Validation of a Brachial Cuff-Based Method for Estimating Central Systolic Blood Pressure

The prognostic value of central systolic blood pressure has been established recently. At present, its noninvasive assessment is limited by the need of dedicated equipment and trained operators. Moreover, ambulatory and home blood pressure monitoring of central pressures are not feasible. An algorithm enabling conventional automated oscillometric blood pressure monitors to assess central systolic pressure could be of value. We compared central systolic pressure, calculated with a transfer-function like method (ARCSolver algorithm), using waveforms recorded with a regular oscillometric cuff suitable for ambulatory measurements, with simultaneous high-fidelity invasive recordings, and with noninvasive estimations using a validated device, operating with radial tonometry and a generalized transfer function. Both studies revealed a good agreement between the oscillometric cuff-based central systolic pressure and the comparator. In the invasive study, composed of 30 patients, mean difference between oscillometric cuff/ARCSolver-based and invasive central systolic pressures was 3.0 mm Hg (SD: 6.0 mm Hg) with invasive calibration of brachial waveforms and −3.0 mm Hg (SD: 9.5 mm Hg) with noninvasive calibration of brachial waveforms. Results were similar when the reference method (radial tonometry/transfer function) was compared with invasive measurements. In the noninvasive study, composed of 111 patients, mean difference between oscillometric cuff/ARCSolver–derived and radial tonometry/transfer function–derived central systolic pressures was −0.5 mm Hg (SD: 4.7 mm Hg). In conclusion, a novel transfer function-like algorithm, using brachial cuff-based waveform recordings, is suited to provide a realistic estimation of central systolic pressure.

[1]  Jaspal Kooner,et al.  Estimation of central aortic pressure by SphygmoCor requires intra-arterial peripheral pressures. , 2003, Clinical science.

[2]  G. Mancia,et al.  Central blood pressure measurements and antihypertensive therapy: a consensus document. , 2007, Hypertension.

[3]  M. Safar,et al.  A preliminary evaluation of the mean arterial pressure as measured by cuff oscillometry. , 2008, American journal of hypertension.

[4]  Riccardo Pini,et al.  Central but not brachial blood pressure predicts cardiovascular events in an unselected geriatric population: the ICARe Dicomano Study. , 2008, Journal of the American College of Cardiology.

[5]  N. Kon,et al.  Does radial artery pressure accurately reflect aortic pressure? , 1992, Chest.

[6]  Thomas Weber,et al.  Arterial Stiffness, Wave Reflections, and the Risk of Coronary Artery Disease , 2004, Circulation.

[7]  Thomas H Marwick,et al.  Validation of a Generalized Transfer Function to Noninvasively Derive Central Blood Pressure During Exercise , 2006, Hypertension.

[8]  Hao-Min Cheng,et al.  Central or peripheral systolic or pulse pressure: which best relates to target organs and future mortality? , 2009, Journal of hypertension.

[9]  Dariusz Dudek,et al.  Pulsatile but Not Steady Component of Blood Pressure Predicts Cardiovascular Events in Coronary Patients , 2008, Hypertension.

[10]  Waqas Ahmed,et al.  Comparison of Oscillometric and Intraarterial Systolic and Diastolic Blood Pressures in Lean, Overweight, and Obese Patients , 2006, Angiology.

[11]  Nikos Stergiopulos,et al.  Individualization of transfer function in estimation of central aortic pressure from the peripheral pulse is not required in patients at rest. , 2008, Journal of applied physiology.

[12]  Joseph Cheriyan,et al.  The accuracy of central SBP determined from the second systolic peak of the peripheral pressure waveform , 2009, Journal of hypertension.

[13]  L. Poston,et al.  A validation of the Mobil O Graph (version 12) ambulatory blood pressure monitor , 2000, Blood pressure monitoring.

[14]  Brian McCrindle,et al.  Recommendations for blood pressure measurement in human and experimental animals; part 1: blood pressure measurement in humans. , 2006, Hypertension.

[15]  I. Ungi,et al.  Use of generalized transfer function-derived central blood pressure for the calculation of baroreflex gain , 2008, Journal of hypertension.

[16]  J. Blacher,et al.  Central Pulse Pressure and Mortality in End-Stage Renal Disease , 2002, Hypertension.

[17]  Felix Breitenecker,et al.  Modeling arterial and left ventricular coupling for non-invasive measurements , 2008, Simul. Model. Pract. Theory.

[18]  Yasmin,et al.  Central Pressure: Variability and Impact of Cardiovascular Risk Factors: The Anglo-Cardiff Collaborative Trial II , 2008, Hypertension.

[19]  Alun D. Hughes,et al.  Differential Impact of Blood Pressure–Lowering Drugs on Central Aortic Pressure and Clinical Outcomes: Principal Results of the Conduit Artery Function Evaluation (CAFE) Study , 2006 .

[20]  Richard B. Devereux,et al.  Central Pressure More Strongly Relates to Vascular Disease and Outcome Than Does Brachial Pressure: The Strong Heart Study , 2007, Hypertension.

[21]  M. Safar,et al.  Selective reduction of cardiac mass and central blood pressure on low-dose combination perindopril/indapamide in hypertensive subjects , 2004, Journal of hypertension.

[22]  M. Safar,et al.  Clinical Utility of Aortic Pulses and Pressures Calculated From Applanated Radial-Artery Pulses , 2003, Hypertension.

[23]  A S Berson,et al.  National Standard for Measurement of Resting and Ambulatory Blood Pressures With Automated Sphygmomanometers , 1993, Hypertension.

[24]  Hao-Min Cheng,et al.  Estimation of central systolic blood pressure using an oscillometric blood pressure monitor , 2010, Hypertension Research.

[25]  B. Imholz,et al.  Evaluation of the Mobil-O-Graph new generation ABPM device using the ESH criteria , 2010, Blood pressure monitoring.

[26]  M. O'Rourke,et al.  Prospective Evaluation of a Method for Estimating Ascending Aortic Pressure From the Radial Artery Pressure Waveform , 2001, Hypertension.

[27]  J. Blacher,et al.  Carotid versus brachial pulse pressure in elderly persons. , 2008, Journal of the American College of Cardiology.

[28]  Hao-Min Cheng,et al.  Wave Reflection and Arterial Stiffness in the Prediction of 15-Year All-Cause and Cardiovascular Mortalities: A Community-Based Study , 2010, Hypertension.

[29]  Daniel W. Jones,et al.  Recommendations for blood pressure measurement in humans and experimental animals: Part 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research. , 2005, Hypertension.

[30]  Alice Stanton,et al.  Differential Impact of Blood Pressure–Lowering Drugs on Central Aortic Pressure and Clinical Outcomes: Principal Results of the Conduit Artery Function Evaluation (CAFE) Study , 2006, Circulation.

[31]  Kimon S Stamatelopoulos,et al.  Non-invasive methods and techniques for central blood pressure estimation: procedures, validation, reproducibility and limitations. , 2009, Current pharmaceutical design.

[32]  C. Vlachopoulos,et al.  The effect of antihypertensive drugs on central blood pressure beyond peripheral blood pressure. Part II: Evidence for specific class-effects of antihypertensive drugs on pressure amplification. , 2009, Current pharmaceutical design.