A systematic review of invasive, high-fidelity pressure studies documenting the amplification of blood pressure from the
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ORIGINAL RESEARCH
A systematic review of invasive, high‑fidelity pressure studies documenting the amplification of blood pressure from the aorta to the brachial and radial arteries Denis Chemla1 · Sandrine Millasseau2 Received: 27 May 2020 / Accepted: 28 September 2020 © Springer Nature B.V. 2020
Abstract It is commonly accepted that systolic blood pressure (SBP) is significantly higher in the brachial/radial artery than in the aorta while mean (MBP) and diastolic (DBP) pressures remain unchanged. This may have implications for outcome studies and for non-invasive devices calibration. We performed a systematic review of invasive high-fidelity pressure studies documenting BP in the aorta and brachial/radial artery. We selected articles published prior to July 2015. Pressure amplification (Amp = peripheral minus central pressure) was calculated (weighted mean). The six studies retained (n = 294, 76.5% male, mean age 63.5 years) mainly involved patients with suspected coronary artery disease (CAD). In two studies at the aortic/ brachial level (n = 64), MBP and DBP were unchanged (MPAmp = 0.1 mmHg, DPAmp = −1.3 mmHg), while SBP increased (SPAmp = 4.2 mmHg; relative amplification = 3.1%). In four studies in which MBP was not documented (n = 230), brachial DBP remained unchanged and SBP increased (SPAmp = 6.6 mmHg; 4.9%). One of these four studies also reported radial SBP and DBP, not MBP (n = 12). Few high-fidelity pressure studies were found, and they have been performed mainly in elderly male patients with suspected CAD. Counter to expectations, the mean amplification of SBP from the aorta to brachial artery was 10 mmHg, 20% had SPAmp 5–10 mmHg, 26.7% had SPAmp 0–5 mmHg and 26.7% patients had a negative SPAmp, i.e., aortic SBP was higher than brachial SBP in more than a quarter of patients (see also ESM Fig. 1, lower panel). 2.1.2 Group 2: high‑fidelity SBP and DBP data set at both aortic and brachial sites (4 articles, 230 subjects)
available. MBP data were not reported. The study reported stable DBP values from the aorta to radial artery (−2 mmHg and −3.2% for the mean difference and relative amplification, respectively). SBP increased from the aorta to the radial artery (8 mmHg and 5.8% for SPAmp and relative SPAmp, respectively) (Table 3).
2.2 Secondary analysis of fluid‑filled pressure studies (see ESM)
Four high-fidelity pressure studies [21–24] reported SBP and DBP only with no MBP reported. They are presented in Table 2 and included a total of 230 patients, mean age 64 years, with 73% male patients. DBP remained unchanged between the central and brachial artery (0.2 mmHg and 0.3% for the mean difference and relative amplification, respectively) while SBP increased (6.6 mmHg and 4.9% for the mean SPAmp and relative SPAmp, respectively).
Characteristics of the studies included, and the rationale for having excluded other studies from our analysis are detailed in ESM- Table 2 at the aortic/brachial artery level in awake patients. No study providing the full data set (SBP, DBP and MBP) and meeting other
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