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(Hypertension. 2009;54:e132.)
© 2009 American Heart Association, Inc.

Letters to the Editor

Response to Flawed Measurement of Brachial Tonometry for Calculating Aortic Pressure?

Biofluid, Tissue and Solid Mechanics for Medical Applications, Institute Biomedical Technology, Ghent University, Ghent, Belgium

Dries Mahieu

Heymans Institute of Pharmacology, Ghent University, Ghent, Belgium

Jan Kips

Biofluid, Tissue and Solid Mechanics for Medical Applications, Institute Biomedical Technology, and, Heymans Institute of Pharmacology, Ghent University, Ghent, Belgium

Ernst Rietzschel; Marc De Buyzere

Department of Cardiovascular Diseases, Ghent University Hospital, Ghent, Belgium

Luc Van Bortel

Heymans Institute of Pharmacology, Ghent University, Ghent, Belgium

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

We share O’Rourke and Takazawa’s¹ interest in and pursuit of reliable, accurate noninvasive central blood pressure assessment. To that end, we use carotid applanation tonometry, calibrated with diastolic and mean blood pressures, for which we rely on brachial tonometry.

In the Asklepios Study, all of the radial, brachial, and carotid artery data were measured by a single skilled, trained operator (a prerequisite for applanation tonometry in general) with a high-fidelity Millar pen-type tonometer, and 20-second sequences were processed automatically to an ensemble average after a procedure extensively described earlier.² The relatively high dropout for the brachial measurements (virtually nonexistent for the other sites) is largely attributable to the pursued high standards, accepting only high-quality recordings with brachial and carotid/radial waveforms showing a similar number of accepted beats (minimally 10) and width of CIs of the ensemble average.

We do realize that measurability of brachial artery pulsations does not imply that they also adequately reflect the intra-arterial pressure. There is, however, consistency in our data.³ The form factor (FF=[mean–diastolic blood pressure]/pulse pressure), an indication of the peaking of the curve, decreases from the carotid to the radial artery (approximately progressive central-to-peripheral peaking), with, especially in men, brachial FF in between as one might anticipate (see Reference ², Figure 1). The FF of 40% to 44% at the brachial artery is similar to the value of 40% proposed by Bos et al⁴ on the basis of invasive recordings. In addition, in an ongoing study in 148 subjects (mean age: 29.6 years), the . . . [Full Text of this Article]