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At least 19 recordsLinked to original sources
PubMed2006

Central arterial pressure and arterial pressure pulse: new views entering the second century after Korotkov.

The ubiquitous brachial cuff method gained widespread clinical acceptance for blood pressure recording after confirmation of its prognostic value in 1917. This method displaced radial pulse waveform analysis by sphygmography, which also gave prognostic Information but was difficult to use. Since that time, brachial cuff sphygmomanometry has migrated from the physician's office to 24-hour monitoring and home use, with electronic methods replacing the Korotkov sound technique for determining systolic and diastolic pressure. Detailed instrumental studies, required by regulatory bodies, revealed inaccuracies of all cuff methods for recording true intra-arterial pressure. A major source of inaccuracy in assessing left ventricular load is the amplification of the pressure wave in its transit from the central aorta to upper limb arteries, as extensively studied by Earl H. Wood at the Mayo Clinic in Rochester, Minn, in the 1950s. This limitation can be overcome by combining newer methods using radial artery waveform analysis in conjunction with conventional cuff sphygmomanometry to noninvasively measure the central aortic pressure waveforms. Recent studies using radial tonometry have proved that this is more effective than conventional manometry in predicting cardiovascular events and gauging response to therapy. Measurement of central as well as peripheral arterial pressure and physiology is becoming increasingly used as an office practice and a laboratory procedure.

Aging↗
PubMed2002

[Comparison of clinical arterial pressure, home-arterial pressure measurement, and ambulatory arterial pressure monitoring in patients with type II diabetes mellitus and diabetic nephropathy].

BACKGROUND: Hypertension is common in type 2 diabetes with diabetic nephropathy, and increases the risk of cardiovascular complications and renal chronic insufficiency. The aim of our evaluation in these patients was: a) to study the correlation between office blood pressure (BP), self-monitored (SMBP) and 24-hour ambulatory blood pressure monitoring (ABPM). b) To study the correlation between these methods and cardiovascular and renal complications. METHODS: We studied 60 patients (mean age 66.7 +/- 9 years, mean duration of diabetes 11.3 +/- 7 years) with arterial hypertension, type 2 diabetes and diabetic nephropathy. Macroangiopathy and echocardiography were recorded. We measured, SMBP and ABPM without modifying the antihypertensive treatment. The white coat phenomenon (WCP) was determined and patients were classified as dippers or non dippers according to their blood pressure diurnal rhythm. RESULTS: Mean glycated haemoglobin was 7.8% and mean serum creatinine 1.2 +/- 0.5 mg/dl, 30% of patients had proteinuria and 70% microalbuminuria The mean number of antihypertensive drugs was 2.2 +/- 1. The mean BP was: Office BP: 158.2 +/- 24/85.3 +/- 9 mmHg, pulse pressure (PP) 72.9 +/- 21 mmHg; SMBP: 145.4 +/- 18/77.5 +/- 7 mmHg, PP 67.9 +/- 18 mmHg and BP in the early morning 150.2 +/- 20/79.9 +/- 9 mmHg; ABPM: diurnal mean 138.9 +/- 15/74.1 +/- 6 mmHg, PP 64.8 +/- 15 mmHg and BP in the early morning 146.5 +/- 16/78.5 +/- 7 mmHg. The three techniques showed a good correlation and WCP was detected in 46.7% of patients with SMBP and in 56.7% with ABPM. We found no correlation between BP and macroangiopathy, but an increase of systolic BP in SMBP and ABPM in proteinuric patients were found and correlation between mass left ventricular index (MLVI) and PP in office and systolic BP and PP in SMBP and ABPM was significant. 70% of patients were non dippers, with a higher MLVI. CONCLUSIONS: Decreases in BP in type 2 diabetes with diabetic nephropathy are difficult of maintain despite combinations of different antihypertensive drugs. These patients present an important WCP and worse prognosis data, such as elevation of systolic BP, increased PP, poor night BP fall and a BP rise in the early morning. Also, we can't reduced the BP during 24 hours in an important number of patients. These characteristics can be detected by combining the office BP measurement, SMBP and ABPM. The alternative possibility would be lifestyle modification, appropriate drug combinations and to start treatment at lower levels than those currently used as thresholds (the guidelines for antihypertensive treatment have been drastically shifted in this direction over the past years).

Aged↗
PubMed1995

Analysis of aprotinin on the mean arterial pressure, carotid artery blood flow, and hindlimb vascular resistance in the live rat, and pulmonary vascular resistance in the isolated perfused rat lung.

The effects of aprotinin on mean arterial pressure, carotid artery blood flow, pulmonary vascular resistance, and systemic vascular resistance have not been well documented. Therefore, the responses of aprotinin on the mean arterial pressure, carotid artery blood flow and the changes in pulmonary and hindlimb vascular resistances were investigated in the rat using ultrasonic flow probe analysis, and in two isolated vascular bed preparations. In studies on cardiac output using ultrasonic flow analysis, injections of aprotinin, in doses of 70-7000 KIU intravenously (iv), resulted in no changes in carotid artery ultrasonic flow, suggesting no changes in cardiac output. In isolated blood-perfused lung studies under conditions of controlled pulmonary blood flow, aprotinin, in doses of 7-7000 KIU intra-arterially (ia), caused no significant changes in pulmonary arterial perfusion pressure. Aprotinin, in doses of 7-240 KIU, was injected iv into the hindquarters perfusion circuit, and hindquarters arterial perfusion pressure did not change. Additionally, in the hindquarters perfusion preparation, aprotinin, in doses of 70-7000 KIU, ia resulted in no changes in mean arterial pressure. The present data demonstrate aprotinin has no significant response in MAP, carotid artery blood flow, pulmonary vascular resistance, or hindlimb vascular resistance in the rat.

Animals↗
PubMed2000

A new method of predicting pulmonary capillary wedge pressure: the arterial pressure ratio.

The response of arterial blood pressure to an increase in intrathoracic pressure has been shown to be predictive of pulmonary capillary wedge pressure. We devised a new method, which we termed the arterial pressure ratio. We defined arterial pressure ratio as the ratio of systolic blood pressure of the final beat during the strain phase of the Valsalva manoeuvre to that during apnoea before the manoeuvre, and tested the accuracy of arterial pressure ratio in predicting pulmonary capillary wedge pressure. In 30 patients scheduled for elective abdominal aortic reconstruction, following induction of general anaesthesia and tracheal intubation, a 20-G catheter and pulmonary artery catheter were inserted through the radial artery and right internal jugular vein, respectively. Pulmonary capillary wedge pressure was then measured during a brief period of apnoea and the Valsalva manoeuvre was performed by application of pressure to the reservoir bag. Airway pressure was maintained at 30 cmH2O for 10 s and then released. Radial arterial pressure and airway pressure were recorded simultaneously, and arterial pressure ratio was calculated. There was a close linear correlation between arterial pressure ratio and pulmonary capillary wedge pressure (r = 0.88, p < 0.0001).

Aged↗
PubMed1975

The relation between intracrainal pressure, mean arterial pressure and cerebral blood flow in patients with severe head injury.

UNLABELLED: In patients with severe head injuries ICP, MAP and CBF were measured continuously. In most patients there was a positive vasopressor response to increasing ICP, but the ICP/MAP ratio varied considerably in individual cases. CBF was diminished either by increasing ICP or by decreasing MAP. This effect was more marked with ICP above 40 mm Hg or MAP below 110 mm Hg. In terminal stages there was often a negative MAP/ICP ratio accompanied by massive cerebral hyperaemia. Key words: Severe head injury--intracranial pressure--mean arterial pressure--cerebral blood flow--cerebral perfusion pressure--critical limit of ICP and CBF. ABBREVIATIONS: ICP equals intracranial pressure (mm Hg); CBF, Flow equals cerebral blood flow (ml/min); MAP equals mean arterial pressure (mm Hg); CPP equals cerebral perfusion pressure (mm Hg) (difference between MAP and ICP); BP equals blood pressure.

Blood Pressure↗
PubMed1985

Clinical comparison of automated auscultatory and oscillometric and catheter-transducer measurements of arterial pressure.

Arterial pressure measurements recorded from a radial artery catheter-transducer (RAC) system were compared with similar data obtained from an automated sphygmomanometer that uses both oscillometric (OSC) and auscultatory measurement techniques. Data were obtained from 50 patients during and immediately after surgery. The fundamental frequency of the RAC system was 23.7 +/- 6.7 Hz (mean +/- SD; range, 13 to 40 Hz), and the damping coefficient was 0.26 +/- 0.06 (mean +/- SD; range, 0.15 to 0.34). Linear regression analysis of RAC against OSC values (n = 385) revealed the following correlations: (1) systolic pressure: OSC = 0.92(RAC) + 3.5, r = 0.91; (2) diastolic pressure: OSC = 0.92(RAC) + 1.3, r = 0.76; and (3) mean pressure: OSC = 0.96(RAC) + 0.68, r = 0.84. There were significant differences between each pair of pressure values; mean percent differences (RAC pressure minus OSC pressure) were 4.5 +/- 0.3%, 5.5 +/- 0.7%, and - 2.7 +/- 0.5% for systolic, diastolic, and mean values, respectively. Manual and automated auscultatory measurements closely agreed, and both correlated well with OSC values for systolic and diastolic pressure. However, both manual and automated auscultatory, as well as OSC measurements, underestimated RAC systolic and overestimated RAC diastolic pressure.

Adolescent↗
PubMedDate not supplied

Transient and persistent changes in rabbit blood vessels associated with maintained elevation in arterial pressure.

Arteries and veins of hypertensive rabbits were examined 8 weeks after partially constricting the abdominal aorta above both kidneys, and compared with those from sham-operated animals. Structural and functional changes in blood vessels after 2 weeks, when the arterial pressure first attained a new elevated level, have been described previously, and are now compared with changes 6 weeks later. The increase in blood vessel mass could be correlated with an increase in deoxyribonucleic acid (DNA) content. In contrast to the status at 2 weeks postoperatively, there was no increased uptake of 3H-thymidine, 3H-proline, or 3H-lysine at 2 months. Furthermore, at this time cell nuclei labeled with 3H-thymidine were infrequent. Some vessels showed evidence of change in the physical characteristics of their wall. Only minimal changes were observed in those parameters of adrenergic nerve function measured -- neuronal 3H-norepinephrine uptake and vessel wall catecholamine content -- that had been markedly changed at 2 weeks. The results of this work, together with those of other studies of this model, suggest two phases of response of the arterial wall to pressure rise: an initial dynamic proliferative cellular response mainly of vascular smooth muscle associated with changes in adrenergic neuronal parameters, and a subsequent equilibrium phase characterized by an increased number of smooth muscle cells, some changes in the extracellular components, and minimal changes in the adrenergic innervation.

Animals↗
PubMed2004

New formula for predicting mean pulmonary artery pressure using systolic pulmonary artery pressure.

STUDY OBJECTIVES: Mean pulmonary artery pressure (MPAP) and systolic pulmonary artery pressure (SPAP) are used interchangeably to define pulmonary hypertension (PH). We tested the hypothesis that the measurement of MPAP and SPAP is redundant in resting humans over a wide pressure range. DESIGN: Prospective, observational study. SETTING: Catheterization laboratory in a university hospital. PATIENTS: This study involved 31 patients, as follows: primary PH, nine patients; chronic pulmonary thromboembolism, seven patients; venous PH, six patients; and control subjects with normal pulmonary artery pressure, nine patients. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: High-fidelity pulmonary artery pressures were obtained when patients were at rest. Over the wide MPAP range that was under study (10 to 78 mm Hg), MPAP and SPAP were strongly related (r(2) = 0.98). Regression analysis performed on the first 16 subjects (test sample) allowed us to propose a formula (MPAP = 0.61 SPAP + 2 mm Hg), the accuracy of which was confirmed in the remaining 15 subjects (validation sample bias, 0 +/- 2 mm Hg). If PH was defined by an SPAP in excess of 30 or 40 mm Hg, this corresponded to an MPAP in excess of 20 or 26 mm Hg. If PH was defined by an MPAP of > 25 mm Hg, this corresponded to an SPAP of > 38 mm Hg. CONCLUSIONS: In resting humans, MPAP can be accurately predicted from SPAP over a wide pressure range. The new formula may help to refine the threshold pressure values used in the diagnosis of PH. Further studies are needed to test the hypothesis that our formula may allow the noninvasive prediction of MPAP from Doppler-derived SPAP values.

Blood Pressure Determination↗
PubMed1996

Effects of rocuronium and vecuronium on intracranial pressure, mean arterial pressure and heart rate in neurosurgical patients.

We have evaluated the effects of a single bolus dose of rocuronium 0.6 mg kg-1 (group 1, n = 10) or vecuronium 0.1 mg kg-1 (group 2, n = 10) on intracranial pressure (ICP), mean arterial pressure (MAP), cerebral perfusion pressure (CPP) and heart rate (HR) in 20 neurosurgical patients undergoing mechanical ventilation of the lungs during continuous sedation with sufentanil and midazolam. Before and after neuromuscular block using twice the ED90 of the blockers, ICP, MAP, CPP and HR were recorded continuously for 15 min. Treatment caused no significant changes in ICP, CPP or MAP and there was no evidence of histamine release. Mean maximum block in the rocuronium group was slightly less than that in the vecuronium group (95.9 (3.1)% vs 100%; ns) The difference between the two groups in onset time (rocuronium 142 (62) s, vecuronium 192 (64) s; P = 0.04) was significant. Patients in the rocuronium group showed a slight (7(4)%) but significant (P = 0.003) increase in heart rate.

Adult↗
PubMed1985

Experimental carbon dioxide laser brain lesions and intracranial dynamics: Part 1. Effect on intracranial pressure, systemic arterial pressure, central venous pressure, electroencephalography, and gross pathology.

Experimental brain lesions were created in the left parietooccipital cortex of the albino rabbit through the intact dura mater with high radiating carbon dioxide laser energy (40-watt impacts of 0.5-second duration for a total of 4 seconds on a 12.5-mm surface). Behavior, intracranial pressure (ICP), systolic arterial pressure (SAP), central venous pressure (CVP), electroencephalography (EEG), and gross pathology were studied at 2, 6, and 24 hours after the insult at a constant PaCO2 (38-42 torr). Disruption of the blood-brain barrier (Evans blue extravasation) was uniformly seen extending from the impact crater into the surrounding white matter in all groups. The ICP was elevated in sham-operated animals at 2 hours after the impact, and it remained elevated at 6 and 24 hours. The EEG revealed severe slowing with high voltage waves in the insulted left hemisphere. There was no change in mean SAP or CVP when compared to the sham-operated group. In the dexamethasone-pretreated group, there was a reduction of ICP when compared to the untreated group at 24 hours after the insult (P less than 0.005), but no changes in the gross pathology were noted.

Animals↗
PubMed1998

Radial artery pressure monitoring underestimates central arterial pressure during vasopressor therapy in critically ill surgical patients.

OBJECTIVES: Radial artery pressure is known to differ from central arterial pressure in normal patients (distal pulse amplification) and in the early postcardiopulmonary bypass period. The adequacy of the radial artery as a site for blood pressure monitoring in critically ill patients receiving high-dose vasopressors has not been carefully examined. DESIGN: Prospective observational study comparing simultaneous intra-arterial measurements of radial (peripheral) and femoral artery (central) pressures. SETTING: Clinical investigation in a university-based surgical intensive care unit. PATIENTS: Fourteen critically ill patients with presumed sepsis who received norepinephrine infusions at a rate of > or =5 microg/min. INTERVENTIONS: All patients were managed in accordance with our standard practice for presumed sepsis, which consisted of intravascular volume repletion followed by vasopressor administration titrated to a mean arterial pressure of > or =60 mm Hg. MEASUREMENTS AND MAIN RESULTS: Systolic and mean arterial pressures were significantly higher when measured from the femoral vs. radial site (p < .005). The higher mean arterial pressures enabled an immediate reduction in norepinephrine infusions in 11 of the 14 patients. No change in cardiac output or pulmonary artery occlusion pressure was noted after dose reduction. In the two patients in whom simultaneous recordings were made after discontinuation of norepinephrine infusions, equalization of mean arterial pressures was observed. CONCLUSIONS: Radial artery pressure underestimates central pressure in hypotensive septic patients receiving high-dose vasopressor therapy. Clinical management, based on radial pressures, may lead to excessive vasopressor administration. Awareness of this phenomena may help minimize adverse effects of these potent agents by enabling dosage reduction.

Bias↗