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Discovery of New Blood Pressure Phenotypes and Relation to Accuracy of Cuff Devices Used in Daily Clinical Practice.

Picone DS, Schultz MG, Peng X, Black JA, Dwyer N, Roberts-Thomson P, Chen CH, Cheng HM, Pucci G, Wang JG, Sharman JE.

Hypertension. 2018 Jun;71(6):1239-1247.

DOI: 10.1161/HYPERTENSIONAHA.117.10696 

Dean Picone (Australia)

1) Summarize your work in one sentence.

We examined whether distinct blood pressure (BP) phenotypes (categories) exist in the way BP is transmitted from central (aorta) to peripheral (brachial, radial) arteries and whether measurements from standard cuff BP could discriminate these phenotypes.

2) Summarize your findings in one sentence.

We discovered four distinct BP phenotype, with patients in two of the phenotypes having significantly raised aortic BP, but this was undetected by standard cuff device measurements.

3) Which were the more important methods you used in this work? If it is not a traditional method you can briefly explain the concept of that methodology.

We performed standard upper arm cuff and invasive (catheter) BP measurements in patients undergoing coronary angiography.

The invasive BP protocol was the most important method and was developed for this study. At the end of the clinical procedure, the catheter was positioned in the ascending aorta and a steady, stable invasive BP trace was recorded for 20 seconds. The catheter was then ‘pulled back’ and positioned in the mid-brachial artery and the BP measurements repeated. Finally, the catheter was pulled back to the radial artery and the BP measurements repeated.

The invasive systolic BP values from the aorta, brachial and radial arteries were analysed and used to define the BP phenotypes.

Cuff BP was taken using different devices at several different times.

4) What did you learn from this paper, what was your take-home message?

The way that BP is transmitted from the central-to-peripheral arteries is highly variable and can be defined in terms of four distinct BP phenotypes. Across these phenotypes, significantly different aortic BP cannot be detected by standard cuff BP. This could be because the cuff devices use the same generic operating function on all patients (e.g oscillometric algorithms or Korotkoff sounds), instead of accounting for more detailed phenotypic features. Ultimately, information from the phenotypes could be used in future work to improve the accuracy of cuff BP.


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