Prospective Evaluation of a Method for Estimating Ascending Aortic Pressure From the Radial Artery Pressure Waveform
Abstract
Pressure wave reflection in the upper limb causes amplification of the arterial pulse so that radial systolic and pulse pressures are greater than in the ascending aorta. Wave transmission properties in the upper limbs (in contrast to the descending aorta and lower limbs) change little with age, disease, and drug therapy in adult humans. Such consistency has led to use of a generalized transfer function to synthesize the ascending aortic pressure pulse from the radial pulse. Validity of this approach was tested for estimation of aortic systolic, diastolic, pulse, and mean pressures from the radial pressure waveform. Ascending aortic and radial pressure waveforms were recorded simultaneously at cardiac surgery, before initiation of cardiopulmonary bypass, with matched, fluid-filled manometer systems in 62 patients under control conditions and during nitroglycerin infusion. Aortic pressure pulse waves, generated from the radial pulse, showed agreement with the measured aortic pulse waves with respect to systolic, diastolic, pulse, and mean pressures, with mean differences <1 mm Hg. Control differences in Bland-Altman plots for mean±SD in mm Hg were systolic, 0.0±4.4; diastolic, 0.6±1.7; pulse, −0.7±4.2; and mean pressure, −0.5±2.0. For nitroglycerin infusion, differences respectively were systolic, −0.2±4.3; diastolic, 0.6±1.7; pulse, −0.8±4.1; and mean pressure, −0.4±1.8. Differences were within specified limits of the Association for the Advancement of Medical Instrumentation SP10 criteria. In contrast, differences between recorded radial and aortic systolic and pulse pressures were well outside the criteria (respectively, 15.7±8.4 and 16.3±8.5 for control and 14.5±7.3 and 15.1±7.3 mm Hg for nitroglycerin). Use of a generalized transfer function to synthesize radial artery pressure waveforms can provide substantially equivalent values of aortic systolic, pulse, mean, and diastolic pressures.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
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?
Brachial pulse wave was assessed using a valid transfer function.
“Following the 10-minute rest, the brachial pulse wave was assessed to determine measures of PWR using a valid transfer function.12”
From The Effects of Caffeine and Resistance Exercise on Pulse Wave Reflection in Resistance-Trained Women (2025) · cites this paper as [12]
Data Handling and Analysis (page unavailable) describes applying a generalized transfer function to a radial pressure waveform to estimate an aortic waveform; the Discussion reports substantial agreement with measured aortic pressures. This supports the transfer function’s validity for that application, but not the claim that it was used to assess a brachial pulse wave for PWR. (LLM, conf=0.85)
Experimental — accuracy not yet measuredIn response to an acute bout of resistance exercise, measures of pulse wave reflection are significantly increased.
“In response to an acute bout of resistance exercise (RE) measures of PWR are significantly increased.9–12”
From The Effects of Caffeine and Resistance Exercise on Pulse Wave Reflection in Resistance-Trained Women (2025) · cites this paper as [12]
The Abstract describes measurements in cardiac-surgery patients under control conditions and during nitroglycerin infusion, not after resistance exercise. The Discussion mentions wave-reflection indices in relation to vasoactive agents, but the passages found when searching for resistance exercise and exercise-related wave reflection do not report whether those indices increase after an acute bout. (LLM, conf=0.75)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
STATISTICAL METHODS FOR ASSESSING AGREEMENT BETWEEN TWO METHODS OF CLINICAL MEASUREMENT
Martin Bland, J., & Altman, D. (1986) · The Lancet · doi:10.1016/s0140-6736(86)90837-8 · Cited by 47,965 · see citing works
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
Self-citationKELLY, R. P., GIBS, H. H., O'ROURKE, M. F., DALEY, J. E., MANG, K., MORGEN, J. J., & AVOLID, A. P. (1990) · European Heart Journal · doi:10.1093/oxfordjournals.eurheartj.a059669 · Cited by 312 · see citing works
Self-citation
Flagged first, then by citations
Research works printed but not linked: 33
- Benetos A, Rudnichi A, Safar M, Guize L. Pulse pressure and cardiovas- cular mortality in normotensive and hypertensive subjects. Hypertension. 1998;32:560 -564.
- Franklin SS, Khan SA, Wong ND, Larson MG, Levy D. Is pulse pressure useful in predicting risk for coronary heart disease? The Framingham Heart Study. Circulation. 1999;100:354 -360.
- O'Rourke MF, Frohlich ED. Pulse pressure: is this a clinically useful risk factor? Hypertension. 1999;34:372-374. Editorial.
- Breithaupt-Grogler K, Belz G. Epidemiology of arterial stiffness. Pathol Biol. 1999;47:604 -613.
- Franklin SS, Khan SA, Wong ND, Larson MG, Levy D. Does the relation of blood pressure to coronary heart disease risk change with aging? Framingham Heart Study. Circulation. 2001;103:1245-1249.
- Pauca AL, Wallenhaupt SL, Kon ND, Tucker WY. Does radial artery pressure accurately reflect aortic pressure? Chest. 1992;102:1193-1198.
- Moffitt EA, Sethna DH, Gray RJ, DeRobertis M, Matloff JM, Bussell JA. Rate-pressure product correlates poorly with myocardial oxygen consumption during anaesthesia in coronary patients. Can Anaesth Soc J. 1984;31:5-12.
- Chen CH, Ting CT, Lin SJ, Hsu TL, Yin FCP, Siu CO, Chou P, Wang SP, Chang MS. Different effects of fosinopril and atenolol on wave reflections in hypertensive patients. Hypertension. 1995;25:1034 -1041.
- Mitchell GF, Pfeffer MA, Finn PV, Pfeffer JM. Equipotent antihyper- tensive agents variously effect pulsatile hemodynamics and regression of cardiac hypertrophy in spontaneously hypertensive rats. Circulation. 1996;94:2923-2929.
- Karamanoglou M, O'Rourke MF, Avolio AP, Kelly RP. An analysis of the relationship between central aortic and peripheral upper limb pressure waves in man. Eur Heart J. 1993;14:160 -167.
- Chen CH, Nevo E, Fetics B, Pak PH, Yin FCP, Maughan L, Kass D. Estimation of central aortic pressure waveform by mathematical trans- formation of radial tonometry pressure: validation of generalized transfer function. Circulation. 1997;95:1827-1836.
- Kass DA, Chen CH, Nevo E, Fetics B, Pak PH, Maughan WL, Yin FCP. Estimation of central aortic pressure waveform by mathematical transformation of radial tonometry pressure data. Circulation. 1998;98:186-187. Letter.
- Fetics B, Nevo E, Chen C-H, Kass DA. Parametric model derivation of transfer function for noninvasive estimation of aortic pressure by radial tonometry. IEEE Trans Biomed Eng. 1999;46:698 -706.
- Gardner RM. Direct blood pressure measurement: dynamic response requirements. Anesthesiology. 1981;54:227-236.
- Kleinman B, Powell S, Kumar P, Gardner R. The flush test measures the dynamic responses of the entire pressure monitoring system. Anesthe- siology. 1992;77:1215-1220.
- Wiggers C. The Pressure Pulse in the Cardiovascular System. New York, NY: Longmans; 1928:47-90, 106 -118.
- Kroeker EJ, Wood EH. Beat-to-beat alterations in relationship of simul- taneously recorded central and peripheral arterial pressure pulses during Valsalva maneuver and prolonged expiration in man. J Appl Physiol. 1956;8:483-494.
- Kroeker EJ, Wood EH. Comparison of simultaneously recorded central and peripheral arterial pressure pulses during rest, exercise and tilted position in man. Circ Res. 1955;3:623-632.
- Remington JW, Wood EH. Formation of peripheral pulse contour in man. J Appl Physiol. 1956;9:433-442.
- Rowell LB, Brengelmann GL, Blackman JR, Bruce RA, Murray JA. Dis- parities between aortic and peripheral pulse pressured induced by upright exercise and vasomotor changes in man. Circulation. 1968;37:954 -964.
- O'Rourke MF. Influence of ventricular ejection on the relationship between central aortic and brachial pressure pulse in man. Cardiovasc Res. 1970;4:291-300.
- Liao D, Arnett DK, Tyroler HA, Riley WA, Chambless LE, Szklo M, Heiss G. Arterial stiffness and the development of hypertension: the ARIC study. Hypertension. 1999;34:201-206.
- Simons PCG, Algra A, Bots ML, Grobbee DE, van der Graaf Y, for the SMART Study Group. Common carotid intima-media thickness and ar- terial stiffness: indicators of cardiovascular risk in high-risk patients: the SMART Study (Second Manifestations of ARTerial disease). Circu- lation. 1999;100:951-957.
- Mann DL. Mechanisms and models in heart failure: a combinatorial approach. Circulation. 1999;100:999 -1008.
- Heart Outcomes Prevention Evaluation Study Investigators. Effects of an angiotensin-converting-enzyme inhibitor, Ramipril, on death from car- diovascular causes, myocardial infarction, and stroke in high-risk patients. N Engl J Med. 2000;342:145-153.
- O'Rourke MF, Nichols WW. Effects of ramipril on cardiovascular events in high risk patients. N Engl J Med. 2000;343:64 -65.
- O'Rourke MF. Pressure and flow waves in systemic arteries and the ana- tomical design of the arterial system. J Appl Physiol. 1967;23:139 -149.
- Avolio AP, Chen S, Wang R, Zhang C, Li M, O'Rourke MF. Effects of aging on changing arterial compliance and left ventricular load in a northern Chinese urban community. Circulation. 1983;68:50 -58.
- Gallagher D. Analysis of Pressure Wave Propagation in the Human Upper Limb: Physical Determinants and Clinical Applications [MD thesis]. New South Wales, Australia: University of New South Wales; 1993.
- Lasance HAJ, Wesseling KH, Ascoop CA. Peripheral pulse contour analysis in determining stroke volume. In: Progress Report 5. Utrecht, Netherlands; Institute of Medical Physics; 1976:59 -62.
- Soderstrom S, Nyberg J, Ponten J, Sellgren J, O'Rourke MF. Substantial equivalence between ascending aortic pressure waveforms and waveforms derived from the radial pulse using a generalised transfer function? FASEB J. 1998;12:A712.
- White WB, Berson AS, Robbins C, Jamieson MJ, Prisant LM, Roccella E, Sheps SG. National standard for measurement of resting and ambu- latory blood pressures with automated sphygmomanometers. Hyper- tension. 1993;21:504 -509.
- Harms MPM, Wesseling KH, Pott F, Jenstrup M, Van Goudoever J, Secher NH, Van Lieshout JJ. Continuous stroke volume monitoring by modelling flow from non-invasive measurement of arterial pressure in humans under orthostatic stress. Clin Sci. 1999;97:291-301.
Cited by
Sorted by citations
Expert consensus document on arterial stiffness: methodological issues and clinical applications
Laurent, S., Cockcroft, J., Van Bortel, L., Boutouyrie, P., Giannattasio, C., Hayoz, D., Pannier, B., Vlachopoulos, C., Wilkinson, I., Struijker-Boudier, H., et al. (2006) · European Heart Journal · doi:10.1093/eurheartj/ehl254 · Cited by 6,077 · see citing works
Schwartz, G., Tee, B. C.-K., Mei, J., Appleton, A. L., Kim, D. H., Wang, H., & Bao, Z. (2013) · Nature Communications · doi:10.1038/ncomms2832 · Cited by 2,042 · see citing works
O’Rourke, M. F., & Safar, M. E. (2005) · Hypertension · doi:10.1161/01.hyp.0000168052.00426.65 · Cited by 1,279 · see citing works
Self-citationArterial stiffness, wave reflections, and the risk of coronary artery disease
Weber, T., Auer, J., O’Rourke, M. F., Kvas, E., Lassnig, E., Berent, R., & Eber, B. (2004) · Circulation · doi:10.1161/01.cir.0000105767.94169.e3 · Cited by 1,081 · see citing works
Self-citationPimenta, E., Gaddam, K. K., Oparil, S., Aban, I., Husain, S., Dell'Italia, L. J., & Calhoun, D. A. (2009) · Hypertension · doi:10.1161/hypertensionaha.109.131235 · Cited by 531 · see citing works
Vlachopoulos, C., Dima, I., Aznaouridis, K., Vasiliadou, C., Ioakeimidis, N., Aggeli, C., Toutouza, M., & Stefanadis, C. (2005) · Circulation · doi:10.1161/circulationaha.105.535435 · Cited by 492 · see citing works
CPAP and measures of cardiovascular risk in males with OSAS
Kohler, M., Pepperell, J. C. T., Casadei, B., Craig, S., Crosthwaite, N., Stradling, J. R., & Davies, R. J. O. (2008) · European Respiratory Journal · doi:10.1183/09031936.00026608 · Cited by 197 · see citing works
Okada, Y., Galbreath, M. M., Shibata, S., Jarvis, S. S., VanGundy, T. B., Meier, R. L., Vongpatanasin, W., Levine, B. D., & Fu, Q. (2012) · Hypertension · doi:10.1161/hypertensionaha.111.176560 · Cited by 190 · see citing works
Arterial Stiffness in Mild Primary Hyperparathyroidism
Rubin, M. R., Maurer, M. S., McMahon, D. J., Bilezikian, J. P., & Silverberg, S. J. (2005) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2004-1400 · Cited by 145 · see citing works
Increased central arterial stiffness in hypothyroidism
Obuobie, K., Smith, J., Evans, L. M., John, R., Davies, J. S., & Lazarus, J. H. (2002) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2002-020493 · Cited by 119 · see citing works
Depression, anxiety, and arterial stiffness
Seldenrijk, A., van Hout, H. P. J., van Marwijk, H. W. J., de Groot, E., Gort, J., Rustemeijer, C., Diamant, M., & Penninx, B. W. J. H. (2011) · Biological Psychiatry · doi:10.1016/j.biopsych.2010.12.034 · Cited by 101 · see citing works
Acute caffeine intake influences central more than peripheral blood pressure in young adults
Waring, W. (2003) · American Journal of Hypertension · doi:10.1016/s0895-7061(03)01014-8 · Cited by 84 · see citing works
Casey, D. P., Curry, T. B., Joyner, M. J., Charkoudian, N., & Hart, E. C. (2011) · Hypertension · doi:10.1161/hypertensionaha.110.164517 · Cited by 83 · see citing works
Scott, J. A., Coombes, J. S., Prins, J. B., Leano, R. L., Marwick, T. H., & Sharman, J. E. (2008) · American Journal of Hypertension · doi:10.1038/ajh.2008.166 · Cited by 82 · see citing works
Effect of Caffeine on Aortic Elastic Properties and Wave Reflection
Vlachopoulos, C., Hirata, K., & O'Rourke, M. F. (2003) · Journal of Hypertension · doi:10.1097/00004872-200303000-00022 · Cited by 79 · see citing works
Self-citationEffect of testosterone replacement therapy on arterial stiffness in older hypogonadal men
Yaron, M., Greenman, Y., Rosenfeld, J. B., Izkhakov, E., Limor, R., Osher, E., Shenkerman, G., Tordjman, K., & Stern, N. (2009) · European Journal of Endocrinology · doi:10.1530/eje-09-0052 · Cited by 78 · see citing works
Armstrong, M. K., Schultz, M. G., Picone, D. S., Black, J. A., Dwyer, N., Roberts-Thomson, P., & Sharman, J. E. (2019) · Hypertension · doi:10.1161/hypertensionaha.119.12674 · Cited by 59 · see citing works
Krasińska, B., Miazga, A., Cofta, S., Szczepaniak-Chicheł, L., Trafas, T., Krasiński, Z., Pawlaczyk-Gabriel, K., & Tykarski, A. (2016) · Polish Archives of Internal Medicine · doi:10.20452/pamw.3410 · Cited by 43 · see citing works
Vanhatalo, A., L'Heureux, J. E., Black, M. I., Blackwell, J. R., Aizawa, K., Thompson, C., Williams, D. W., van der Giezen, M., Winyard, P. G., & Jones, A. M. (2025) · Free Radical Biology and Medicine · doi:10.1016/j.freeradbiomed.2025.07.002 · Cited by 15 · see citing works
Acute resistance exercise using free weights on aortic wave reflection characteristics
Tai, Y. L., Gerhart, H., Mayo, X., & Kingsley, J. D. (2018) · Clinical Physiology and Functional Imaging · doi:10.1111/cpf.12396 · Cited by 14 · see citing works
Measurements of arterial pressure and flow in vivo
Sharman, J. E., Segers, P., & Chirinos, J. A. (2022) · Textbook of Arterial Stiffness and Pulsatile Hemodynamics in Health and Disease · doi:10.1016/b978-0-323-91391-1.00002-9 · Cited by 3 · see citing works
Li, D., Jovanovski, E., Zurbau, A., Sievenpiper, J., Milicic, D., El-Sohemy, A., & Vuksan, V. (2024) · Nutrients · doi:10.3390/nu16173018 · Cited by 3 · see citing works
The Effects of Caffeine and Resistance Exercise on Pulse Wave Reflection in Resistance-Trained Women
Kearney, S. G., Smith, T. M., Paskert Joplin, M. C., Marshall, E. M., Parks, J. C., Humm, S. M., Kern, M. A., & Kingsley, J. D. (2025) · International Journal of Exercise Science · doi:10.70252/rwdy4284 · Cited by 2 · see citing works
- Authors
- Pauca, A. L., O’Rourke, M. F., & Kon, N. D.
- Affiliations
- UNSW Sydney (AU)
- ORCID
- O’Rourke, Michael F.
- Venue
- Hypertension
- Published
- 2001-10
- Volume
- 38
- Issue
- 4
- Pages
- 932-937
- ISSN
- 0194-911X (ISSN-L)
- 1524-4563
- OpenAlex
- W2096998744
- Cited by
- 1,179
- References
- 3
- Citations by year
- 2026: 16 · 2025: 18 · 2024: 28 · 2023: 23 · 2022: 37 · 2021: 38 · 2020: 42 · 2019: 44 · 2018: 39 · 2017: 58 · 2016: 59 · 2015: 65 · 2014: 80 · 2013: 70 · 2012: 84
- FWCI
- 19.59
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Hypertension (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Health Sciences › Medicine › Surgery › Hemodynamic Monitoring and Therapy
- Physical Sciences › Engineering › Biomedical Engineering › Non-Invasive Vital Sign Monitoring
- Keywords
- radial artery pressure waveform, pressure wave reflection, generalized transfer function, nitroglycerin, cardiopulmonary bypass, systolic blood pressure, diastolic blood pressure, pulse pressure, mean pressure
- MeSH terms
- Aged, Anesthesia, Aorta, Blood Pressure, Blood Pressure Determination, Cardiopulmonary Bypass, Female, Nitroglycerin, Heart Diseases, Hemodynamics, Humans, Male, Middle Aged, Prospective Studies, Radial Artery, Sphygmomanometers
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
