Age-related changes in the characteristics of the photoplethysmographic pulse shape at various body sites
Open accessAbstract
It is accepted that older subjects have increasing arterial stiffness resulting in changes in the propagation of the pulse to the periphery, and thereby influencing the peripheral pulse timing and shape characteristics. However, this age association with pulse shape is less clear in younger subjects and for different peripheral measurement sites. The aim of this study was to determine the association between age and changes in pulse shape characteristics at the ears, fingers and toes. Photoplethysmography pulse waveforms were recorded non-invasively from the right and left sides at the ears, index fingers and great toes of 116 normal healthy human subjects. Their median age was 41 years (range 13-72) allowing four distinct age groups to be considered (subjects younger than 30 years, 30-39 years, 40-49 years and 50 years of age or older). Normalized ear, finger and toe pulse shapes were calculated, for the whole subject group, and for the subjects within each age group. The differences in shape, relative to the oldest group, were also calculated for two distinct regions of interest: the systolic rising edge and the dicrotic notch of the pulse. Subtle, gradual and significant changes in the pulse shape were found at all sites with overall elongation of the systolic rising edge (p < 0.05) and damping of the dicrotic notch (p < 0.05) with age. The overall age-related changes in multi-site PPG pulse shape characteristics at the ear, finger and toe sites have been demonstrated and quantified. Age-matched normal ranges must be considered when evaluating pulses from patients with possible vascular disease.
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Allen and Murray found that an increase in pulse wave velocity with age is related to a diminished dicrotic notch.
“Corroborating with other literature, an increase in pulse wave velocity with age is related to a diminished dicrotic notch.”
From Sources of inaccuracy in photoplethysmography for continuous cardiovascular monitoring (2021) · cites this paper as [90]
Dicrotic notch shape decreases as age increases.
“| Dicrotic notch shape | Decrease | Allen et al., 2003 | [90] |”
From Sources of inaccuracy in photoplethysmography for continuous cardiovascular monitoring (2021) · cites this paper as [90]
Artery compliance decreases as age increases.
“| Artery compliance | Decrease | Knight et al., 2017 Allen et al., 2002 | [78,90] |”
From Sources of inaccuracy in photoplethysmography for continuous cardiovascular monitoring (2021) · cites this paper as [90]
Systolic rising edge slope decreases as age increases.
“| Systolic rising edge slope | Decrease | Allen et al., 2003 | [90] |”
From Sources of inaccuracy in photoplethysmography for continuous cardiovascular monitoring (2021) · cites this paper as [90]
PPG waveforms are largely similar between bilateral anatomies at the ear, finger, and toe at rest.
“Allen and Murray have noted that PPG waveforms are largely similar between bilateral anatomies at the ear, finger, and toe at rest, according to their study featuring 116 (68 male, 48 female) healthy Caucasian subjects with a median age of 43 [90].”
From Sources of inaccuracy in photoplethysmography for continuous cardiovascular monitoring (2021) · cites this paper as [90]
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- Authors
- Allen, J., & Murray, A.
- Affiliations
- Freeman Hospital (GB)
- Venue
- Physiological Measurement
- Publisher
- IOP Publishing
- Published
- 2003-03-13
- Volume
- 24
- Issue
- 2
- Pages
- 297-307
- ISSN
- 0967-3334 (ISSN-L)
- OpenAlex
- W1982898684
- Cited by
- 202
- References
- 22
- Citations by year
- 2026: 12 · 2025: 8 · 2024: 13 · 2023: 18 · 2022: 17 · 2021: 17 · 2020: 11 · 2019: 6 · 2018: 15 · 2017: 7 · 2016: 7 · 2015: 8 · 2014: 10 · 2013: 9 · 2012: 8
- FWCI
- 2.64
- Type
- journal article
- Language
- en
- Open access
- green
- doi.org
- Locations
- Physiological Measurement (publishedVersion)
- PubMed (publishedVersion)
- Newcastle University ePrints (Newcastle Univesity)
- Topics
- Physical Sciences › Engineering › Biomedical Engineering › Non-Invasive Vital Sign Monitoring
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Keywords
- photoplethysmography, pulse shape, aging, arterial stiffness, pulse wave propagation, dicrotic notch, age-related changes
- MeSH terms
- Adolescent, Adult, Aged, Aging, Arteries, Ear, Female, Fingers, Humans, Male, Middle Aged, Plethysmography, Pulsatile Flow, Toes
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