Menzies Institute for Medical Research, University of Tasmania, Australia.
Department of Cardiology, Royal Hobart Hospital, Australia.
Am J Hypertens. 2020 Apr 1;33(4):325-330. doi: 10.1093/ajh/hpaa013.
Central artery reservoir-excess pressure parameters are clinically important but impractical to record directly. However, diastolic waveform morphology is consistent across central and peripheral arteries. Therefore, peripheral artery reservoir-excess pressure parameters related to diastolic waveform morphology may be representative of central parameters and share clinically important associations with end-organ damage. This has never been determined and was the aim of this study.
Intra-arterial blood pressure (BP) waveforms were measured sequentially at the aorta, brachial, and radial arteries among 220 individuals (aged 61 ± 10 years, 68% male). Customized software was used to derive reservoir-excess pressure parameters at each arterial site (reservoir and excess pressure, systolic and diastolic rate constants) and clinical relevance was determined by association with estimated glomerular filtration rate (eGFR).
Between the aorta and brachial artery, the mean difference in the diastolic rate constant and reservoir pressure integral was -0.162 S-1 (P = 0.08) and -0.772 mm Hg s (P = 0.23), respectively. The diastolic rate constant had the strongest and most consistent associations with eGFR across aortic and brachial sites (β = -0.20, P = 0.02; β = -0.20, P = 0.03, respectively; adjusted for traditional cardiovascular risk factors). Aortic, but not brachial peak reservoir pressure was associated with eGFR in adjusted models (aortic β = -0.48, P = 0.02).
The diastolic rate constant is the most consistent reservoir-excess pressure parameter, in both its absolute values and associations with kidney dysfunction, when derived from the aorta and brachial artery. Thus, the diastolic rate constant could be utilized in the clinical setting to improve BP risk stratification.
中央动脉储器过剩压力参数在临床上很重要，但直接记录并不实际。然而，舒张波形形态在中央和外周动脉之间是一致的。因此，与舒张波形形态相关的外周动脉储器过剩压力参数可能代表中央参数，并与终末器官损伤具有重要的临床关联。这一点从未得到确定，也是本研究的目的。
在 220 名个体（年龄 61 ± 10 岁，68%为男性）中，依次测量主动脉、肱动脉和桡动脉的动脉内血压（BP）波形。使用定制软件在每个动脉部位得出储器过剩压力参数（储器和过剩压力、收缩和舒张速率常数），并通过与估算肾小球滤过率（eGFR）的相关性来确定临床相关性。
在主动脉和肱动脉之间，舒张速率常数和储器压力积分的平均差值分别为-0.162 S-1（P = 0.08）和-0.772 mm Hg s（P = 0.23）。舒张速率常数与主动脉和肱动脉部位的 eGFR 具有最强和最一致的相关性（β = -0.20，P = 0.02；β = -0.20，P = 0.03，分别为调整后的心血管危险因素）。调整后的模型中，主动脉峰值储器压力而非肱动脉峰值储器压力与 eGFR 相关（主动脉β = -0.48，P = 0.02）。
当从主动脉和肱动脉得出时，舒张速率常数是最一致的储器过剩压力参数，其绝对值和与肾功能障碍的相关性均如此。因此，舒张速率常数可用于临床环境，以改善血压风险分层。
