Role of Pulse Pressure Amplification in Arterial Hypertension

Avolio, Alberto; Bortel, Luc M. Van; Boutouyrie, Pierre; Cockcroft, John R.; McEniery, Carmel M.; Protogerou, Athanase D.; Roman, Mary J.; Safar, Michel E.; Segers, Patrick; Smulyan, Harold

doi:10.1161/hypertensionaha.109.134379

Cited by 468 publications

(419 citation statements)

References 82 publications

(103 reference statements)

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“…[25][26] However, pressure amplification, when expressed as the ratio of peripheral divided by central pulse pressure, should be independent of possible calibration errors. 27 As shown in the Supplementary Table available online, pressure amplification ratio (peripheral/central pulse pressure) consistently decreased with age in both cross-sectional and longitudinal analyses.…”

Section: Discussionmentioning

confidence: 78%

Age dependency of peripheral and central systolic blood pressures: cross-sectional and longitudinal observations in a Chinese population

Staessen

Sheng

et al. 2011

Hypertens Res

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Few studies have described the age-related changes in both peripheral and central systolic blood pressures (SBPs) in populations. We addressed this issue in 1066 women and 978 men, all untreated (mean age, 45.1 years; 27.2% hypertensive) and randomly selected from a Chinese population, of whom 369 and 330 underwent a repeat examination after 3.6 years (median). In cross-sectional analyses, central SBP increased more with age than peripheral SBP in women below age 50 (1.21 vs. 1.01 mm Hg per year; Po0.001) and in men below age 60 (0.73 vs. 0.48 mm Hg per year; Po0.001), whereas in older women (0.64 vs. 0.58 mm Hg per year; P¼0.27) and older men (0.45 vs. 0.44 mm Hg per year; P¼0.79), the slopes of central and peripheral SBPs on age were similar. Compared with men, women had steeper (Po0.001) age-related increases in peripheral and central SBPs. Systolic augmentation pressure increased with age, but this increase was substantially smaller (Po0.0001) for peripheral than central augmentation (women, 0.086 vs. 0.45 mm Hg per year; men, 0.083 vs. 0.39 mm Hg per year). In multivariable-adjusted regression, age contributed X89.7% of the explained variance in peripheral and central SBPs. In longitudinal analyses, the annual percentage increases from baseline to follow-up in peripheral and central SBP were similar (PX0.76) in both women (2.14% vs. 2.16 % per year) and men (1.33% vs. 1.34 % per year; P-values for sex difference p0.044). In conclusion, in younger subjects assessed cross-sectionally, the age-related increase was larger for central than peripheral SBP, whereas the corresponding cross-sectional estimates in older subjects and the longitudinal estimates in all subjects showed similar age-related increases in central and peripheral SBP.

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Section: Discussionmentioning

confidence: 78%

Age dependency of peripheral and central systolic blood pressures: cross-sectional and longitudinal observations in a Chinese population

Staessen

Sheng

et al. 2011

Hypertens Res

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“…Hence, ABI as assessed by the Doppler should be higher because of higher amplification of systolic BP distally as a result of the existence of pressure wave reflections and an arterial stiffness gradient within the arterial tree. 21,22 Therefore, the difference found between the oscillometric and Doppler methods cannot be attributed to the slightly different points of ankle BP measurement but rather to the When agreement studies in the diagnosis of PAD were performed by applying criteria with high clinical relevance (k statistic, ROC curve), the oscillometric technique was found to be quite reliable. More specifically, the agreement between the two techniques was satisfactory, with high k values.…”

Section: Discussionmentioning

confidence: 97%

Automated determination of the ankle-brachial index using an oscillometric blood pressure monitor: validation vs. Doppler measurement and cardiovascular risk factor profile

et al. 2011

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The ankle-brachial index (ABI) is a method used widely for peripheral arterial disease (PAD) diagnosis and cardiovascular risk prediction. This study validated automated ABI measurements taken using an oscillometric blood pressure (BP) monitor allowing simultaneous arm-leg BP measurements. A total of 93 patients (hypertension 83%; dyslipidemia 72%; diabetes 45%; cardiovascular disease 23%; smoking 15%) were submitted to Doppler and automated ABI measurements, performed using a professional oscillometric BP monitor (Microlife WatchBP Office; triplicate simultaneous arm-leg BP measurements), in a randomized order. The mean difference between the Doppler reading (1.08±0.17) and (1) the first oscillometric ABI reading was 0.03±0.11, (2) the average of two oscillometric readings was 0.02±0.10 and (3) the average of three oscillometric readings was 0.02 ± 0.09 (Po0.01 for all). Strong correlations were found between oscillometric and Doppler ABI (r 0.80, 0.85 and 0.86 for single and average of two and three oscillometric readings, respectively; Po0.001 for all). Agreement between oscillometric and Doppler ABI in diagnosing PAD (Doppler ABI o0.9) was found in 95% of cases (j 0.79; agreement in diabetics: 94%, j 0.79). A receiver operating characteristic (ROC) curve revealed area under the curve at 0.98, with a 0.97 oscillometric ABI cutoff for optimal sensitivity (92%) and specificity (92%) in diagnosing PAD. Average time for automated ABI measurement was 5.8 vs. 9.3 min for Doppler (Po0.001). Doppler and oscillometric ABI were associated and predicted (multivariate regression analysis) by the same cardiovascular risk factors (pulse pressure, smoking and cardiovascular disease history). Automated ABI measurement using a professional BP monitor allowing simultaneous arm-leg BP measurements appears to be a reliable and faster alternative to Doppler measurement.

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“…The Doppler ABI should be higher because of a greater amplification of systolic BP distally, which is generated by the pressure-wave reflections and arterial stiffness gradient within the arterial tree. 44 Therefore, the difference found between the oscillometric and Doppler ABI cannot be attributable to the slightly different points of the ankle BP measurement but rather to the intrinsic characteristics of each method. Taking the BP a few inches more proximally may avoid arterial occlusive disease that might be present between the cuff and the two pedal pulses.…”

Section: Automated Ankle-brachial Index Assessment Wj Verberk Et Almentioning

confidence: 95%

Automated oscillometric determination of the ankle-brachial index: a systematic review and meta-analysis

2012

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Measurement of the ankle-brachial index (ABI) using a Doppler device is widely used to identify subjects with peripheral artery disease (PAD), and those who are at high risk of cardiovascular disease. This paper presents a systematic review (Medline/ PubMed, Embase and Cochrane) and meta-analysis of studies assessing the usefulness of automated oscillometric devices for ABI estimation and PAD detection compared with the conventional Doppler method. A total of 25 studies including 4186 subjects were analyzed. A random-effects model analysis showed that the average oscillometric ABI was similar to the Doppler ABI (mean difference ± s.e. 0.020 ± 0.018, P ¼ 0.3) but that the absolute differences were significant (0.048 ± 0.009, Po0.01). The pooled correlation coefficient (r) between the oscillometric and Doppler ABI was 0.71 ± 0.05. Simultaneous arm-leg measurements resulted in a smaller difference between the average oscillometric ABI value and the average Doppler ABI value than did sequential measurements ( À0.012 ± 0.022 vs. 0.040 ± 0.026, respectively, Po0.01). The average sensitivity and specificity of the oscillometric ABI estimation in PAD diagnosis was 69 ± 6% and 96 ± 1%, respectively (with Doppler ABI taken as the reference). These data suggest that an automated ABI measurement obtained by oscillometric blood pressure monitors is a reliable and practical alternative to the conventional Doppler measurement for the detection of PAD.To increase the sensitivity of the PAD diagnosis based on an oscillometric ABI, a higher threshold of 1.0 might be preferable.

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Role of Pulse Pressure Amplification in Arterial Hypertension

Cited by 468 publications

References 82 publications

Age dependency of peripheral and central systolic blood pressures: cross-sectional and longitudinal observations in a Chinese population

Age dependency of peripheral and central systolic blood pressures: cross-sectional and longitudinal observations in a Chinese population

Automated determination of the ankle-brachial index using an oscillometric blood pressure monitor: validation vs. Doppler measurement and cardiovascular risk factor profile

Automated oscillometric determination of the ankle-brachial index: a systematic review and meta-analysis

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