Pulsology Rediscovered

Abstract

Nearly everything that modern practicing clinicians know about hypertension and its treatment is based on simple noninvasive measurement of brachial artery blood pressure. As the study by Williams and colleagues1 illustrates, however, additional knowledge of pulse-wave characteristics may be important in the future to fully assess optimal cardiovascular drug therapy. The study of pulse-wave characteristics is far older than the study of absolute pressure values, dating back thousands of years to the Chinese masters who used their fingertips and their powers of observation to associate “hardening of the pulse” with adverse outcomes in people who ingested too much salt. These qualitative observations were less well developed in Western medicine, but as early as the 1870s, the sphygmocardiogram was developed as a reproduction of a peripheral pulse wave on a rotating drum via a tonometer attached to a levered stylus.1a Morrell and other early investigators were clearly able to differentiate the effects of nitrovasodilators from digitalis using this early equipment, but interpretations remained largely qualitative. Within a few decades, the development of sphygmomanometry by Korotkovand Riva-Rocci allowed quantitation of brachial cuff blood pressures, and the more descriptive methods largely disappeared. Article p 1213 Indeed, brachial cuff blood pressure has become an enduring clinical variable. Actuarial data from the life insurance industry and subsequent prospective observational data have clearly shown that hypertension, or elevated cuff blood pressure, is closely related to many forms of cardiovascular disease.2–4 Most recently, a very large meta-analysis by the Prospective Studies Collaborators that involved almost 1 million persons enrolled in 61 prospective observational studies demonstrated a log-linear relationship between cuff systolic or diastolic blood …