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Estimation of Central Systolic Blood Pressure from Peripheral Pressure Waves using a Novel Second Systolic
Shin-Ichiro Katsuda1, Akihiro Hazama1
1Department of Cellular and Integrative Physiology, Fukushima Medical University School of Medicine.
Insights
Estimating central systolic blood pressure (cSBP) from peripheral measurements is crucial. The study found that the average peripheral systolic blood pressure (pSBPm) is a more precise estimate of cSBP than other peripheral measures, even in hypercholesterolemic rabbits.
Area of Science:
- Cardiovascular Physiology
- Hypertension Research
- Biomedical Engineering
Background:
- Central systolic blood pressure (cSBP) is a stronger indicator of hypertension-related organ damage than peripheral systolic blood pressure (pSBP).
- Accurate estimation of cSBP is vital for clinical assessment and management of cardiovascular risk.
- Current methods for estimating cSBP often rely on generalized transfer functions, which may not be universally applicable.
Purpose of the Study:
- To develop and validate a method for estimating cSBP from pSBP without using a generalized transfer function.
- To evaluate the accuracy of this estimation method in normal and hypercholesterolemic rabbit models.
Main Methods:
- Simultaneous recording of pressure waves in the ascending aorta (AA) and brachial artery (Br) using catheter-tip transducers in rabbits.
- Administration of angiotensin II and sodium nitroprusside to induce varying blood pressure levels.
- Analysis of peripheral systolic blood pressure (pSBP), its second peak (pSBP2), and their average (pSBPm) against cSBP using Bland-Altman plots and peripheral augmentation index (pAI).
Main Results:
- Both pSBP and pSBP2 showed significant correlation with cSBP, but with considerable and pressure-dependent biases.
- Analysis of pSBPm demonstrated a mean bias close to zero and reduced variance compared to pSBP and pSBP2.
- pSBPm eliminated pressure- or pAI-dependent systematic biases, indicating its precision as a cSBP estimate.
Conclusions:
- The average peripheral systolic blood pressure (pSBPm) provides a more precise estimation of central systolic blood pressure (cSBP) compared to pSBP2.
- This improved accuracy of pSBPm holds true irrespective of blood pressure levels, peripheral augmentation index, or the presence of atherosclerosis.
- pSBPm represents a potentially valuable, non-invasive method for estimating cSBP in clinical settings.
Aim:
Central systolic blood pressure (cSBP) was closely related to hypertension-related organ damage rather than peripheral systolic blood pressure (pSBP). We aimed to estimate cSBP from pSBP without generalized transfer function in normal and Kurosawa and Kusanagi-hypercholesterolemic (KHC) rabbits aged 12 months.
Methods:
Two catheter-tip transducers were advanced into the ascending aorta (AA) and distal end of the right brachial artery (Br) through the right common carotid and right radial arteries, respectively, under pentobarbital anesthesia. Pressure waves in response to the intravenous administration of angiotensin II and sodium nitroprusside were simultaneously recorded in AA and Br under regular cardiac pacing.
Results:
The first (pSBP) and second peaks (pSBP2) of the brachial blood pressure and their average (pSBPm) were significantly correlated with cSBP, despite Murgo's wave pattern of central pressure waves in both rabbit groups. In Bland-Altman plot and its modification as a function of the peripheral augmentation index (pAI) analyses, the differences between pSBP and cSBP decreased, and those between pSBP2 and cSBP increased significantly in their average- or pAI-dependent manner, with undeniable mean biases in both rabbit groups. When the same analyses for SBPm were performed instead, the mean bias was around zero, with reduced variance in the two rabbit groups. The observed pressure or pAI-dependent systematic biases for pSBP and pSBP2 disappeared, representing the precise feature of pSBPm as a cSBP estimate.
Conclusions:
We conclude that pSBPm could be more precise than pSBP2 as a cSBP estimate, irrespective of blood pressure levels, pAI, or the presence of atherosclerosis.
Related Concept Videos
01:21Sites for measruring blood pressure
The Brachial Artery: Primary Site for Blood Pressure Measurement
01:23Assessment of blood pressure in brachial artery(two-step method)
01:19Assessing Blood pressure using a doppler ultrasound
Pre-Procedural Guidelines for Doppler Ultrasound Blood Pressure Assessment:
Preparation of Equipment:
01:28Special considerations while measuring blood pressure
Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.
01:15Assessment of blood pressure in brachial artery(one-step method)
Prepare for the Procedure:
01:17Measurement of Blood Pressure