title: Development and validation of a noninvasive method to determine arterial pressure and vascular compliance.
abstract: The ability not only to record automated systolic and diastolic pressure, but also to derive measurements of the rate of pressure change during the cardiac cycle, would have great potential clinical value. A new method has been developed to obtain pressure measurements at 20-ms intervals by oscillometric cuff signal pattern recognition. Derivation of noninvasive pressure measurements is based on a T tube aorta and straight tube brachial artery, and assumes that the systolic phase of the suprasystolic cuff signal and the diastolic phase of the subdiastolic cuff signal most closely approximate systolic and diastolic aortic pressures, respectively. Arterial pressures obtained by this method were compared with simultaneous invasive measurements from the thoracic aorta in 36 patients. Good agreement was observed between noninvasive and invasive methods for systolic (146 +/- 4 vs 145 +/- 5 mm Hg), diastolic (80 +/- 2 vs 77 +/- 2 mm Hg), and mean (100 +/- 3 vs 100 +/- 3 mm Hg) arterial pressures, and correlation coefficients were r = 0.94, 0.91, and 0.95, respectively. To assess the validity of measurements of the rate of pressure change, oscillometric cuff signals from a subgroup of 14 patients were analyzed in detail for the peak positive pressure derivative (dP/dt(Max)), peak negative pressure derivative (dP/dt(Min)), and time interval between peak positive and peak negative pressure derivatives [t(pp)]. Results (mean +/- SEM) were: [table in text]. The incorporation of measurements of the rate of pressure change into a physical model of the brachial artery was used to derive vascular compliance. A significant correlation was observed between vascular compliance derived from the oscillometric signal and determinations by either thermodilution or Fick methods and noninvasive pressures (n = 20, r = 0.83, p <0.001). Day-to-day variability for blood pressure and vascular compliance derived by the noninvasive method did not differ by >4%, representing a reproducible measure of vascular structure and function. We conclude that the measurement of absolute pressure and rate of pressure change show good correlation with catheter data and that vascular compliance can be reliably assessed by this new method. The technology should provide a valuable noninvasive tool for the assessment of both cardiac function and vascular properties.
authors.affiliation: Department of Medicine, University of California, San Diego, USA.
authors.forename: T J
authors.initials: TJ
authors.lastname: Brinton
authors.forename: B
authors.initials: B
authors.lastname: Cotter
authors.forename: M T
authors.initials: MT
authors.lastname: Kailasam
authors.forename: D L
authors.initials: DL
authors.lastname: Brown
authors.forename: S S
authors.initials: SS
authors.lastname: Chio
authors.forename: D T
authors.initials: DT
authors.lastname: O'Connor
authors.forename: A N
authors.initials: AN
authors.lastname: DeMaria
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001795:Blood Pressure Determination / Q000379:methods*; D001808:Blood Vessels / Q000502:physiology*; D006328:Cardiac Catheterization; D002318:Cardiovascular Diseases / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009991:Oscillometry; D015203:Reproducibility of Results