Cited by 168Cardiovascular Health and Disease PreventionBlood Pressure and Hypertension StudiesNon-Invasive Vital Sign Monitoring

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Use of radial artery applanation tonometry and a generalized transfer function to determine aortic pressure augmentation in subjects with treated hypertension

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Cameron, James D., McGrath, Barry P., Dart, Anthony M.·1998·Journal of the American College of Cardiology

DOI 10.1016/s0735-1097(98)00411-2

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Abstract

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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Estimation of Central Aortic Pressure Waveform by Mathematical Transformation of Radial Tonometry Pressure: Validation of Generalized Transfer Function
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Background
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Background
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“…et al. 2004; Pauca et al. 2001; Fetics et al. 1999; Chen et al. 1997; Karamanoglou et al. 1993], it should be noted that there are no large clinical studies validating its efficacy, and some researchers have questioned its reliability [Hope et al. 2003; Smulyan et al. 2003; Cameron et al. 1998].”
Result
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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.”
BackgroundResult
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Reply
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Background
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Editorial Commentary
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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).”
Background
Central 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.”
The Effect of Heart Rate on Wave Reflections May Be Determined by the Level of Aortic Stiffness: Clinical and Technical Implications
Papaioannou, T. G., Vlachopoulos, C., Alexopoulos, N. A., Dima, I., Pietri, P. G., Protogerou, A. D., Vyssoulis, G. P., & Stefanadis, C. (2008) · American Journal of Hypertension · doi:10.1038/ajh.2007.52 · Cited by 39
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…”
Background
Gender differences of aortic wave reflection and influence of menopause on central blood pressure in patients with arterial hypertension
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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].”
Background
Arterial compliance is a main variable determining the effectiveness of intra-aortic balloon counterpulsation: quantitative data from an in vitro study
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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].”
Method
A controlled study of the effects of isosorbide mononitrate on arterial blood pressure and pulse wave form in systolic hypertension
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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).”
Background
Increased pulse wave velocity is not associated with elevated augmentation index in patients with diabetes
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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].”
Result
Association 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 28
“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].”
Background
Reference 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
Surveillance of cardiovascular risk in the normotensive patient with repaired aortic coarctation
Swan, L., Kraidly, M., Muhll, I. V., Collins, P. D., & Gatzoulis, M. Α. (2008) · International Journal of Cardiology · doi:10.1016/j.ijcard.2008.10.043 · Cited by 29
Higher arterial stiffness is associated with lower cognitive performance in patients with hypertension
Muela, H. C. S., Costa‐Hong, V., Yassuda, M. S., Moraes, N. C., Memória, C. M., Machado, M. F., Bor‐Seng‐Shu, E., Nogueira, R. D. C., Mansur, A. J., Massaro, A. R., et al. (2017) · Journal of Clinical Hypertension · doi:10.1111/jch.13129 · Cited by 28
Effects of ACE inhibitor therapy on derived central arterial waveforms in hypertension
Dart, A. M., Reid, C. M., McGrath, B., & on behalf of the Tonometry Study Group (2001) · American Journal of Hypertension · doi:10.1016/s0895-7061(01)02142-2 · Cited by 28
Prader-Willi Syndrome Is Associated with Activation of the Innate Immune System Independently of Central Adiposity and Insulin Resistance
Viardot, A., Sze, L., Purtell, L., Sainsbury, A., Loughnan, G., Smith, E., Herzog, H., Steinbeck, K. S., & Campbell, L. V. (2010) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2009-2492 · Cited by 27
Clinical usefulness of the second peak of radial systolic blood pressure for estimation of aortic systolic blood pressure
Kohara, K., Tabara, Y., Tomita, H., Nagai, T., Igase, M., & Miki, T. (2009) · Journal of Human Hypertension · doi:10.1038/jhh.2008.154 · Cited by 25
Principles of Vascular Physiology
Segers, P., & Verdonck, P. (2002) · Springer eBooks · doi:10.1007/978-3-642-56225-9_6 · Cited by 25
Atherosclerotic risk factors and carotid stiffness in elderly asymptomatic HD patients
Tseke, P., Grapsa, E., Stamatelopoulos, K. S., Samouilidou, E. C., Protogerou, A. D., Papamichael, C. M., & Lagouranis, A. (2006) · International Urology and Nephrology · doi:10.1007/s11255-006-9000-1 · Cited by 24
Arterial Compliance
McVeigh, G. E., Bank, A. J., & Cohn, J. N. (2007) · Springer eBooks · doi:10.1007/978-1-84628-715-2_88 · Cited by 23
Low night-time heart rate is longitudinally associated with lower augmentation index and central systolic blood pressure in hypertension
Palatini, P., Saladini, F., Mos, L., Fania, C., Mazzer, A., & Casiglia, E. (2018) · European Journal of Applied Physiology · doi:10.1007/s00421-017-3789-4 · Cited by 22
“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).”
Background
Model-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
Correlation between augmentation index and pulse wave velocity in rabbits
Obara, S., Hayashi, S., Hazama, A., Murakawa, M., & Katsuda, S.-I. (2009) · Journal of Hypertension · doi:10.1097/hjh.0b013e32831ac951 · Cited by 22
Pulse pressure amplification in relation to body fatness
Wykrętowicz, A., Rutkowska, A., Krauze, T., Przymuszala, D., Guzik, P., Marciniak, R., & Wysocki, H. (2011) · British Journal of Clinical Pharmacology · doi:10.1111/j.1365-2125.2011.04129.x · Cited by 20
Predictors of high central blood pressure in young with isolated systolic hypertension
Radchenko, G., Torbas, O. O., & Sirenko, Y. (2016) · Vascular Health and Risk Management · doi:10.2147/vhrm.s97304 · Cited by 18
The Influence of Wave Reflection on Left Ventricular Hypertrophy in Hypertensive Patients Is Modified by Age and Gender
Matsui, Y., Ishikawa, J., Eguchi, K., Hoshide, S., Miyashita, H., Shimada, K., & Kario, K. (2008) · Hypertension Research · doi:10.1291/hypres.31.649 · Cited by 18
“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).”
Background
Arterial Compliance is an Independent Factor Predicting Acute Hemodynamic Performance of Intra-aortic Balloon Counterpulsation
Papaioannou, 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
Augmentation index is associated with coronary revascularization in patients with high Framingham risk scores: a hospital-based observational study
Choi, J., Kim, S., Joo, S., & Kim, K.-S. (2015) · BMC Cardiovascular Disorders · doi:10.1186/s12872-015-0123-0 · Cited by 17
“Age has been a known determinant of the AIx@75 [18].”
Background
Assessment of left ventricular end-systolic elastance from aortic pressure-left ventricular volume relations
Lee, W.-S., Nakayama, M., Huang, W., Chiou, K.-R., Wu, C., Nevo, E., Fetics, B. J., Kass, D. A., Ding, P. Y., & Chen, C. (2002) · Heart and Vessels · doi:10.1007/s003800200003 · Cited by 17
Development of spatial pulse diagnostic apparatus with magnetic sensor array
Choi, S. D., Kim, S. W., Kim, G. W., Ahn, M. C., Kim, M. S., Hwang, D. G., & Lee, S. (2006) · Journal of Magnetism and Magnetic Materials · doi:10.1016/j.jmmm.2006.10.1027 · Cited by 17
Atherosclerosis and folic acid supplementation trial in chronic renal failure: Baseline results
Zoungas, S., Branley, P., Kerr, P. G., Ristevski, S., Muske, C., Demos, L., Atkins, R. C., Becker, G. J., Fraenkel, M. B., HUTCHISON, B. G., et al. (2004) · Nephrology · doi:10.1111/j.1440-1797.2004.00242.x · Cited by 17
Association of augmentation index of radial pressure wave form with diurnal variation pattern of blood pressure in untreated patients with essential hypertension
Shinohata, R., Nakatsu, T., Yuki, Y., Nishitani, A., Mashima, K., Toyonaga, S., Ogawa, H., Hirohata, S., Usui, S., Kitawaki, T., et al. (2008) · Journal of Hypertension · doi:10.1097/hjh.0b013e3282f2fdb6 · Cited by 16
Noninvasive measurements of central arterial pressure and distensibility by arterial applanation tonometry with a generalized transfer function: Implications for nursing
Tsai, P.-S., & Yucha, C. B. (2001) · Heart & Lung · doi:10.1067/mhl.2001.119829 · Cited by 16
Central aortic pressure is independently associated with diastolic function
Subherwal, S., Fuentes, L. D. L., Waggoner, A. D., Heuerman, S., Spence, K. E., & Dávila‐Román, V. G. (2010) · American Heart Journal · doi:10.1016/j.ahj.2010.02.024 · Cited by 15
Does Measurement of Central Blood Pressure have Treatment Consequences in the Clinical Praxis?
Mitchell, G. F. (2015) · Current Hypertension Reports · doi:10.1007/s11906-015-0573-x · Cited by 15
Impaired arterial elasticity in young patients with white-coat hypertension
Longo, D., Zaetta, V., Perkovic, D., Frezza, P., Ragazzo, F., Mos, L., Santonastaso, M., Garbelotto, R., Bénétos, A., & Palatini, P. (2006) · Blood Pressure Monitoring · doi:10.1097/01.mbp.0000209083.47740.35 · Cited by 15
Arterial Wave Reflections Are Associated With Left Ventricular Diastolic Dysfunction in Adamantiades-Behçet's Disease
Ikonomidis, I., Aznaouridis, K., Protogerou, A. D., Stamatelopoulos, K. S., Markomihelakis, N., Papamichael, C. M., Kaklamanis, P. G., Mavrikakis, M., & Lekakis, J. P. (2006) · Journal of Cardiac Failure · doi:10.1016/j.cardfail.2006.04.001 · Cited by 15
Baseline predictors of central aortic blood pressure: A PEAR substudy
Rosenwasser, R., Shah, N. K., Smith, S. M., Wen, X., Gong, Y., Gums, J. G., Nichols, W. W., Chapman, A. B., Boerwinkle, E., Johnson, J. A., et al. (2014) · Journal of the American Society of Hypertension · doi:10.1016/j.jash.2013.12.008 · Cited by 14
“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
Kim, S. W., Hwang, D. G., Choi, Y.-C., Lee, H. S., Park, D. H., Lee, S., Kim, G. W., Lee, S. G., & Lee, S. J. (2006) · Journal of Applied Physics · doi:10.1063/1.2177388 · Cited by 13
Optimal Range of Plasma Concentration of True 1-84 Parathyroid Hormone in Patients on Maintenance Dialysis
Fournier, A., Cohen-Solal, M. E., Oprisiu, R., Mazouz, H., Morini�re, P., Choukroun, G. J., & Bouillon, R. (2001) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.86.4.7436-8 · Cited by 13
Assessment of large artery function
Cameron, J. D., Gatzka, C. D., & Kingwell, B. A. (2002) · Coronary Artery Disease · doi:10.1097/00019501-200212000-00004 · Cited by 13
Augmentation index in the assessment of wave reflections and systolic loading
Kaya, M., Balasubramanian, V., & Li, J. K. ‐. (2019) · Computers in Biology and Medicine · doi:10.1016/j.compbiomed.2019.103418 · Cited by 12
Comparative effectiveness of a fixed-dose combination of losartan + HCTZ versus bisoprolol + HCTZ in patients with moderate-to-severe hypertension: results of the 6-month ELIZA trial
Radchenko, G., Sirenko, Y., Kushnir, Torbas, O. O., & Dobrohod (2013) · Vascular Health and Risk Management · doi:10.2147/vhrm.s44568 · Cited by 12
Regarding the accuracy of generalized transfer functions for estimating central aortic blood pressure
Lehmann, E. D. (1999) · Journal of Hypertension · doi:10.1097/00004872-199917080-00024 · Cited by 12
On the optimal temporal resolution for phase contrast cardiovascular magnetic resonance imaging: establishment of baseline values
Santini, F., Pansini, M., Paar, M. H., Yates, D. P., Langenickel, T., Bremerich, J., Bieri, O., & Schubert, T. B. (2020) · Journal of Cardiovascular Magnetic Resonance · doi:10.1186/s12968-020-00669-1 · Cited by 11
Wave reflection quantification analysis and personalized flow wave estimation based on the central aortic pressure waveform
Sun, H., Yao, Y., Liu, W., Zhou, S., Du, S., Tan, J., Yin, Y., Xu, L., & Avolio, A. P. (2023) · Frontiers in Physiology · doi:10.3389/fphys.2023.1097879 · Cited by 11
“, 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…”
Background
Cardiovascular risk analysis by means of pulse morphology and clustering methodologies
Almeida, V., Borba, J., Pereira, H. C., Pereira, T., Correia, C. M. B. A., Pêgo, M., & Cardoso, J. M. R. (2014) · Computer Methods and Programs in Biomedicine · doi:10.1016/j.cmpb.2014.06.010 · Cited by 11
“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].”
Background
Evaluation of noninvasive blood pressure recording by photoplethysmography in clinical studies using angiotensin challenges
Buclin, T., Buchwalder‐Csajka, Brunner, & Biollaz (1999) · British Journal of Clinical Pharmacology · doi:10.1046/j.1365-2125.1999.00049.x · Cited by 11

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.
ORCID: Cameron, James D.
Dart, Anthony M.
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)
DOI: 10.1016/s0735-1097(98)00411-2
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: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (vor, 5371 d)
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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Use of radial artery applanation tonometry and a generalized transfer function to determine aortic pressure augmentation in subjects with treated hypertension

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