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Impact of arterial location, pressure wave indicators, and measurement devices on arterial form factor and mean and central arterial pressure

Journal of Human Hypertension volume 37, pages 891–897 (2023)Cite this article

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Abstract

Mean arterial pressure (MAP) is often estimated from cuff systolic (S) and diastolic (D) blood pressure (BP) using a fixed arterial form factor (FF, usually 0.33). If MAP is measured directly, a true FF can be calculated: FF = [MAP–DBP]/[SBP–DBP]. Because waveform shapes vary, true FF should also vary and MAP accuracy will be affected. We studied factors affecting FF using radial tonography (SphygmoCor, n = 376) or brachial oscillometry (Mobil-O-Graph, n = 157) and to compare devices, 101 pairs were matched precisely for SBP and DBP. SphygmoCor brachioradial FF correlated strongly with central FF (r2 = 0.75), central augmentation index (cAI, r2 = 0.39), and inversely with pulse pressure amplification (PPA) ratio (r2 = 0.44) [all p < 0.000]; brachioradial FF was lower than central (c) FF (0.34 vs. 0.44, 95% CI’s [0.23,0.46] and [0.34,0.54], p < 0.000). On forward stepwise regression, brachioradial FF correlated with PPA ratio, age, heart rate, and cAI (multiple-r2 0.63, p < 0.000). With Mobil-O-Graph: brachial FF was fixed, lower than the corresponding cFF [mean(SD)] 0.46(0.00098) vs. 0.57(0.048), p < 0.000], and uncorrelated with clinical characteristics; MAP and cSBP were higher than SphygmoCor by 6.3 and 2.2 mmHg (p < 0.005) at the midpoint with systematic negative biases. We conclude that FF derived from radial tonometry (SphygmoCor) varies with pulse wave morphology within and between individuals and by measurement site, age, and heart rate. With oscillometry (Mobil-O-Graph), brachial FF was fixed and high and unrelated to other clinical variables; MAP and cSBP were higher than tonometry, with systematic negative biases.

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Fig. 1: Form factors and pulse wave shape: influence of arterial site, amplification, and augmentation (SphygmoCor).
Fig. 2: Central and forearm form factors with different devices.
Fig. 3: Matched pairs analysis of MAP and central SBP with SphygmoCor (SPG) and Mobil-O-Graph (MOB).

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Data are available from the author upon request.

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Acknowledgements

This work was presented in part at the European Society of Hypertension meeting in 2022.

Funding

This work was supported in part by a grant from the Research in Erie County Foundation.

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Authors and Affiliations

  1. Department of Medicine, Jacobs School of Medicine, State University of New York at Buffalo, New York, NY, USA

    Joseph L. Izzo, Debduti Mukhopadhyay, Sagar Nagpal & Peter Osmond

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  1. Joseph L. Izzo
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  3. Sagar Nagpal
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  4. Peter Osmond
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JI was responsible for overall supervision, including conceptualizing the study, analyzing the data, and writing the paper. DM, SN, and PO contributed to the data analysis.

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Correspondence to Joseph L. Izzo.

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Izzo, J.L., Mukhopadhyay, D., Nagpal, S. et al. Impact of arterial location, pressure wave indicators, and measurement devices on arterial form factor and mean and central arterial pressure. J Hum Hypertens 37, 891–897 (2023). https://doi.org/10.1038/s41371-022-00791-w

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