Abstract
BackgroundLarge artery stiffening and wave reflections are independent predictors of adverse events. To date, their assessment has been limited to specialised techniques and settings. A new, more practical method allowing assessment of central blood pressure from waveforms recorded using a conventional automated oscillometric monitor has recently been validated in laboratory settings. However, the feasibility of this method in a community based setting has not been assessed.MethodsOne-off peripheral and central haemodynamic (systolic and diastolic blood pressure (BP) and pulse pressure) and wave reflection parameters (augmentation pressure (AP) and index, AIx) were obtained from 1,903 volunteers in an Austrian community setting using a transfer-function like method (ARCSolver algorithm) and from waveforms recorded with a regular oscillometric cuff. We assessed these parameters for known differences and associations according to gender and age deciles from <30 years to >80 years in the whole population and a subset with a systolic BP < 140 mmHg.ResultsWe obtained 1,793 measures of peripheral and central BP, PP and augmentation parameters. Age and gender associations with central haemodynamic and augmentation parameters reflected those previously established from reference standard non-invasive techniques under specialised settings. Findings were the same for patients with a systolic BP below 140 mmHg (i.e. normotensive). Lower values for AIx in the current study are possibly due to differences in sampling rates, detection frequency and/or averaging procedures and to lower numbers of volunteers in younger age groups.ConclusionA novel transfer-function like algorithm, using brachial cuff-based waveform recordings, provides robust and feasible estimates of central systolic pressure and augmentation in community-based settings.
Highlights
Large artery stiffening and wave reflections are independent predictors of adverse events
Central haemodynamic parameters Men and women demonstrated a similar increase in peripheral systolic blood pressure with age, whereas diastolic blood pressure increased to approximately 50 years and plateaued
Peripheral pulse pressure (PP) widened from 50 years onward with differences between men and women in the manner (p = 0.016, analysis of variance (ANOVA) gender by age) but not magnitude (p = 0.96, ANOVA gender) of change
Summary
Large artery stiffening and wave reflections are independent predictors of adverse events. To date, their assessment has been limited to specialised techniques and settings. The augmentation index is defined by a boost (augmentation) to blood pressure in late systole, attributed to the early return of wave reflection from peripheral sites [13]. It may have utility as a predictor of vascular events as large artery stiffening and wave reflections have been identified as the most important pathophysiological determinants of isolated systolic hypertension [14]. Pulse wave analysis is potentially a useful adjunct to cardiovascular risk assessment in clinical practice [16,17,18,19]
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