British Heart Foundation Centre, King's College London, King's Health Partners, London, United Kingdom.
Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Science, King's College London, King's Health Partners, London, United Kingdom.
Am J Physiol Heart Circ Physiol. 2021 Apr 1;320(4):H1601-H1608. doi: 10.1152/ajpheart.00818.2020. Epub 2021 Feb 19.
Central systolic blood pressure (cSBP, the peak of the central waveform) is usually regarded as the determinant of peripheral systolic blood pressure with amplification of peripheral systolic blood pressure (pSBP) measured with reference to cSBP. However, the earlier portion of the central waveform up to the first systolic shoulder (P1) may be the major determinant of pSBP. We performed in silico simulation studies and examined previously acquired experimental data ( = 131) in which peripheral and central blood pressure waveforms had been acquired both invasively and noninvasively to examine the determinants of pSBP. Measurements were made at baseline and during perturbation of hemodynamics by inotropic and vasoactive drugs. In silico simulations using a central-to-peripheral transfer function demonstrated that pSBP is dependent on P1 and the rate of change (dP/d) of central pressure up to the time of P1 but not cSBP. In computational simulations, peripheral reflection in the radial artery was closely related to dP/d, and 97% of the variability in amplification as measured with reference to P1 was explained by dP/d. In vivo, amplification of pSBP over P1 was correlated with dP/d ( > 0.75, < 0.0001 for all data sets), and P1 and dP/d were independently correlated with pSBP, explaining 90% of the variability in pSBP. We conclude that P1 and dP/d are major determinants of pSBP and that pSBP and cSBP are, in part, determined by different cardiac, central, and peripheral vascular properties. Peripheral systolic BP is determined mainly by the first shoulder and the rate of rise of the central systolic blood pressure waveform rather than the peak of this waveform (central systolic BP). Peripheral and central systolic blood pressure are determined by different cardiac and vascular properties.
中心收缩压（cSBP，即中心波峰）通常被视为外周收缩压的决定因素，外周收缩压通过参照 cSBP 进行放大测量。然而，中心波的早期部分，直至第一个收缩肩（P1），可能是外周收缩压的主要决定因素。我们进行了计算机模拟研究，并检查了之前获得的实验数据（n = 131），这些数据是通过侵入性和非侵入性方法同时获取外周和中心血压波形获得的，以检查外周收缩压的决定因素。在药物干预血流动力学时，在基线和波动期进行了测量。使用中心到外周传递函数的计算机模拟表明，外周收缩压取决于 P1 和中心压力的变化率（dP/d），直至 P1 时间，但不取决于 cSBP。在计算模拟中，桡动脉中的外周反射与 dP/d 密切相关，并且通过参照 P1 测量的放大率的 97%的变异性可以通过 dP/d 来解释。在体内，pSBP 相对于 P1 的放大与 dP/d 相关（所有数据集均> 0.75，<0.0001），并且 P1 和 dP/d 与 pSBP 独立相关，解释了 pSBP 变异性的 90%。我们得出结论，P1 和 dP/d 是 pSBP 的主要决定因素，而 pSBP 和 cSBP 在一定程度上由不同的心脏、中心和外周血管特性决定。外周收缩压主要由中央收缩压波形的第一个肩部和上升速率决定，而不是该波形的峰值（中央收缩压）决定。外周和中央收缩压由不同的心脏和血管特性决定。
