REVIEWCentral Arterial Pressure and Arterial Pressure Pulse: New Views Entering the Second Century After Korotkov
Section snippets
TECHNOLOGICAL INNOVATIONS
The changing views regarding arterial pressure during the past 15 years have been accompanied by a number of technological innovations that have and will substantially change clinical practice and are a focus of the remainder of this article.
The earliest innovation was introduction of the oscillometric device for clinic, home, and 24-hour blood pressure recording. One of the incentives to introduce such a device was to eliminate use of mercury because of environmental concerns. The
MEASUREMENT OF CENTRAL PRESSURE
Blood pressure is customarily measured in the upper limb as a matter of convenience and available technology. The brachial method is the standard, but other noninvasive devices have been developed to measure pressure at the wrist or in the finger29; a finger-based device (Portapres) has been used in the space program.33
Ever since blood pressure recordings have been obtained invasively from experimental animals and humans, it has been known that the pressure pulse is amplified as it travels from
VALUE OF CENTRAL AORTIC PRESSURE MEASUREMENT
As previously discussed, there is little difference in mean and diastolic pressure between central and peripheral arteries5, 41; however, any value of this knowledge relates to the ability of the examiner to confidently measure systolic or pulse pressure in the ascending aorta.
The most obvious benefits pertain to situations in which there can be significant differences between central and peripheral pressure, which may influence medical diagnosis or treatment or provide interpretation of
CONCLUSION
Views on the prognostic value of arterial pressure have evolved during the past 2 centuries. The description of high tension of the pulse at the wrist by Richard Bright led to identification of a characteristic radial pulse waveform in sphygmograms. This was used clinically by physicians and life insurance examiners during the next century. The introduction of the brachial cuff for measurement of systolic and diastolic pressure drew attention to the value of systolic, then diastolic pressure,
REFERENCES (96)
Isolated systolic hypertension: a long-neglected cause of cardiovascular complications
Am J Med
(1989)- et al.
Effects of age on ventricular-vascular coupling
Am J Cardiol
(1985) - et al.
Age-specific relevance of usual blood pressure to vascular mortality [letter]
Lancet
(2003) - et al.
Age-specific relevance of usual blood pressure to vascular mortality [letter]
Lancet
(2003) - et al.
Prognosis of “masked” hypertension and “white-coat” hypertension detected by 24-h ambulatory blood pressure monitoring 10-year follow-up from the Ohasama study
J Am Coll Cardiol
(2005) - et al.
Relation between ascending aortic pressures and outcomes in patients with angiographically demonstrated coronary artery disease
Am J Cardiol
(2005) - et al.
Noninvasive determination of aortic input impedance and external left ventricular power output: a validation and repeatability study of a new technique
J Am Coll Cardiol
(1992) - et al.
The second peak of the radial artery pressure wave represents aortic systolic pressure in hypertensive and elderly patients
Br J Anaesth
(2004 May) - et al.
C-reactive protein is related to arterial wave reflection and stiffness in asymptomatic subjects from the community
Am J Hypertens
(2005) - et al.
Normal vascular aging: differential effects on wave reflection and aortic pulse wave velocity: the Anglo-Cardiff Collaborative Trial (ACCT)
J Am Coll Cardiol
(2005 Nov 1)
Spurious systolic hypertension of youth: fit young men with elastic arteries
Am J Hypertens
Pulsatility of ascending aorta and restenosis after coronary angioplasty in patients <60 years of age with stable angina pectoris
Am J Cardiol
Pulsatility of ascending aortic blood pressure waveform is associated with an increased risk of coronary heart disease
Am J Hypertens
Aortic pulse pressure and extent of coronary artery disease in percutaneous transluminal coronary angioplasty candidates
Am J Hypertens
Aortic pulse pressure is related to the presence and extent of coronary artery disease in men undergoing diagnostic coronary angiography: a multicenter study
Am J Hypertens
Ascending aortic, but not brachial blood pressure-derived indices are related to coronary atherosclerosis
Atherosclerosis
Reflection in the arterial system and the risk of coronary heart disease
Am J Hypertens
Inflection point of ascending aortic waveform is a powerful predictor of restenosis after percutaneous transluminal coronary angioplasty
Am J Hypertens
Relation of arterial pressure waveform to left ventricular and carotid anatomy in normotensive subjects
J Am Coll Cardiol
Fractional diastolic and systolic pressure in the ascending aorta are related to the extent of coronary artery disease
Am J Hypertens
Cardiovascular protection and blood pressure reduction: a meta-analysis [published correction appears in Lancet. 2002;359:360]
Lancet
Mechanism(s) of selective systolic blood pressure reduction after a low-dose combination of perindopril/indapamide in hypertensive subjects: comparison with atenolol
J Am Coll Cardiol
Un nuovo sfigomanometro
Gazz Med Di Torino
A contribution to the problem of methods for the determination of blood pressure
Rep Imperial Milit-Med Acad St Petersburg
A Century of Arterial Hypertension, 1896-1996
This day 50 years ago
N Engl J Med
McDonald's Blood Flow in Arteries: Theoretical, Experimental and Clinical Principles
Beyond blood pressure: subtle effects of drug classes
Arterioscler Thromb Vasc Biol
Principles of Diagnosis and Treatment in Heart Affections
Systolic blood pressure, arterial rigidity, and risk of stroke: the Framingham Study
JAMA
Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension: final results of the Systolic Hypertension in the Elderly Program (SHEP)
JAMA
Isolated systolic hypertension, pulse pressure, and arterial stiffness as risk factors for cardiovascular disease
Curr Hypertens Rep
Isolated systolic hypertension in the elderly
J Hypertens
Prevalence of hypertension in the US adult population: results from the Third National Health and Nutrition Examination Survey, 1988-1991
Hypertension
Birth weight, growth, and blood pressure: an annual follow-up study of children aged 5 through 21 years
Hypertension
Hemodynamic patterns of age-related changes in blood pressure: the Framingham Heart Study
Circulation
Arterial and cardiac aging: major shareholders in cardiovascular disease enterprises. III. Cellular and molecular clues to heart and arterial aging
Circulation
Does the relation of blood pressure to coronary heart disease risk change with aging? the Framingham Heart Study
Circulation
Is pulse pressure useful in predicting risk for coronary heart disease? the Framingham Heart Study
Circulation
Epidemiological findings imply that goals for drug treatment of hypertension need to be revised
Circulation
Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies [published correction appears in Lancet. 2003;361:1060]
Lancet
National standard for measurement of resting and ambulatory blood pressures with automated sphygmomanometers
Hypertension
Blood pressure measuring devices: recommendations of the European Society of Hypertension
BMJ
Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure
Hypertension
Recommendations for blood pressure measurement in humans and experimental animals, I: 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
Circulation
2003 European Society of Hypertension-European Society of Cardiology guidelines for the management of arterial hypertension [published corrections appear in J Hypertens. 2003;21:2203-2204 and 2004; 22:435]
J Hypertens
Cited by (0)
Dr O'Rourke is a founding director of AtCor Medical Pty Ltd, manufacturer of systems for pulse waveform analysis.