Analyzing the radial pulse waveform: narrowing the gap between blood pressure and outcomes

The use of peripheral pressure wave recording devices to estimate central vessel pressure profiles has grown over the past decade. This review will briefly recount the history behind this technology and discuss where it fits into the measurement of vascular properties that may predict outcomes such as death, heart attack, stroke or kidney disease progression.

Recent cross-sectional studies involving both children with chronic kidney disease and adult patients with cardiovascular disease are reviewed. Importantly there are now at least three prospective series that indicate pulse wave analysis technology may be useful both for endpoint prediction (complementing blood pressure and other standard vascular risk factors) and for informing mechanisms of benefit when clinical trials with similar blood pressure control have discordant outcomes depending on the drug assignment.

Pulse wave analysis is an interesting technology with the plausible benefit of estimating central vascular pressures. Since the principal target organs we seek to protect with our treatments are all connected to the aorta, it may be that a better understanding of target organ risk from an aortic as opposed to a brachial standpoint will help move forward our interventions to reduce vascular disease.