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(Hypertension. 2005;46:e15.)
© 2005 American Heart Association, Inc.

Hypertension Electronic Pages

Calibration of Noninvasively Recorded Upper-Limb Pressure Waves

St Vincent’s Clinic, University of New South Wales, Sydney, Australia

An extract of the first 250 words of the full text is provided, because this article has no abstract.

To the Editor:

The article by Verbeke et al¹ raises an important question: how does one calibrate the radial artery waveform obtained by applanation tonometry? Does one apply systolic and diastolic brachial values from the Korotkov technique, the "gold standard", or does one use an oscillometric wrist technique, despite lack of confidence in any available method? Alternatively, as implied by Verbeke et al, should one use brachial tonometry instead, calibrated to brachial-cuff values?

The study by Verbeke et al¹ suggests (from noninvasive methods alone) that the present technique of calibrating radial tonometry to brachial-cuff pressure may have substantial inaccuracy. The method by Verbeke et al¹ depends on a technique originally described by Kelly and Fitchett² where systolic pressure was extrapolated on the assumption that diastolic and mean pressure were identical throughout the arterial tree. The technique currently recommended in the SphygmoCor process is based on invasive studies of arterial pressure waves, which showed that amplification between brachial and radial artery is small in comparison to that between aorta and brachial artery.^3,4

We repeated essentials of the Verbeke et al¹ study and confirmed estimation of high pressure amplification between brachial and radial sites. But in the process we became aware of several technical factors that could account for the estimations and, hence, regard these as flawed. First, we could not be confident of successfully applanating the brachial artery. Unlike carotid and radial arteries, the brachial has no support behind so the artery surface cannot confidently be flattened when the tonometer is . . . [Full Text of this Article]

Francis Verbeke

Ghent University Hospital, Department of Internal Medicine, Nephrology Section, Ghent, Belgium

Patrick Segers

Ghent University, Hydraulics Laboratory, Department of Civil Engineering, Ghent, Belgium

Raymond Vanholder

University Hospital Ghent, Department of Internal Medicine, Nephrology Section, Ghent, Belgium

Pascal Verdonck

Ghent University, Hydraulics Laboratory, Department of Civil Engineering, Ghent, Belgium

Luc M. Van Bortel

Ghent University, Heymans Institute of Pharmacology, Ghent, Belgium

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				M. F. O'Rourke and K. Takazawa Flawed Measurement of Brachial Tonometry for Calculating Aortic Pressure? Hypertension, November 1, 2009; 54(5): e131 - e131. [Full Text] [PDF]