Arterial Stiffness

Assessment of arterial stiffness in hypertension: comparison of oscillometric (Arteriograph), piezoelectronic (Complior) and tonometric (SphygmoCor) techniquesM Noor A. Jatoi, Azra Mahmud, Kathleen Bennett and John Feely1 Background Arterial stiffness, measured as aortic pulse wave velocity (PWV), and wave reflection, measured as augmentation index (AIx), are independent predictors for total and cardiovascular morbidity and mortality. The aim of this study was to compare a new device, based on oscillometric pressure curves (Arteriograph), which simultaneously measures PWV and AIx, with standard techniques for measuring PWV (Complior) and AIx (SphygmoCor) in untreated hypertensive patients. Methods We compared PWV and AIx measured using the Arteriograph with corresponding Complior and SphygmoCor measurements in 254 untreated hypertensive patients, age 48W14 years (meanWSD, range 17–85 years). Results Arteriograph PWV and AIx were closely related with Complior (rU0.60, P<0.001) and SphygmoCor (rU0.89, P<0.001), respectively. Using stepwise regression analysis, the independent determinants of Arteriograph PWV were age, mean arterial pressure, heart rate and sex (r2U0.44, P<0.0001) and for AIx were age, weight, mean arterial pressure, heart rate and sex (r2U0.65, P<0.0001). The bias between the different techniques was determined by age and sex for PWV and age, body weight, sex, heart rate and mean arterial pressure for AIx. Bland–Altman plots showed that although the techniques were closely related, the limits of agreement were wide. Conclusion Although Arteriograph values and the determinants of PWV and AIx are in close agreement with corresponding parameters obtained by Complior and SphygmoCor, respectively, the techniques are not interchangeable. J Hypertens 27:2186–2191 Q 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins. Journal of Hypertension 2009, 27:2186–2191 Keywords: arterial stiffness, arteriograph, augmentation index, hypertension, pulse wave velocity Abbreviations: AIx, augmentation index; BP, blood pressure; CAD, coronary artery disease; CI, confidence interval; ESH, European Society of Hypertension; HR, heart rate; MAP, mean arterial pressure; PP, pulse pressure; PWV, pulse wave velocity Department of Pharmacology and Therapeutics, Trinity College Centre for Health Sciences and Hypertension Clinic, St. James’s Hospital, Dublin, Ireland Correspondence to Azra Mahmud, MRCPI, PhD, Department of Therapeutics & Hypertension Clinic, Trinity Centre for Health Sciences, St. James’s Hospital, Dublin 8, Ireland Tel: +353 1896 2667; fax: +353 1453 9033; e-mail: mahmuda@tcd.ie 1 John Feely deceased. Received 21 October 2008 Revised 5 June 2009 Accepted 28 June 2009 See editorial commentary on page 2159 Introduction Arterial stiffness is now regarded as an importantmarker of cardiovascular risk [1] andmeasured as pulse wave velocity (PWV) has been shown to be a strong independent predictor of cardiovascular morbidity in hypertension [2], type II diabetes [3] and of all-cause mortality in patients with hypertension [2] end-stage renal disease [4], and in the general population [5] and is recommended in current European Society of Hypertension (ESH) and European Society of Cardiology (ESC) guidelines for risk assessment in hypertension [6]. Wave reflection as an augmentation index (AIx), a composite of PWV, arterial wave reflection and left ventricular ejection is an independent factor associated with poor survival in end-stage renal disease [7] and the extent of angiographic coronary artery disease (CAD) in men of less than 60 years of age [8]. Currently, two systems are in common use: Complior