Radial Applanation Tonometry as an Adjuvant Tool in the Noninvasive Arterial Stiffness and Blood Pressure Assessment

DOI: 10.4236/wjcd.2014.45030   PDF   HTML     5,576 Downloads   7,544 Views   Citations


Since antiquity, the human arterial pulse represents an important parameter in the clinical assessment. Besides being routinely assessed in the medical practice, such pulse is not observed in its completeness yet, once many of the data obtained through it cannot be evaluated using conventional methods. Taking into account such methods, the measurement of arterial blood pressure using sphygmomanometry, although broadly widespread in the assessment and follow-up of patients who require accompaniment of their cardiovascular status, is not able to properly guide about parameters related to the central hemodynamic status, the latter most strongly associated with cardiovascular risk. Such incapability is due to the centrifugal augmentation of the pressures taken at different points of the arterial bed, based on the properties of the closed arterial system through which the blood flow travels. In this context, methodologies capable of assessing central parameters estimated using the pulse wave analysis, such as applanation tonometry, represent a promising adjuvant for evaluating patients with cardiovascular diseases, by providing detailed information concerning hemodynamic parameters otherwise inaccessible. In this scenario, the present review focuses on the applanation tonometry and its assessment on the radial artery, highlighting the importance of this method in the cardiovascular assessment, as well as its relevance in the clinical practice, when determining parameters peripherally obtained capable of estimating the central hemodynamic status.

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Sá da Fonseca, L. , Mota-Gomes, M. and Rabelo, L. (2014) Radial Applanation Tonometry as an Adjuvant Tool in the Noninvasive Arterial Stiffness and Blood Pressure Assessment. World Journal of Cardiovascular Diseases, 4, 225-235. doi: 10.4236/wjcd.2014.45030.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Avolio, A.P., Butlin, M. and Walsh, A. (2010) Arterial Blood Pressure Measurement and Pulse Wave Analysis—Their Role in Enhancing Cardiovascular Assessment. Physiological Measurement, 31, R1-R47.
[2] Palatini, P., Casiglia, E., Gasowski, J., Gluszek, J., Jankowski, P., Narkiewicz, K., Saladini, F., Stolarz-Skrzypek, K., Tikhonoff, V., Bortel, L., Wojciechowska, W. and Kawecka-Jaszcz, K. (2011) Arterial Stiffness, Central Hemodynamics, and Cardiovascular Risk in Hypertension. Vascular Health and Risk Management, 7, 725-739.
[3] Nelson, M.R., Stepanek, J., Cevette, M., Cocalciuc, M., Hurst, R.T. and Tajik, A.J. (2010) Noninvasive Measurement of Central Vascular Pressures with Arterial Tonometry: Clinical Revival of the Pulse Pressure Waveform? Mayo Clinic Proceedings, 85, 460-472.
[4] Davies, J.I. and Struthers, A.D. (2003) Pulse Wave Analysis and Pulse Wave Velocity: A Critical Review of Their Strengths and Weaknesses. Journal of Hypertension, 21, 463-472.
[5] O’Rourke, M.F., Pauca, A. and Jiang, X.-J. (2001) Pulse Wave Analysis. British Journal of Clinical Pharmacology, 51, 507-522.
[6] O’Rourke, M.F. and Adji, A. (2008) Basis for Use of Central Blood Pressure Measurement in Office Clinical Practice. Journal of the American Society of Hypertension, 2, 28-38.
[7] Laurent, S., Cockcroft, J., Bortel, L.V., Boutouyrie, P., Giannattasio, C., Hayroz, D., Pannier, B., Vlachopoulos, C., Wilkinson, I. and Struijker-Boudier, H., on the Behalf of the European Network for Non-invasive Investigation of Large Arteries (2006) Expert Consensus Document on Arterial Stiffness: Methodological Issues and Clinical Applications. European Heart Journal, 27, 2588-2605.
[8] Qasem, A. and Avolio, A. (2008) Determination of Aortic Pulse Wave Velocity from Waveform Decomposition of the Central Aortic Pressure Pulse. Hypertension, 51, 188-195.
[9] Chen, W., Srinivasan, S.R. and Berenson, G.S. (2008) Differential Impact of Heart Rate on Arterial Wall Stiffness and Thickness in Young Adults: The Bogalusa Heart Study. Journal of the American Society of Hypertension, 2, 152-157.
[10] Grassi, G. and Borghi, C. (2008) Central Blood Pressure as Estimate of Cardiovascular Risk: Potentials and Limitations. Journal of Hypertension, 26, 16-17.
[11] Schnabel, R., Larson, M.G., Dupuis, J., Lunetta, K.L., Lipinska, I., Meigs, J.B., Yin, X., Rong, J., Vita, J.A., Newton-Cheh, C., Levy, D., Keany Jr., J.F., Vasan, R.S., Mitchell, G.F. and Benjamin, E.J. (2008) Relations of Inflammatory Biomarkers and Common Genetic Variants With Arterial Stiffness and Wave Reflection. Hypertension, 51, 1651-1657.
[12] Dengo, A.L., Dennis, E.A., Orr, J.S., Marinik, E.L., Ehrlich, E., Davy, B.M. and Davy, K.P. (2010) Arterial Destiffening with Weight Loss in Overweight and Obese Middle-Aged and Other Adults. Hypertension, 55, 855-861.
[13] Duprez, D.A. (2010) Arterial Stiffness and Endothelial Function: Key Players in Vascular Health. Hypertension, 55, 612-613.
[14] Cunha, R.S. (2004) Rigidez Arterial: Conceito e Implicações Metodológicas. Revista Brasileira de Hipertensão, 11, 152-156.
[15] Takazawa, K. (2005) Augmentation Index in Heart Disease. AJH, 18, 15S-18S.
[16] Wassertheurer, S., Mayer, C. and Breitenecker, F. (2008) Modeling Arterial and Left Ventricular Coupling for Non-Invasive Measurements. Simulation Modelling Practice and Theory, 16, 988-997.
[17] (2011) Omron Healthcare Europe B.V.
[18] Sugawara, J., Hayashi, K., Yokoi, T. and Tanaka, H. (2010) Carotid-Femoral Pulse Wave Velocity: Impact of Different Arterial Path Length Measurements. Artery Research, 4, 27-31.
[19] Vermeersch, S.J., Rietzschel, E.R., De Buyzere, M.L., Van Bortel, L.M., Gillebert, T.C., Verdonck, P.R., Laurent, S., Segers, P. and Boutouyrie, P. (2009) Distance Measurements for the Assessment of Carotid to Femoral Pulse Wave Velocity. Journal of Hypertension, 27, 2377-2385.
[20] Malachias, M.V.B. (2004) A Rigidez Arterial como Marcador de Lesão no Presente e Preditor de Risco no Futuro. Revista Brasileira de Hipertensão, 11, 157-160.
[21] Yasmin and Brown, M.J. (1999) Similarities and Differences between Augmentation Index and Pulse Wave Velocity in the Assessment of Arterial Stiffness. QJM: An International Journal of Medicine, 92, 595-600.
[22] Millasseau, S.C., Patel, S.J., Redwood, S.R., Ritter, J.M. and Chowienczyk, P.J. (2003) Pressure Wave Reflection Assessed from the Peripheral Pulse. Is a Transfer Function Necessary? Hypertension, 41, 1016-1020.
[23] Crilly, M., Coch, C., Bruce, M., Clark, H. and Williams, D. (2007) Repeatability of Central Aortic Blood Pressures Measured Non-Invasively Using Radial Applanation Tonometry and Peripheral Pulse Wave Analysis. Blood Pressure, 16, 262-269.
[24] Wohlfahrt, P., Wichterle, D., Seidlerová, J., Filipovsky, J., Bruthans, J., Adámková, V. and Cífková, R. (2012) Relation of Central and Brachial Blood Pressure to Left Ventricular Hypertrophy. The Czech Post-MONICA Study. Journal of Human Hypertension, 26, 14-19.
[25] Takazawa, K., Kobayashi, H., Shindo, N., Tanaka, N. and Yamashina, A. (2007) Relationship between Radial and Central Arterial Pulse Wave and Evaluation of Central Aortic Pressure Using the Radial Arterial Pulse Wave. Hypertension Research, 30, 219-228.
[26] Hayward, C.S., Kraidly, M., Webb, C.M. and Collins, P. (2002) Assessment of Endothelial Function Using Peripheral Waveform Analysis: A Clinical Application. Journal of the American College of Cardiology, 40, 521-528.
[27] Crilly, M., Coch, C., Bruce, M., Clark, H. and Williams, D. (2007) Indices of Cardiovascular Function Derived from Peripheral Pulse Wave Analysis Using Applanation Tonometry: A Measurement Repeatability Study. Vascular Medicine, 12, 189-197.
[28] Smulyan, H., Siddiqui, D.S., Carlson, R.J., London, G.M. and Safar, M.E. (2003) Clinical Utility of Aortic Pulses and Pressures Calculated From Applanated Radial-Artery Pulses. Hypertension, 42, 150-155.
[29] Williams, B., Lacy, P.S., Thom, S.M., Cruickshank, K., Stanton, A., Collier, D., Hughes, A.D. and Thurston, H. (2006) Differential Impact of Blood Pressure-Lowering Drugs on Central Aortic Pressure and Clinical Outcomes. Principal Results of the Conduit Artery Function Evaluation (CAFE) Study. Circulation, 113, 1213-1225.
[30] Safar, M. (2004) Fatores Mecanicos Preditores do Risco Cardiovascular. Revista Brasileira de Hipertensão, 11, 175-179.
[31] Pizzi, O., Brandão, A.A., Magalhães, M.E.C., Pozzan, R. and Brandão, A.P. (2006) Velocidade de Onda de Pulso—O Método e suas Implicações Prognósticas na Hipertensão Arterial. Revista Brasileira de Hipertensão, 13, 59-62.
[32] Najjar, S.S., Scuteri, A., Shetty, V., Wright, J.G., Muller, D.C., Fleg, J.L., Spurgeon, H.P., Ferrucci, L. and Lakatta, E.G. (2008) Pulse Wave Velocity Is an Independent Predictor of the Longitudinal Increase in Systolic Blood Pressure and of Incident Hypertension in the Baltimore Longitudinal Study of Aging. Journal of the American College of Cardiology, 51, 1377-1383.
[33] Fischer-Rasokat, U., Brenck, F., Zeiher, A.M. and Spyridopoulos, I. (2009) Radial Augmentation Index Unmasks Premature Coronary Artery Disease in Younger Males. Blood Pressure Monitoring, 14, 59-67.
[34] Korhonen, P.E., Syvänen, K.T., Vesalainen, R.K., Kantola, I.M., Kautiainen, H., Järvenpää, S. and Aarnio, P.T. (2009) Ankle-Brachial Index Is Lower in Hypertensive than in Normotensive Individuals in a Cardiovascular Risk Population. Journal of Hypertension, 27, 2036-2043.
[35] Wilkinson, I.B., Hall, I.R., Maccallum, H., Mackenzie, I.S., McEniery, C.M., Van der Arend, B.J., Shu, Y.E., Mackay, L.S., Webb, D.J. and Cockcroft, J.R. (2002) Pulse Wave Analysis. Clinical Evaluation of a Noninvasive, Widely Applicable Method for Assessing Endothelial Function. Arteriosclerosis, Thrombosis, and Vascular Biology, 22, 147-152.
[36] Fantin, F., Mattocks, A., Bulpitt, C.J., Bayana, W. and Rajkumar, C. (2007) Is Augmentation Index a Good Measure of Vascular Stiffness in the Elderly? Age and Ageing, 36, 43-48.
[37] Mota-Gomes, M.A., Feitosa, A.M., Brandão, M.C.B. and Chaves, H. (2006) Augmentation Index—Novo Preditor de Risco Cardiovascular. Revista Brasileira de Hipertensão, 13, 63-64.
[38] Gatzka, C.D., Kingwell, B.A., Cameron, J.D., Berry, K.L., Liang, Y.L., Dewar, E.M., Reid, C.M., Jennings, G.L., Dart, A.M. and the ANBP2 Investigators (2001) Gender Differences in the Timing of Arterial Wave Reflection beyond Differences in Body Height. Journal of Hypertension, 19, 2197-2203.
[39] Sutton-Tyrrell, K., Najjar, S.S., Boudreau, R.M., Venkitachalam, L., Kupelian, V., Simonsick, E.M., Havlik, R., Lakatta, E.G., Spurgeon, H., Kritchevsky, S., Pahor, M., Bauer, D. and Newman, A., for the Health ABC Study (2005) Elevated Aortic Pulse Wave Velocity, a Marker of Arterial Stiffness, Predicts Cardiovascular Events in Well-Functioning Older Adults. Circulation, 111, 3384-3390.
[40] Brewer, G.J. (2010) Epigenetic Oxidative Redox Shift (EORS) Theory of Aging Unifies the Free Radical and Insulin Signaling Theories. Experimental Gerontology, 45, 173-179.
[41] Giollo Jr., L.T., Mota-Gomes, M.A. and Martin, J.F.V. (2010) A Avaliação da Resposta Anti-hipertensiva com Tonometria de Aplanação. Revista Brasileira de Hipertensão, 17, 189-190.
[42] Kotsis, V., Stabouli, S., Karafillis, I. and Nilsson, P. (2011) Early Vascular Aging and the Role of Central Blood Pressure. Journal of Hypertension, 29, 1847-1853.
[43] Bellien, J., Favre, J., Iacob, M., Gao, J., Thuillez, C., Richard, V. and Joannidès, R. (2010) Arterial Stiffness Is Regulated by Nitric Oxide and Endothelium-Derived Hyperpolarizing Factor during Changes in Blood Flow in Humans. Hypertension, 55, 674-680.
[44] Weber, T., Ammer, M., Rammer, M., Adji, A., O’Rourke, M.F., Wassertheurer, S., Rosenkranz, S. and Eber, B. (2009) Noninvasive Determination of Carotid-Femoral Pulse Wave Velocity Depends Critically on Assessment of Travel Distance: A Comparison with Invasive Measurement. Journal of Hypertension, 27, 1624-1630.
[45] Kovaite, M., Petrulioniene, Z., Ryliskyte, L., Badariene, J., Dzenkeviciute, V., Cypiene, A., Laucevicius, A., Polena, S. and Gintautas, J. (2007) Systemic Assessment of Arterial Wall Structure and Function in Metabolic Syndrome. Proceedings of the Western Pharmacology Society, 50, 123-130.
[46] Chen, C.H., Nevo, E., Fetics, B., Pak, P.H., Yin, F.C.P., Maughan, W.L. and Kass, D.A. (1997) Estimation of Central Aortic Pressure Waveform by Mathematical Transformation of Radial Tonometry Pressure. Circulation, 95, 1827-1836.
[47] Nichols, W.W. (2005) Clinical Measurement of Arterial Stiffness Obtained from Noninvasive Pressure Waveforms. American Journal of Hypertension, 18, 3S-10S.
[48] Kohara, K., Tabara, Y., Oshiumi, A., Miyawaki, Y., Kobayashi, T. and Miki, T. (2005) Radial Augmentation Index: A Useful and Easily Obtainable Parameter for Vascular Aging. American Journal of Hypertension, 18, 11S-14S.
[49] Shinohata, R., Nakatsu, T., Yuki, Y., Nishitani, A., Mashima, K., Toyonaga, S., Ogawa, H., Hirohata, S., Usui, S., Kitawaki, T. and Kusachi, S. (2008) Association of Augmentation Index of Radial Pressure Wave Form with Diurnal Variation Pattern of Blood Pressure in Untreated Patients with Essential Hypertension. Journal of Hypertension, 26, 535-543.
[50] Khalegui, M. and Kullo, I.J. (2007) Aortic Augmentation Index Is Associated with Ankle-Brachial Index: A Community-Based Study. Atherosclerosis, 195, 248-253.
[51] Crilly, M., Coch, C., Clark, H., Bruce, M. and Williams, D. (2007) Repeatability of the Measurement of Augmentation Index in the Clinical Assessment of Arterial Stiffness Using Radial Applanation Tonometry. Scandinavian Journal of Clinical & Laboratory Investigation, 67, 413-422.
[52] Michel, T. and Vanhoutte, P.M. (2010) Cellular Signaling and NO Production. European Journal of Physiology, 459, 807-816.
[53] Vanhoutte, P.M., Shimokawa, H., Tang, E.H.C. and Feletou, M. (2009) Endothelial Dysfunction and Vascular Disease. Acta Physiologica, 196, 193-222.
[54] Vanhoutte, P.M. and Tang, E.H.C. (2008) Endothelium-Dependent Contractions: When a Good Guy Turns Bad! Journal of Physiology, 586, 5295-5304.
[55] Furchgott, R.F. and Zawadzki, J.V. (1980) The Obligatory Role of Endothelial Cells in the Relaxation of Arterial Smooth Muscle by Acetylcholine. Nature, 288, 373-376.
[56] Najjar, S.S., Scuteri, A. and Lakatta, E.G. (2005) Arterial Aging: Is It an Immutable Cardiovascular Risk Factor? Hypertension, 46, 454-462.
[57] Hope, S.A., Tay, D.B., Meredith, I.T. and Cameron, J.D. (2002) Comparison of Generalized and Gender-Specific Transfer Functions for the Derivation of Aortic Waveform. American Journal of Physiology. Heart and Circulatory Physiology, 283, H1150-H1156.
[58] O’Rourke, M.F. and Adji, A. (2010) Clinical Use of Applanation Tonometry: Hope Remains in Pandora’s Box. Journal of Hypertension, 28, 229-233.
[59] Kips, J.G., Schutte, A.E., Vermeersch, S.J., Huisman, H.W., Van Rooyen, J.M., Glyn, M.C., Fourie, C.M., Malan, L., Schutte, R., Van Bortel, L.M. and Segers, P. (2011) Comparison of Central Pressure Estimates Obtained from SphygmoCor, Omron HEM-9000AI and Carotid Applanation Tonometry. Journal of Hypertension, 29, 1115-1120.
[60] Murgo, J.P., Westerhof, N., Giolma, J.P. and Altobelli, S.A. (1980) Aortic Input Impedance in Normal Man: Relationship to Pressure Wave Forms. Circulation, 62, 105-116.
[61] Vlachopoulos, C., Aznaouridis, K., O’Rourke, M.F., Safar, M.E., Baou, K. and Stefanidis, C. (2010) Prediction of Cardiovascular Events and All-Cause Mortality with Central Haemodynamics: A Systematic Review and Meta-Analysis. European Heart Journal, 31, 1865-1871.
[62] Safar, M.E., Blacher, J., Protogerou, A. and Achimastos, A. (2008) Arterial Stiffness and Central Hemodynamics in Treated Hypertensive Subjects According to Brachial Blood Pressure Classification. Journal of Hypertension, 26, 130-137.
[63] Munir, S., Guilcher, A., Kamalesh, T., Clapp, B., Redwood, S., Marber, M. and Chowienczyk, P. (2008) Peripheral Augmentation Index Defines the Relationship between Central and Peripheral Pulse Pressure. Hypertension, 51, 112-118.
[64] Miyashita, H. (2012) Clinical Assessment of Central Blood Pressure. Current Hypertension Reviews, 8, 80-90.
[65] Cameron, J.D., McGrath, B.P. and Dart, A.M. (1998) Use of Radial Artery Applanation Tonometry and a Generalized Transfer Function to Determine Aortic Pressure Augmentation in Subjects with Treated Hypertension. Journal of the American College of Cardiology, 32, 1214-1220.
[66] Wilkinson, I.B., MacCallum, H., Flint, L., Cockcroft, J.R., Newby, D.E. and Webb, D.J. (2000) The Influence of Heart Rate on Augmentation Index and Central Arterial Pressure in Humans. Journal of Physiology, 1, 263-270.
[67] Gedikli, O., Ozturk, S., Yilmaz, H., Baykan, M., Kiris, A., Durmus, I., Karaman, K., Karahan, C. and Celik, S. (2009) Low Total Antioxidative Capacity Levels Are Associated with Augmentation Index but Not Pulse-Wave Velocity. Heart and Vessels, 24, 366-370.
[68] Boutouyrie, P. and Vermeersch, S.J. (2010) Determinants of Pulse Wave Velocity in Healthy People and in the Presence of Cardiovascular Risk Factors: “Establishing Normal and Reference Values”. The Reference Values for Arterial Stiffness’ Collaboration. European Heart Journal, 31, 2338-2350.
[69] Sociedade Brasileira de Cardiologia/Sociedade Brasileira de Hipertensão/Sociedade Brasileira de Nefrologia (2010) VI Diretrizes Brasileiras de Hipertensão. Arquivos Brasileiros de Cardiologia, 91, 1-51.

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