Clinical Use of Pulse Wave Analysis: Proceedings From a Symposium Sponsored by North American Artery

Abstract

The use of pulse wave analysis may guide the provider in making choices about blood pressure treatment in prehypertensive or hypertensive patients. However, there is little clinical guidance on how to interpret and use pulse wave analysis data in the management of these patients. A panel of clinical researchers and clinicians who study and clinically use pulse wave analysis was assembled to discuss strategies for using pulse wave analysis in the clinical encounter. This manuscript presents an approach to the clinical application of pulse waveform analysis, how to interpret central pressure waveforms, and how to use existing knowledge about the pharmacodynamic effect of antihypertensive drug classes in combination with brachial and central pressure profiles in clinical practice. The discussion was supplemented by case-based examples provided by panel members, which the authors hope will provoke discussion on how to understand and incorporate pulse wave analysis into clinical practice.

Figure 1

Idealized central aortic pressure waveform. Left ventricle ejection initiates the pressure wave. The return of the reflected wave before the conclusion of systole generates a deflection in the systolic contour upstroke (marked with the arrow) and produces an augmentation in the pressure profile. The total excursion of the pressure wave (PP) is the central pulse pressure. AP indicates augmentation pressure; AIx, augmentation index.

Figure 2

Changes in contour and magnitude as the blood pressure wave moves distally. Published from Nichols et al.14

Figure 3

Example of a good‐quality pulse wave analysis study.

Figure 4

Example of a poor‐quality pulse wave analysis waveform. A normal radial artery upstroke (the left side of Figure 4) should not have a deviation mid segment as shown just above 110 mm Hg. Such deviations are likely secondary to the tonometer being slightly off‐center in alignment to the radial artery. The diastolic portion is also flattened as a result of too great a pressure on the tonometer used to obtain the radial waveform.

Figure 5

Pulse wave analysis in a 33‐year‐old Caucasian man with persistent systolic hypertension. BBP indicates brachial blood pressure systolic/diastolic; CBP, central blood pressure systolic/diastolic; CPP, central pulse pressure; PPA, pulse pressure amplification; AIx, augmentation index; HR, heart rate; bpm, beats per minute.

Figure 6

Pulse wave analysis in an unmedicated 41‐year‐old man. BBP indicates brachial blood pressure systolic/diastolic; CBP, central blood pressure systolic/diastolic; CPP, central pulse pressure; AIx, augmentation index; HR, heart rate; bpm, beats per minute.

Figure 7

Follow‐up pulse wave analysis in an unmedicated 41‐year‐old man. BBP indicates brachial blood pressure systolic/diastolic; CBP, central blood pressure systolic/diastolic; CPP, central pulse pressure; AIx, augmentation index; HR, heart rate; bpm, beats per minute.

Figure 8

Pulse wave analysis in a 64‐year‐old smoker with comorbidity and hypertension. BBP indicates brachial blood pressure systolic/diastolic; CBP, central blood pressure systolic/diastolic; CPP, central pulse pressure; AIx, augmentation index; HR, heart rate; bpm, beats per minute.

Figure 9

Follow‐up pulse wave analysis in a 64‐year‐old ex‐smoker with comorbidity and hypertension. BBP indicates brachial blood pressure systolic/diastolic; CBP, central blood pressure systolic/diastolic; CPP, central pulse pressure; AIx, augmentation index; HR, heart rate; bpm, beats per minute.

Figure 10

Pulse wave analysis in a 45‐year‐old man with diabetes, obesity, and hypertension. BBP indicates brachial blood pressure systolic/diastolic; CBP, central blood pressure systolic/diastolic; CPP, central pulse pressure; AIx, augmentation index; HR, heart rate; bpm, beats per minute.

Figure 11

Pulse wave analysis in a 45‐year‐old man with diabetes, obesity, and hypertension after addition of atenolol. BBP indicates brachial blood pressure systolic/diastolic; CBP, central blood pressure systolic/diastolic; CPP, central pulse pressure; AIx, augmentation index; HR, heart rate; bpm, beats per minute.

Figure 12

Pulse wave analysis in a 45‐year‐old man with diabetes, obesity, and hypertension after addition of atenolol and subsequent addition of amlodipine. BBP indicates brachial blood pressure systolic/diastolic; CBP, central blood pressure systolic/diastolic; CPP, central pulse pressure; AIx, augmentation index; HR, heart rate; bpm, beats per minute.

Figure 13

Pulse wave analysis in a 58‐year‐old African American woman with diabetes and hypertension. BBP indicates brachial blood pressure systolic/diastolic; CBP, central blood pressure systolic/diastolic; CPP, central pulse pressure; AIx, augmentation index; HR, heart rate; bpm, beats per minute.

Figure 14

Pulse wave analysis in a 58‐year‐old African American woman with diabetes and hypertension after the addition of nebivolol and a diuretic, along with increase in amlodipine. BBP indicates brachial blood pressure systolic/diastolic; CBP, central blood pressure systolic/diastolic; CPP, central pulse pressure; AIx, augmentation index; HR, heart rate; bpm, beats per minute.

Figure 15

Pulse wave analysis in a 70‐year‐old woman with hypertension and chronic kidney disease. BBP indicates brachial blood pressure systolic/diastolic; CBP, central blood pressure systolic/diastolic; CPP, central pulse pressure; AIx, augmentation index; HR, heart rate; bpm, beats per minute.

Figure 16

Pulse wave analysis in a 70‐year‐old woman with hypertension and chronic kidney disease after amlodipine. BBP indicates brachial blood pressure systolic/diastolic; CBP, central blood pressure systolic/diastolic; CPP, central pulse pressure; AIx, augmentation index; HR, heart rate; bpm, beats per minute.