Elsevier

Mayo Clinic Proceedings

Volume 81, Issue 8, August 2006, Pages 1057-1068
Mayo Clinic Proceedings

REVIEW
Central Arterial Pressure and Arterial Pressure Pulse: New Views Entering the Second Century After Korotkov

https://doi.org/10.4065/81.8.1057Get rights and content

The ubiquitous brachial cuff method gained widespread clinical acceptance for blood pressure recording after confirmation of its prognostic value in 1917. This method displaced radial pulse waveform analysis by sphygmography, which also gave prognostic information but was difficult to use. Since that time, brachial cuff sphygmomanometry has migrated from the physician's office to 24-hour monitoring and home use, with electronic methods replacing the Korotkov sound technique for determining systolic and diastolic pressure. Detailed instrumental studies, required by regulatory bodies, revealed inaccuracies of all cuff methods for recording true intra-arterial pressure. A major source of inaccuracy in assessing left ventricular load is the amplification of the pressure wave in its transit from the central aorta to upper limb arteries, as extensively studied by Earl H. Wood at the Mayo Clinic in Rochester, Minn, in the 1950s. This limitation can be overcome by combining newer methods using radial artery waveform analysis in conjunction with conventional cuff sphygmomanometry to noninvasively measure the central aortic pressure waveforms. Recent studies using radial tonometry have proved that this is more effective than conventional manometry in predicting cardiovascular events and gauging response to therapy. Measurement of central as well as peripheral arterial pressure and physiology is becoming increasingly used as an office practice and a laboratory procedure.

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,

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    Dr O'Rourke is a founding director of AtCor Medical Pty Ltd, manufacturer of systems for pulse waveform analysis.

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