Age-related changes in peripheral pulse timing characteristics at the ears, fingers and toes
Open accessAbstract
It is accepted that older subjects have increasing arterial stiffness, which results in increasingly faster pulse transmission to the periphery. However, this age association is less clear in younger subjects and for different peripheral measurement sites. The aims of this study were to determine the association between age and pulse timing characteristics over a five decade age range at the ears, fingers and toes, and to compare these with any additional effects associated with differences in subject height, systolic blood pressure and heart rate. Photoplethysmography pulse wave-forms were recorded noninvasively from the right and left sides at the ears, fingers and toes of 116 normal healthy human subjects. Their median age was 42 years (range 13-72 years). Systolic blood pressure, height and heart rate were also measured. Pulse transit times (PTTs) were determined and referenced to the electrocardiogram R wave. The results revealed that age was the strongest contributor to PTT differences at all sites (P<0.0001). The decrease with ageing was greatest at the toes: -1.6, -0.6, -0.4 ms/year for the toes, fingers, and ears, respectively. Changes for the right and left body sides at each level were highly similar. Blood pressure was also an important contributor to PTT at all sites (P<0.0001); -1.0, -0.4, -0.3 ms/mm Hg, respectively, with approximately half of the effect explained by age. Height was significantly and independently related to PTT at the fingers and toes (P<0.0001); +1.1, +0.7 ms/cm, respectively. The fraction of PTT variability explained by these relationships was 0.65, 0.48, 0.26 for the toes, fingers and ears, respectively (P<0.0001). Finally, we concluded that the age effect decreased linearly from the second to the seventh decades, demonstrating that the effect of changes in arterial stiffness can be detected noninvasively from an early age at three main peripheral sites. Age is the dominant factor in contributing to PTT, and is greatest at the toes, followed by the fingers and then the ears.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
As age increases, PTT decreases.
“PTT is inversely related to PWV—the same authors note in a different work that as age increases, PTT decreases.”
From Sources of inaccuracy in photoplethysmography for continuous cardiovascular monitoring (2021) · cites this paper as [91]
In a population of 134 healthy, Caucasian subjects (median age 43, total range: 13-72), there was a statistically significant decrease in PTT at the toes (r2 = 0.48), fingers (r2 = 0.26), and ears (r2 = 0.15).
“By analyzing the change in PTT as a function of age within a population of 134 healthy, Caucasian subjects (median age 43, total range: 13–72), it was found that there is a statistically significant decrease at the toes (r2 = 0.48), fingers (r2 = 0.26), and ears (r2 = 0.15) [91,92].”
From Sources of inaccuracy in photoplethysmography for continuous cardiovascular monitoring (2021) · cites this paper as [91]
PTT decreases as age increases.
“| PTT | Decrease | Allen et al., 2002 Monte-Moreno, 2011 | [91,92] |”
From Sources of inaccuracy in photoplethysmography for continuous cardiovascular monitoring (2021) · cites this paper as [91]
PTT is also similar bilaterally at the ears and finger, while a small difference exists at the toes.
“Additionally, PTT is also similar bilaterally at the ears and finger, while a small difference exists at the toes [91].”
From Sources of inaccuracy in photoplethysmography for continuous cardiovascular monitoring (2021) · cites this paper as [91]
Cites
McDonald's Blood Flow in Arteries: Theoretical, Experimental and Clinical Principles
Vlachopoulos, C., O'Rourke, M., & Nichols, W. W. (2011) · doi:10.1201/b13568 · Cited by 1,613 · see citing works
Asmar, R., Benetos, A., Topouchian, J., Laurent, P., Pannier, B., Brisac, A.-M., Target, R., & Levy, B. I. (1995) · Hypertension · doi:10.1161/01.hyp.26.3.485 · Cited by 1,376 · see citing works
McDonaldʼs Blood Flow in Arteries
Nichols, W. W., O'Rourke, M. F., & Kenney, W. L. (1991) · Journal of Cardiopulmonary Rehabilitation · doi:10.1097/00008483-199111000-00023 · Cited by 456 · see citing works
Chen, W., Kobayashi, T., Ichikawa, S., Takeuchi, Y., & Togawa, T. (2000) · Medical & Biological Engineering & Computing · doi:10.1007/bf02345755 · Cited by 425 · see citing works
Wilkinson, I. B., Hall, I. R., MacCallum, H., Mackenzie, I. S., McEniery, C. M., van der Arend, B. J., Shu, Y.-E., Mackay, L., Webb, D. J., & Cockcroft, J. R. (2002) · Arteriosclerosis Thrombosis and Vascular Biology · doi:10.1161/hq0102.101770 · Cited by 371 · see citing works
Skin photoplethysmography — a review
Kamal, A. A. R., Harness, J. B., Irving, G., & Mearns, A. J. (1989) · Computer Methods and Programs in Biomedicine · doi:10.1016/0169-2607(89)90159-4 · Cited by 328 · see citing works
Noninvasive Assessment of the Digital Volume Pulse
Millasseau, S., Guigui, F. G., Kelly, R. P., Prasad, K., Cockcroft, J., Ritter, J. M., & Chowienczyk, P. (2000) · Hypertension · doi:10.1161/01.hyp.36.6.952 · Cited by 292 · see citing works
Bortolotto, L. A., Blacher, J., Kondo, T., Takazawa, K., & Safar, M. E. (2000) · American Journal of Hypertension · doi:10.1016/s0895-7061(99)00192-2 · Cited by 272 · see citing works
Pulse Wave Velocity as a Measure of Blood Pressure Change
Gribbin, B., Steptoe, A., & Sleight, P. (1976) · Psychophysiology · doi:10.1111/j.1469-8986.1976.tb03344.x · Cited by 227 · see citing works
The difference in pulse transit time to the toe and finger measured by photoplethysmography
Nitzan, M., Khanokh, B., & Slovik, Y. (2001) · Physiological Measurement · doi:10.1088/0967-3334/23/1/308 · Cited by 218 · see citing works
Photoelectric Plethysmography of the Fingers and Toes in Man
Hertzman, A. B. (1937) · Experimental Biology and Medicine · doi:10.3181/00379727-37-9630 · Cited by 217 · see citing works
Vascular surgery : a comprehensive review
Moore, W. S. (1983) · Cited by 192 · see citing works
Pulse wave analysis and arterial stiffness.
Wilkinson, I. B., Cockcroft, J., & Webb, D. J. (1998) · PubMed · Cited by 157 · see citing works
O’Rourke, M. F., Kelly, R. P., & Avolio, A. P. (1991) · Cited by 148 · see citing works
Non-invasive physiological measurements
Escourrou, P. (1988) · Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society · doi:10.1109/iembs.1988.95111 · Cited by 102 · see citing works
Allen, J., & Murray, A. (2000) · Physiological Measurement · doi:10.1088/0967-3334/21/3/303 · Cited by 93 · see citing works
Self-citationVariability of photoplethysmographyperipheral pulse measurementsat the ears, thumbs and toes
Allen, J., & Murray, A. (2000) · IEE Proceedings - Science Measurement and Technology · doi:10.1049/ip-smt:20000846 · Cited by 76 · see citing works
Self-citationJago, J. R., & Murray, A. (1988) · Clinical Physics and Physiological Measurement · doi:10.1088/0143-0815/9/4/003 · Cited by 74 · see citing works
Self-citationDeterminants of blood pressure changes due to urbanization: a longitudinal study.
Nr, P., Khaw, K., Be, H., et al. (1985) · PubMed · Cited by 71 · see citing works
The Arterial Circulation: Physical Principles and Clinical Applications
Li, J. K.-J. (2000) · Medical Entomology and Zoology · Cited by 71 · see citing works
Allen, J., & Murray, A. (1999) · Physiological Measurement · doi:10.1088/0967-3334/20/3/306 · Cited by 71 · see citing works
Self-citationEstimation of respiratory volumes from the photoplethysmographic signal. Part 2: a model study
Johansson, A., & Öberg, P. Å. (1999) · Medical & Biological Engineering & Computing · doi:10.1007/bf02513265 · Cited by 58 · see citing works
Vascular Surgery, a Comprehensive Review
Marty, A. T. (1991) · Critical Care Medicine · doi:10.1097/00003246-199108000-00034 · Cited by 54 · see citing works
Increase in pulse transit time to the foot after epidural anaesthesia treatment
Babchenko, A., Davidson, E. M., Adler, D., Ginosar, Y., Kurz, V., & Nitzan, M. (2000) · Medical & Biological Engineering & Computing · doi:10.1007/bf02344874 · Cited by 52 · see citing works
The Arterial Circulation: Physical Principles and Clinical Applications: J.K-J. Li
Parker, K. H. (2000) · Medical Engineering & Physics · doi:10.1016/s1350-4533(00)00054-0 · Cited by 49 · see citing works
Influence of thoracic sympathectomy on cardiac induced oscillations in tissue blood volume
Nitzan, M., Babchenko, A., Shemesh, D., & Alberton, J. (2001) · Medical & Biological Engineering & Computing · doi:10.1007/bf02345149 · Cited by 46 · see citing works
Current Noninvasive Vascular Diagnosis.
(1988) · Annals of Internal Medicine · doi:10.7326/0003-4819-108-6-917_6 · Cited by 36 · see citing works
Estimation of respiratory volumes from the photoplethysmographic signal
Johansson, A. J., & Öberg, Å. (1997) · Cited by 32 · see citing works
Allen, J., & Murray, A. (1995) · Physiological Measurement · doi:10.1088/0967-3334/16/1/003 · Cited by 30 · see citing works
Self-citationOkada, M., Kimura, S., & Okada, M. (1986) · Medical & Biological Engineering & Computing · doi:10.1007/bf02441621 · Cited by 26 · see citing works
KAWARADA, A., Shimazu, H., Yamakoshi, K., & Kamiya, A. (1986) · Medical & Biological Engineering & Computing · doi:10.1007/bf02446261 · Cited by 20 · see citing works
A practice of vascular surgery
Kester, R. C., & Leveson, S. H. (1981) · Medical Entomology and Zoology · Cited by 11 · see citing works
Comparison of regional variability in multi-site photoplethysmographic pulse wave characteristics
Allen, J. (2000) · doi:10.1049/cp:20000313 · Cited by 8 · see citing works
Self-citation
Flagged first, then by citations
Cited by
Sorted by citations
Photoplethysmography and its application in clinical physiological measurement
Allen, J. (2007) · Physiological Measurement · doi:10.1088/0967-3334/28/3/r01 · Cited by 3,967 · see citing works
Self-citationToward ubiquitous blood pressure monitoring via pulse transit time: Theory and practice
Mukkamala, R., Hahn, J.-O., Inan, O. T., Mestha, L. K., Kim, C.-S., Toreyin, H., & Kyal, S. (2015) · IEEE Transactions on Biomedical Engineering · doi:10.1109/tbme.2015.2441951 · Cited by 935 · see citing works
Gil, E., Orini, M., Bailón, R., Vergara, J. M., Mainardi, L., & Laguna, P. (2010) · Physiological Measurement · doi:10.1088/0967-3334/31/9/015 · Cited by 461 · see citing works
Sources of inaccuracy in photoplethysmography for continuous cardiovascular monitoring
Fine, J., Branan, K. L., Rodriguez, A. J., Boonya-ananta, T., Ajmal, Ramella-Roman, J. C., McShane, M. J., & Coté, G. L. (2021) · Biosensors · doi:10.3390/bios11040126 · Cited by 348 · see citing works
Cuff-Less and Continuous Blood Pressure Monitoring: A Methodological Review
Sharma, M., Barbosa, K., Ho, V., Griggs, D., Ghirmai, T., Krishnan, S., Hsiai, T., Chiao, J.-C., & Cao, H. (2017) · Technologies · doi:10.3390/technologies5020021 · Cited by 226 · see citing works
Allen, J., & Murray, A. (2003) · Physiological Measurement · doi:10.1088/0967-3334/24/2/306 · Cited by 202 · see citing works
Self-citationPhotoplethysmography signal processing and synthesis
Mejía-Mejía, E., Allen, J., Budidha, K., El-Hajj, C., Kyriacou, P. A., & Charlton, P. H. (2022) · Photoplethysmography · doi:10.1016/b978-0-12-823374-0.00015-3 · Cited by 138 · see citing works
Self-citationEvaluation of blood pressure changes using vascular transit time
Foo, J. Y. A., Lim, C. S., & Wang, P. (2006) · Physiological Measurement · doi:10.1088/0967-3334/27/8/003 · Cited by 62 · see citing works
Alsop, P., & Hauton, D. (2016) · European Journal of Applied Physiology · doi:10.1007/s00421-016-3418-7 · Cited by 37 · see citing works
Sex-Related Differences in Photoplethysmography Signals Measured From Finger and Toe
Dehghanojamahalleh, S., & Kaya, M. (2019) · IEEE Journal of Translational Engineering in Health and Medicine · doi:10.1109/jtehm.2019.2938506 · Cited by 25 · see citing works
- Authors
- Allen, J., & Murray, A.
- Affiliations
- Freeman Hospital (GB)
- Corresponding author
- Allen, J
- Venue
- Journal of Human Hypertension
- Published
- 2002-10-01
- Volume
- 16
- Issue
- 10
- Pages
- 711-717
- ISSN
- 0950-9240 (ISSN-L)
- 1476-5527
- OpenAlex
- W2040077535
- Cited by
- 179
- References
- 33
- Citations by year
- 2026: 5 · 2025: 11 · 2024: 6 · 2023: 3 · 2022: 9 · 2021: 10 · 2020: 10 · 2019: 9 · 2018: 12 · 2017: 11 · 2016: 5 · 2015: 10 · 2014: 8 · 2013: 4 · 2012: 10
- FWCI
- 2.84
- Type
- journal article
- Language
- en
- Open access
- green
- doi.org
- Locations
- Journal of Human Hypertension (publishedVersion)
- PubMed (publishedVersion)
- Newcastle University ePrints (Newcastle Univesity)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Physical Sciences › Engineering › Biomedical Engineering › Non-Invasive Vital Sign Monitoring
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Keywords
- pulse transit time, arterial stiffness, aging, photoplethysmography, systolic blood pressure, body height, heart rate, ear, finger, toe
- MeSH terms
- Adolescent, Adult, Age Factors, Aged, Aging, Body Height, Ear, Female, Fingers, Heart Rate, Humans, Male, Middle Aged, Plethysmography, Pulse, Toes, Linear Models
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
