Abstract
Objectives:Aortic (central) blood pressure (BP) differs from brachial BP and may be a superior predictor of cardiovascular events. However, its measurement is currently restricted to research settings, owing to a moderate level of operator dependency. We tested a new noninvasive device in a large UK cohort. The device estimates central BP using measurements obtained with an upper arm cuff inflated to suprasystolic pressure. We compared these estimates with those obtained using radial tonometry as well as with invasively acquired measurements of aortic BP in a limited number of individuals.Methods:Consecutive cuff-based and tonometry-based estimates of the pressure waveform and the central BP were obtained from 1107 individuals (70 ± 6 years). Short-term and long-term reproducibility studies were performed on 28 individuals. Simultaneous cuff-based and invasively measured pressure traces were acquired and compared in an additional six individuals (65 ± 20 years).Results:Central systolic BP, as estimated by the cuff-based device, was found to be highly reproducible (coefficient of variation 4 and 8% for short and long-term reproducibility, respectively) and was comparable to that estimated by tonometry (average difference 3 ± 6 mmHg, intraclass correlation coefficient = 0.91). The cuff-based pressure waveforms were similar to those acquired invasively (cross-correlation coefficient 0.93), and the difference in the estimated central systolic BP was −5 ± 8 mmHg (P = 0.2).Conclusion:Cuff-based devices show promise to simplify the measurement of central BP, whilst maintaining a similar fidelity to tonometry. This could lead to improved adoption of estimates of central BP in clinical practice.
Highlights
Hypertension is a major determinant of cardiovascular disease (CVD) [1], and measurement of blood pressure (BP) using a brachial cuff is one of the most widely performed clinical investigations
Participating patients Noninvasive measurements were performed on 1107 participants aged 70 Æ 6 years recruited from the Southall And Brent REvisited (SABRE) study
Comparison of the central systolic BP (cSBP) estimated using the tonometer and the cuff-based device revealed that the cSBP was 3 Æ 6 mmHg higher when measured using the cuff-based device (Table 2, Fig. 2a)
Summary
Hypertension is a major determinant of cardiovascular disease (CVD) [1], and measurement of blood pressure (BP) using a brachial cuff is one of the most widely performed clinical investigations. Differences between central (aortic) and brachial BP could be clinically important, as central BP is more closely correlated with target organ damage in hypertension [4]; is differentially influenced by antihypertensive therapy compared with brachial BP [5]; and may be a superior predictor of cardiovascular events than brachial BP [6]. These three factors emphasize the potential importance of routine measurement of central BP in research and clinical settings
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