Assessment of central haemomodynamics from a brachial cuff in a community setting

Abstract

BackgroundLarge artery stiffening and wave reflections are independent predictors of adverse events. To date, their assessment has been limited to specialised techniques and settings. A new, more practical method allowing assessment of central blood pressure from waveforms recorded using a conventional automated oscillometric monitor has recently been validated in laboratory settings. However, the feasibility of this method in a community based setting has not been assessed.MethodsOne-off peripheral and central haemodynamic (systolic and diastolic blood pressure (BP) and pulse pressure) and wave reflection parameters (augmentation pressure (AP) and index, AIx) were obtained from 1,903 volunteers in an Austrian community setting using a transfer-function like method (ARCSolver algorithm) and from waveforms recorded with a regular oscillometric cuff. We assessed these parameters for known differences and associations according to gender and age deciles from <30 years to >80 years in the whole population and a subset with a systolic BP < 140 mmHg.ResultsWe obtained 1,793 measures of peripheral and central BP, PP and augmentation parameters. Age and gender associations with central haemodynamic and augmentation parameters reflected those previously established from reference standard non-invasive techniques under specialised settings. Findings were the same for patients with a systolic BP below 140 mmHg (i.e. normotensive). Lower values for AIx in the current study are possibly due to differences in sampling rates, detection frequency and/or averaging procedures and to lower numbers of volunteers in younger age groups.ConclusionA novel transfer-function like algorithm, using brachial cuff-based waveform recordings, provides robust and feasible estimates of central systolic pressure and augmentation in community-based settings.

Cuff-Based Oscillometric Measurements of Central Hemodynamics: Factors Influencing Central Augmentation Pressure in Normotensive Japanese Individuals

“…Central AP is calculated as the increase from the shoulder of the aortic pressure to the late systolic peak in type A and B waveforms or the fall from the initial peak of the aortic pressure to the shoulder in type C waveforms [13]. The inflection point was defined as the zero crossing of the fourth derivative of central aortic pressure [15, 16], and the Mobil-O-Graph uses the fourth derivative rule [6]. Type C waveforms (negative augmentation) are relatively common in younger adults and men.…”

“…Central AP was positively correlated in men ( r = 0.37, p < 0.001) and women ( r = 0.35, p < 0.001) in individuals aged < 30 to > 80 years in an Austrian community setting [6]. Similarly, in this study, central AP significantly correlated with age in men ( r = 0.408, p = 0.003) and women ( r = 0.360, p = 0.005) (Fig.…”

“…After brachial BP was measured, the cuff was instantly inflated, and brachial artery pressure waves were recorded, holding the diastolic BP level for 10 s. Brachial artery pressure wave was digitized with a high-fidelity pressure sensor connected to a 12-bit A/D converter [5]. Central AIx and AP were calculated using a generalized transfer function [5, 6]. The ARCSolver transfer function includes an algorithm for checking the signal quality.…”

“…GmbH, Stolberg, Germany) is a device based on the ARCSolver transfer function and automatically measures central BP and central AIx using an oscillometric cuff [5]. The measurement of central AIx and augmentation pressure (AP) using the Mobil-O-Graph in the European population was reported to be associated with age and sex [6]. However, factors influencing central AIx and AP measured by using the Mobil-O-Graph in the Asian population have not been shown.…”

“…The relationship between central AIx and age is nonlinear, whereas that between central AP and age is linear [6, 7]. Higher central AIx and central AP are associated with increased risk of development of coronary artery disease in younger and middle-aged men [8].…”