brisbane, 4102, Australia. E-mail jsharman{at}soms.uq.edu.au

Exercise brachial blood pressure (BP) predicts mortality, but because of wave reflection, central (ascending aortic) pressure differs from brachial pressure. Exercise central BP may be clinically important, and a noninvasive means to derive it would be useful. The purpose of this study was to test the validity of a noninvasive technique to derive exercise central BP. Ascending aortic pressure waveforms were recorded using a micromanometer-tipped 6F Millar catheter in 30 patients (56±9 years; 21 men) undergoing diagnostic coronary angiography. Simultaneous recordings of the derived central pressure waveform were acquired using servocontrolled radial tonometry at rest and during supine cycling. Pulse wave analysis of the direct and derived pressure signals was performed offline (SphygmoCor 7.01). From rest to exercise, mean arterial pressure and heart rate were increased by 20±10 mm Hg and 15±7 bpm, respectively, and central systolic BP ranged from 77 to 229 mm Hg. There was good agreement and high correlation between invasive and noninvasive techniques with a mean difference (±SD) for central systolic BP of –1.3±3.2 mm Hg at rest and –4.7±3.3 mm Hg at peak exercise (for both r=0.995; P<0.001). Conversely, systolic BP was significantly higher peripherally than centrally at rest (155±33 versus 138±32 mm Hg; mean difference, –16.3±9.4 mm Hg) and during exercise (180±34 versus 164±33 mm Hg; mean difference, –15.5±10.4 mm Hg; for both P<0.001). True myocardial afterload is not reliably estimated by peripheral systolic BP. Radial tonometry and pulse wave analysis is an accurate technique for the noninvasive determination of central BP at rest and during exercise.

Key Words: exercise • blood pressure • arteries • blood pressure monitoring • hypertension, arterial

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