This Article Full Text Full Text (PDF) All Versions of this Article: 54/5/e131    most recent HYPERTENSIONAHA.109.139915v1 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 Google Scholar Articles by O'Rourke, M. F. Articles by Takazawa, K. PubMed PubMed Citation Articles by O'Rourke, M. F. Articles by Takazawa, K. Related Collections Other diagnostic testing

(Hypertension. 2009;54:e131.)
© 2009 American Heart Association, Inc.

Letters to the Editor

Flawed Measurement of Brachial Tonometry for Calculating Aortic Pressure?

St. Vincent’s Clinic, University of New South Wales, Victor Chang Cardiac Research Institute, Sydney, Australia

Kenji Takazawa

Tokyo Medical University, Hachioji Medical Center, Tokyo, Japan

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 Segers et al¹ on aortic-radial wave transmission and amplification casts doubt on the present approach to the calculation of central aortic pressure from the radial artery tonomographic waveform; this assumes that brachial and radial pressures are substantially identical. Findings of high amplification (8 mm Hg¹ between brachial and radial systolic pulse pressure) cannot support the present practice of calibrating the radial pressure wave from brachial cuff pressures and could strengthen the view that indices of pressure waves that do not depend on cuff pressure (eg, amplification, as a percentage, or augmentation index) might be preferred to estimations of central aortic pressures.

We are uncomfortable about this, believing that central pressures, so determined, have proved useful in trials such as REASON (Preterax in Regression of Arterial Stiffness in a Controlled Double-Blind), CAFÉ (Conduit Artery Function Evaluation substudy of the Anglo-Scandinavian Cardiac Outcomes Trial [ASCOT]), and Strong Heart Study and that invasively recorded pressure waves² do not show the minor pressure increase between carotid and brachial sites and the claimed >2-fold greater increase between brachial and radial arteries.¹ Authors relied on brachial tonometry, but they had difficulties with this. In 18%, recordings were impossible, and in the remainder, a "highly skilled...operator" was required "who qualitatively judged" waveforms as reliable. The problem with such "judgment" is that it is theoretically and practically flawed. The requirements for accurate tonometry cannot be met at the brachial site, because the artery lies under the stiff bicipital aponeurosis, and its . . . [Full Text of this Article]

This article has been cited by other articles:

				J. E. Davies, M. Shanmuganathan, D. P. Francis, J. Mayet, D. R. Hackett, and A. D. Hughes Caution Using Brachial Systolic Pressure to Calibrate Radial Tonometric Pressure Waveforms: Lessons From Invasive Study Hypertension, January 1, 2010; 55(1): e4 - e4. [Full Text] [PDF]

				P. Segers, D. Mahieu, J. Kips, E. Rietzschel, M. De Buyzere, and L. Van Bortel Response to Flawed Measurement of Brachial Tonometry for Calculating Aortic Pressure? Hypertension, November 1, 2009; 54(5): e132 - e132. [Full Text] [PDF]