This Article Full Text Full Text (PDF) All Versions of this Article: 51/1/112    most recent HYPERTENSIONAHA.107.096016v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Munir, S. Articles by Chowienczyk, P. Search for Related Content PubMed PubMed Citation Articles by Munir, S. Articles by Chowienczyk, P. Related Collections Risk Factors Other hypertension Clinical Studies Related Article

(Hypertension. 2008;51:112.)
© 2008 American Heart Association, Inc.

Original Articles

Peripheral Augmentation Index Defines the Relationship Between Central and Peripheral Pulse Pressure

Shahzad Munir; Antoine Guilcher; Tamra Kamalesh; Brian Clapp; Simon Redwood; Michael Marber; Philip Chowienczyk

From the Cardiovascular Division, King’s College London School of Medicine, St Thomas’ Hospital, London, United Kingdom.

Correspondence to Philip Chowienczyk, Department of Clinical Pharmacology, St Thomas’ Hospital, Lambeth Palace Rd, London SE1 7EH, United Kingdom. E-mail phil.chowienczyk{at}kcl.ac.uk

Peripheral systolic blood pressure is amplified above central aortic systolic pressure, but the late systolic shoulder of the peripheral pulse may approximate central systolic pressure. Because late systolic pressure also determines the peripheral augmentation index, a measure of pressure wave reflection within the systemic circulation, this implies a direct relationship between amplification and augmentation. We compared the late systolic shoulder of the peripheral pressure waveform with estimates of central systolic pressure obtained using a transfer function in 391 subjects undergoing diagnostic coronary angiography and/or elective angioplasty (30% with insignificant coronary artery disease). In a subset (n=12) we compared the late systolic shoulder of the peripheral pulse with central pressure obtained with a catheter placed in the aortic root. Measurements were made at baseline, during atrial pacing, and during administration of nitroglycerin. Late systolic shoulder pressure closely approximated transfer function estimates of central pressure (R=0.96; P<0.0001; mean difference±SD: 0.5±5.2 mm Hg). Despite changes in waveform morphology induced by pacing and nitroglycerin (reducing mean values±SE of the augmentation index from 76±3.8% to 66±4.6% and 60±3.3%, respectively), there was close agreement between the late systolic shoulder of the peripheral pulse and measured values of central pressure (R=0.96; P<0.001; mean difference: 1.7±4.8 mm Hg). In conclusion, the late systolic shoulder of the peripheral pulse closely approximates central systolic pressure and peripheral augmentation index, the ratio of central:peripheral pulse pressure. Interventions to lower augmentation index and peripheral vascular resistance will have multiplicative effects in lowering central blood pressure.

Key Words: aorta • augmentation index • central blood pressure • pulse pressure • pulse wave analysis

Related Article:

Peripheral Augmentation Index: Shouldering the Central Pressure Load

Rupert A. Payne and David J. Webb
Hypertension 2008 51: 37-38. [Full Text] [PDF]

This article has been cited by other articles:

				A. D. Hughes, J. E. Davies, D. Francis, J. Mayet, and K. H. Parker Peripheral Augmentation Index and Wave Reflection in the Radial Artery Hypertension, June 1, 2008; 51(6): e45 - e46. [Full Text] [PDF]

				R. A. Payne and D. J. Webb Peripheral Augmentation Index: Shouldering the Central Pressure Load Hypertension, January 1, 2008; 51(1): 37 - 38. [Full Text] [PDF]