Amplification of the Pressure Pulse in the Upper Limb in Healthy, Middle-Aged Men and Women

• Published in: Hypertension (Dallas, Tex. 1979) Vol. 54; no. 2; pp. 414 - 420
• Main Authors: Segers, Patrick, Mahieu, Dries, Kips, Jan, Rietzschel, Ernst, De Buyzere, Marc, De Bacquer, Dirk, Bekaert, Sofie, De Backer, Guy, Gillebert, Thierry, Verdonck, Pascal, Van Bortel, Luc
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Hagerstown, MD American Heart Association, Inc 01.08.2009; Lippincott Williams & Wilkins
• Subjects: Adult; Analysis of Variance; Arterial hypertension. Arterial hypotension; Biological and medical sciences; Blood and lymphatic vessels; Blood Flow Velocity; Blood Pressure - physiology; Blood Pressure Determination - methods; Blood Pressure Determination - standards; Brachial Artery - physiology; Calibration; Cardiology. Vascular system; Carotid Arteries - physiology; Clinical manifestations. Epidemiology. Investigative techniques. Etiology; Cohort Studies; Female; Hemodynamics - physiology; Humans; Male; Medical sciences; Middle Aged; Probability; Radial Artery - physiology; Reference Standards; Reference Values; Sensitivity and Specificity; Upper Extremity - physiology; Amplification; Human; Hypertension; large arteries; Cardiovascular disease; Arterial pressure; cardiovascular physiology; Upper limb; Blood pressure; Hemodynamics; wave reflection
• ISSN: 0194-911X; 1524-4563
• DOI: 10.1161/HYPERTENSIONAHA.109.133009

Central-to-peripheral amplification of the pressure pulse leads to discrepancies between central and brachial blood pressures. This amplification depends on an individualʼs hemodynamic and (patho)physiological characteristics. The aim of this study was to assess the magnitude and correlates of central-to-peripheral amplification in the upper limb in a healthy, middle-aged population (the Asklepios Study). Carotid, brachial, and radial pressure waveforms were acquired noninvasively using applanation tonometry in 1873 subjects (895 women) aged 35 to 55 years. Carotid, brachial, and radial pulse pressures were calculated, as well as the absolute and relative (with carotid pulse pressure as reference) amplifications. With subjects classified per semidecade of age, carotid-to-radial amplification varied from ≈25% in the youngest men to 8% in the oldest women. Amplification was higher in men (20±14%) than in women (13±12%; P<0.001) and decreased with age (P<0.001) in both. Amplification over the brachial-to-radial path contributed substantially to the total amplification. In univariate analysis, the strongest correlation was found with the carotid augmentation index (−0.51 in women; −0.47 in men; both P<0.001). In a multiple linear regression model with carotid-to-radial amplification as the dependent variable, carotid augmentation index, total arterial compliance, and heart rate were identified as the 3 major determinants of upper limb pressure amplification (R=0.36). We conclude that, in healthy middle-aged subjects, the central-to-radial amplification of the pressure pulse is substantial. Amplification is higher in men than in women, decreases with age, and is primarily associated with the carotid augmentation index.