Exploring the Utility of Pulse Wave Analysis in Patients with Uncontrolled Brachial Blood Pressures in the Routine Outpatient Setting

Abstract

Background: Hypertension if left untreated can lead to arteriosclerosis, heart attacks, strokes and kidney disease. Studies suggest that central pressure may be more strongly related to future cardiovascular events than brachial pressure. Proportion of patients not at goal blood pressure is astounding. The aim of this study was to identify patients with hypertension not achieving goal brachial blood pressure and to investigate the co-relation between brachial blood pressure and central systolic blood pressure by using Pulse Wave Analysis (PWA). Methods: We conducted a single center, prospective, cohort study at the Outpatient Nephrology clinic operated by West Virginia University Hospitals between January 2017 and February 2018. Results: 22 patients met the inclusion criteria for the study, however only 14 (63.6%) followed through with getting at least one follow up PWA testing. 7/14 (50%) were males. 12/14 (85.7%) were older than 60 yrs. 10/14 (71.4%) had elevated central systolic pressures and pulse pressures at the initial visit and 2/14 (14.3%) an elevated augmented index. At the end of the study 9/14 (64.2%) were at goal central systolic blood pressure, 6/14 (42.9%) at goal Pulse pressure, with 8/14 (57.1%) at goal augmented index. At study end there was on average a 8.2mm Hg decrease in the central systolic pressure and 9.8mm Hg reduction in the pulse pressure after the lifestyle and anti-hypertensive regimen modification. Conclusion: Our results showed a predominantly elderly and obese population. Discrepancies between brachial and central systolic blood pressure may exist. Patients may benefit from the management of their blood pressure with the use of central blood pressure, pulse pressure and augmented index measurements as obtained by the Atcor Medical XCEL Pulse wave analysis machine. Further studies are needed to reinforce the importance of the utility of Pulse wave analysis and central blood pressure monitoring in the treatment of hypertension.