Noninvasive Measurement of Central Vascular Pressures With Arterial Tonometry: Clinical Revival of the Pulse Pressure Waveform?

Abstract

The arterial pulse has historically been an essential source of information in the clinical assessment of health. With current sphygmomanometric and oscillometric devices, only the peak and trough of the peripheral arterial pulse waveform are clinically used. Several limitations exist with peripheral blood pressure. First, central aortic pressure is a better predictor of cardiovascular outcome than peripheral pressure. Second, peripherally obtained blood pressure does not accurately reflect central pressure because of pressure amplification. Lastly, antihypertensive medications have differing effects on central pressures despite similar reductions in brachial blood pressure. Applanation tonometry can overcome the limitations of peripheral pressure by determining the shape of the aortic waveform from the radial artery. Waveform analysis not only indicates central systolic and diastolic pressure but also determines the influence of pulse wave reflection on the central pressure waveform. It can serve as a useful adjunct to brachial blood pressure measurements in initiating and monitoring hypertensive treatment, in observing the hemodynamic effects of atherosclerotic risk factors, and in predicting cardiovascular outcomes and events. Radial artery applanation tonometry is a noninvasive, reproducible, and affordable technology that can be used in conjunction with peripherally obtained blood pressure to guide patient management. Keywords for the PubMed search were applanation tonometry, radial artery, central pressure, cardiovascular risk, blood pressure, and arterial pulse. Articles published from January 1, 1995, to July 1, 2009, were included in the review if they measured central pressure using radial artery applanation tonometry.

Conformable amplified lead zirconate titanate sensors with enhanced piezoelectric response for cutaneous pressure monitoring

“…The traditional cuff sphygmomanometer is one of the oldest and most established diagnostic tools for blood pressure, but it is not well suited for continuous monitoring and yields only two basic pressure values: systolic (greatest heart contraction) and diastolic (greatest heart dilation) 20 . As a result, capabilities for use in observation during hypertensive treatment, in evaluation for hemodynamic effects of atherosclerotic risk factors or in projections of life-threatening cardiovascular events 21 are limited. A popular alternative, known as arterial tonometry, uses arrays of transducers that press against a radial artery to measure external blood pressure 22 .…”

The Effects of Antihypertensive Agents in Metabolic Syndrome – Benefits Beyond Blood Pressure Control

“…Peripheral systolic BP (SBP) measured at the brachial artery does not accurately reflect CAP, particularly in youths, as a result of peripheral amplification of the pulse pressure wave [67][68][69]. This amplification difference decreases with age and arterial stiffness.…”

“…Although techniques have been developed to a stage where direct noninvasive measurement of CAP could be readily applied to routine clinical practice, the studies conducted to-date, assessing the predictive value of CAP, have been relatively small. Thus, additional data from large interventional studies of clinical outcomes and larger-scale longitudinal epidemiological studies of clinical outcomes are required to confirm the utility of CAP as a predictor of vascular risk before it becomes part of routine clinical practice [67][68][69].…”

“…The recorded waveform is then used to algorithmically derive central pressure indices from a peripheral brachial BP measurement [69]. In addition, aortic pulse wave velocity (PWV), which is usually recorded between the carotid and femoral arteries, is used to determine vessel distensibility; the velocity of the pulse wave increases with decreasing vessel distensibility (increased arterial stiffness) [67].…”

Empirical mode decomposition for self-mixing Doppler signals of hemodynamic optical probes

“…The information extracted from the arterial pulse pressure provides insights into the diagnosis and management of many disease states, including diabetes (Korpas et al 2009), diastolic dysfunction (Nelson et al 2010), obstructive sleep apnea (Phillips et al 2005) or rheumatoid arthritis (Klocke et al 2003).…”