title: Validation of a generalized transfer function to noninvasively derive central blood pressure during exercise.
abstract: Exercise brachial blood pressure (BP) predicts mortality, but because of wave reflection, central (ascending aortic) pressure differs from brachial pressure. Exercise central BP may be clinically important, and a noninvasive means to derive it would be useful. The purpose of this study was to test the validity of a noninvasive technique to derive exercise central BP. Ascending aortic pressure waveforms were recorded using a micromanometer-tipped 6F Millar catheter in 30 patients (56+/-9 years; 21 men) undergoing diagnostic coronary angiography. Simultaneous recordings of the derived central pressure waveform were acquired using servocontrolled radial tonometry at rest and during supine cycling. Pulse wave analysis of the direct and derived pressure signals was performed offline (SphygmoCor 7.01). From rest to exercise, mean arterial pressure and heart rate were increased by 20+/-10 mm Hg and 15+/-7 bpm, respectively, and central systolic BP ranged from 77 to 229 mm Hg. There was good agreement and high correlation between invasive and noninvasive techniques with a mean difference (+/-SD) for central systolic BP of -1.3+/-3.2 mm Hg at rest and -4.7+/-3.3 mm Hg at peak exercise (for both r=0.995; P<0.001). Conversely, systolic BP was significantly higher peripherally than centrally at rest (155+/-33 versus 138+/-32 mm Hg; mean difference, -16.3+/-9.4 mm Hg) and during exercise (180+/-34 versus 164+/-33 mm Hg; mean difference, -15.5+/-10.4 mm Hg; for both P<0.001). True myocardial afterload is not reliably estimated by peripheral systolic BP. Radial tonometry and pulse wave analysis is an accurate technique for the noninvasive determination of central BP at rest and during exercise.
authors.affiliation: Department of Medicine, School of Human Movement Studies, University of Queensland, Princess Alexandra Hospital, Queensland, Australia. jsharman@soms.uq.edu.au
authors.forename: James E
authors.initials: JE
authors.lastname: Sharman
authors.forename: Richard
authors.initials: R
authors.lastname: Lim
authors.forename: Ahmad M
authors.initials: AM
authors.lastname: Qasem
authors.forename: Jeff S
authors.initials: JS
authors.lastname: Coombes
authors.forename: Malcolm I
authors.initials: MI
authors.lastname: Burgess
authors.forename: Jeff
authors.initials: J
authors.lastname: Franco
authors.forename: Paul
authors.initials: P
authors.lastname: Garrahy
authors.forename: Ian B
authors.initials: IB
authors.lastname: Wilkinson
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Marwick
mesh_terms: D000328:Adult; D000368:Aged; D001011:Aorta / Q000502:physiology*; D001794:Blood Pressure / Q000502:physiology*; D001795:Blood Pressure Determination / Q000379:methods* / Q000592:standards*; D015444:Exercise / Q000502:physiology*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D008955:Models, Cardiovascular; D017534:Radial Artery / Q000502:physiology; D012146:Rest / Q000502:physiology