Use of radial artery applanation tonometry and a generalized transfer function to determine aortic pressure augmentation in subjects with treated hypertension
Open accessAbstract
Objectives The purposes of this study were to investigate the use of radial artery applanation tonometry and a generalized transfer function for the assessment of central aortic pressure augmentation in subjects taking commonly used antihypertensive agents (angiotensin-converting enzyme inhibitors, beta-adrenergic blockers, Ca2+ antagonists, diuretic therapy).Background Applanation tonometry of the radial artery with a generalized transfer function has been proposed as a means of assessing central aortic blood pressure. Recently, a commercial apparatus based on this technique has become available; we therefore examined the effect of a generalized transfer function on derived central aortic pressure compared with measured brachial blood pressures and also investigated the potential of this technique to assess the influence of differing drug therapy.Methods Two hundred and sixty-two hypertensive patients on stable medication were studied using the PWV Medical Blood Pressure Analysis System (version 2, DAT-1).Results In univariate analysis, augmentation index showed association with age, sex, height and heart rate. In multivariate analysis, diastolic blood pressure and age (positively), height and heart rate (negatively) and sex were significantly associated. After adjustment for these variables, pressure augmentation was not associated with any antihypertensive treatment investigated. Linear relationships were demonstrated between brachial blood pressures and corresponding central pressures derived by transfer function methods.Conclusions Our findings suggest that if adjustment for central-peripheral pressure difference is necessary, simple linear relationships may be sufficient. Age, heart rate and height but not the class of antihypertensive medication affected the degree of pressure augmentation observed using this technique.
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Augmentation index was corrected for changes in heart rate.
“Because the augmentation index is influenced by changes in heart rate (HR), it was also accordingly corrected (26).”
From Smoking and caffeine have a synergistic detrimental effect on aortic stiffness and wave reflections (2004) · cites this paper as [26]
Wave reflection indices may be influenced by changes in heart rate and by height, and subendocardial viability index by changes in heart rate.
“Wave reflection indices may be influenced by changes in HR and by height and subendocardial viability index by changes in HR.”
From Smoking and caffeine have a synergistic detrimental effect on aortic stiffness and wave reflections (2004) · cites this paper as [26]
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“This confirms our previous findings in hypertensive subjects.(9) The mechanism is likely to be that a slower heart rate allows more time for wave reflection and, thus, leads to central pressure augmentation.”
BackgroundResultAT1-receptor blockade improves augmentation index
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“Although 18% to 37% of the population variance in AI is heritable (9,10), several determinants of AI have been reported, including age (4,6,9,11,12), gender (1,6,7,11), blood pressure (BP) (6,7,9,11), heart rate (6,7,9,11,13), height (6,9,11), and type 2 diabetes (13).”
BackgroundCentral pressure should not be used in clinical practice
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“22,23 This very high degree of correlation means that variation in the difference between central and peripheral pressure is quite small relative to the range of Figure 1 Waveform calibration.”
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ESTIMATION OF ARTERIAL MECHANICS IN CLINICAL PRACTICE AND AS A RESEARCH TECHNIQUE
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“The AI is also, and probably of greater potential relevance, inversely proportional to HR.50 It is clear from consideration of the mechanism involved that a reflected pressure wave returning to the aortic root earlier in the cardiac cycle will be associated with greater augmentation of central aortic pressure than if…”
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“Multiple factors have potential influence on large arteries functional properties: height [2, 3], heart rate [3], left ventricular ejection duration [4] and blood pressure level [3, 5].”
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“This method has been previously described [19] and can be easily performed in the Intensive Care Unit where IABC is usually applied [12].”
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“The augmentation of a reflected pressure wave occurs earlier as a consequence of the new reflecting site provided by the increased peripheral resistance (27, 28).”
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Increased augmentation index and central aortic blood pressure in osteoporotic postmenopausal women
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“In this study, osteoporotic and control groups were similar with respect to a number of factors previously reported to influence AIx, including age, height, heart rate and peripheral blood pressure [ 29 ], LDL cholesterol [15], fasting glucose level [30], and physical activity [31].”
ResultAssociation of left ventricular motion and central augmentation index in healthy young men
Cheng, K., Cameron, J. D., Tung, M., Mottram, P. M., Meredith, I. T., & Hope, S. A. (2012) · Journal of Hypertension · doi:10.1097/hjh.0b013e328358bee2 · Cited by 29 · see citing works
“AIx is inversely related to heart rate [4,36] with differences between the effect of b-blocker and other drug classes on AIx and outcome having been largely attributed to the heart rate differences following therapy [2].”
BackgroundReference Values for the Augmentation Index and Pulse Pressure in Apparently Healthy Korean Subjects
Chung, J. W., Lee, Y. S., Kim, J. H., Seong, M. J., Kim, S. Y., Lee, J. B., Ryu, J. K., Choi, J. Y., Kim, K. S., Chang, S. G., et al. (2010) · Korean Circulation Journal · doi:10.4070/kcj.2010.40.4.165 · Cited by 29 · see citing works
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Principles of Vascular Physiology
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“The device also returned the radial AIx as the ratio of the difference between the pressure at the second systolic shoulder and diastolic BP to that between diastolic BP and pressure at the first inflection point: AIx = 100 × (P2 − DBP)/ (P1 − DBP) (Cameron et al. 1998).”
BackgroundModel-Based Assessment of Cardiovascular Health from Noninvasive Measurements
Xiao, X. G., Ozawa, E. T., Huang, Y., & Kamm, R. D. (2002) · Annals of Biomedical Engineering · doi:10.1114/1.1484217 · Cited by 22 · see citing works
Correlation between augmentation index and pulse wave velocity in rabbits
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“However, the proportion of drug classes was similar among the 4 groups, and it has been demonstrated that the significance of the effect of AIx on the cardiovascular risk is not influenced by cardiovascular drugs (26, 29).”
BackgroundPapaioannou, T., Lekakis, J. P., Dagre, A. G., Stamatelopoulos, K., Terrovitis, J. V., GIALAFOS, E. J., Kanakakis, J., Nanas, J., Stamatelopoulos, S. F., & Moulopoulos, S. D. (2001) · The International Journal of Artificial Organs · doi:10.1177/039139880102400710 · Cited by 18 · see citing works
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“Age has been a known determinant of the AIx@75 [18].”
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Atherosclerosis and folic acid supplementation trial in chronic renal failure: Baseline results
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Central aortic pressure is independently associated with diastolic function
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Does Measurement of Central Blood Pressure have Treatment Consequences in the Clinical Praxis?
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Impaired arterial elasticity in young patients with white-coat hypertension
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“Overall, among a diverse, essential hypertension patient population, the results of the current study support the idea that the earlier the reflected wave returns to the aorta during the cardiac cycle, the greater the central augmented pressure and the lower the PPamp will be, as seen previously in research.(18) Earli…”
Improvement of pulse diagnostic apparatus with array sensor of magnetic tunneling junctions
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Assessment of large artery function
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“, 1993) to obtain the corresponding function between peripheral arterial pressure and central arterial pressure, then collecting new test samples, and validating the peripheral arterial pressure waveform signal by the trained transfer function to estimate the corresponding CAPW(Cameron et al., 1998; Payne et al., 2007…”
BackgroundCardiovascular risk analysis by means of pulse morphology and clustering methodologies
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“The arterial stiffness measurement currently assumes an increasing role in clinical assessment due to its predictive value in cardiovascular events in patients with various risk levels, such as it was demonstrated by several studies [9–12].”
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- Authors
- Cameron, J. D., McGrath, B. P., & Dart, A. M.
- Affiliations
- Baker Heart and Diabetes Institute (AU)
- Monash Medical Centre (AU)
- Corresponding author
- Cameron, James D.
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 1998-11
- Volume
- 32
- Issue
- 5
- Pages
- 1214-1220
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W2050727720
- Cited by
- 168
- References
- 23
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 1 · 2023: 1 · 2022: 4 · 2021: 3 · 2020: 3 · 2019: 5 · 2018: 4 · 2017: 5 · 2016: 6 · 2015: 3 · 2014: 5 · 2013: 2 · 2012: 4
- FWCI
- 7.38
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Physical Sciences › Engineering › Biomedical Engineering › Non-Invasive Vital Sign Monitoring
- Keywords
- generalized transfer function, central blood pressure, augmentation index, treated hypertension, antihypertensive drugs, brachial blood pressure, pulse wave velocity
- MeSH terms
- Adrenergic beta-Antagonists, Adult, Aged, Aged, 80 and over, Angiotensin-Converting Enzyme Inhibitors, Aorta, Blood Pressure, Blood Pressure Determination, Calcium Channel Blockers, Cross-Sectional Studies, Diuretics, Female, Humans, Hypertension, Male, Middle Aged, Radial Artery
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