Cardiovascular Profiler

The ubiquitous brachial cuff method, the blood pressure cuff put on the arm while sitting on the exam table, was developed in 1890 and gained widespread clinical acceptance for blood pressure recording after confirmation of its prognostic value in 1917. Mayo Clin Proc. 2006;81(8):1057-1068

Since that time, brachial cuff sphygmomanometry has migrated from the physician’s office to 24-hour monitoring and home use, with electronic methods replacing the Korotkov sound technique for determining systolic and diastolic pressure.

Detailed instrumental studies, required by regulatory bodies, reveal inaccuracies of all cuff methods for recording true intra-arterial pressure. A major source of inaccuracy in assessing left ventricular load of the heart is the amplification of the pressure wave in its transit from the central aorta to upper limb arteries, as extensively studied by Earl H. Wood at the Mayo Clinic in Rochester, Minn, in the 1950s.

This limitation can be overcome by combining newer methods using radial artery waveform analysis in conjunction with conventional cuff sphygmomanometry to noninvasively measure the central aortic pressure waveforms.
Recent studies using radial tonometry (touching the tissue for vibration or wave form) have proved that this is more effective than conventional manometry (squeezing arm to get a pressure) in predicting cardiovascular events and gauging response to therapy.

Measurement of central as well as peripheral arterial pressure and physiology is becoming increasingly used as an office practice and a laboratory procedure. The Cardiovascular Profiler used in my office can measure small vessel disease which can have specific therapy (l-arginine) given to reverse most of invisible part of the complications of diabetes.

More devices in this class are coming on the market that can also measure aortic pressure, arterial elasticity in age related distribution. Mathematical analysis of the wave form itself will be able to follow the progress of treatment of autonomic neuropathy to be measured. Specific measurement will allow development of new treatments to reverse this complication.

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