Arterial pressure waveforms in hypertension.

Measurement of arterial pressure waveforms in hypertension enhances information on underlying disease and mechanisms, since it provides all information in the waveform, and not just the extreme limits of the waveform (systolic and diastolic pressure) which are obtained from the brachial artery with a cuff sphygmomanometer. Such studies of the waveform reawaken the clinical use of sphygmography which was used in clinical practice and for life insurance examinations before the cuff sphygmomanometer was introduced by Riva-Rocci in 1896. Modern advances include use of accurate electronic tonometers for pressure recording, application of knowledge on wave transmission in the upper limb, and use of computer techniques to manipulate, store and retrieve data. It is now possible to determine the aortic pressure waveform, and so, left ventricular pressure throughout systole, with an accuracy which is limited only by the inaccuracy of the sphygmomanometer cuff. Clinical application assists in recognition of spurious systolic hypertension as a condition which needs no treatment, and in grading the severity of hypertension for any given value of cuff systolic and diastolic pressure. Application also permits tailoring of drug therapy for the underlying abnormality of increased peripheral resistance or increased stiffness of the large elastic arteries. Information obtained also assists in prognosis.