Managing anti-hypertensive treatment with SphygmoCor XCEL
“Measurement of Central aortic BP may provide valuable information on anti-hypertensive drug action that is not apparent with assessment of Brachial pressure” Franklin, SSJ an Soc Hypertens 2008:\; 2(3): 140-151
Central aortic pressure – vital in assessing drug effects
Medication can effect central and bracial pressure differently
The CAFE Study
“The CAFE Study has provided the first randomized, prospective event-based evidence that central BP and related indices may be a useful guide to treatment.”Central Blood Pressure Measurements and Antihypertensive Therapy: A Consensus Document
• Both Atenolol and Amolodipine had similar Brachial pressure reductions.
• Amlodipine reduced central pressure more than Atenolol (average 4.3mg)
• 30% less CV events in the Amolidipine group.
SphygmoCor XCEL
SphygmoCor XCEL validation vs. SphygmoCor with tonometer waveform capture”
• Measurement in under 60 seconds.
• Simple technique – place cuff on arm and press start.
• Operator independent
• Modified SphygmoCor General Transfer function.
• Accurate-data equivalency with earlier SphygmoCor systems
Central Systolic Blood pressureAverage difference 0.5 mmHg ± 1.8 mmHgR value (correlation) r=.99
Central Aortic Pulse PressureAverage difference 0.5 mmHg ± 1.5 mmHgR value (correlation) r=.99
Central Augmentation indexAverage difference 1.8% ± 7%R value (correlation) r=.91
Using central aortic pressure in anti-hypertensive treatment
Vasodialating anti-hypertensive medication such as ARB, ACE’s and CCB’s reduce peripheral wave reflection and in doing so reduce Central Systolic pressure and central pulse pressure.
Traditional beta-blockers such as atenolol decrease Brachial BP by slowing heart rate, not by reducing arterial stiffness. Even on high doses of Beta blockers, patients can be at risk from high wave reflection and high Central pulse pressure
Dramatic positive changes in waveform shape may motivate patient compliance
Waveform shape provides visual information about reduction in reflected wave after a higher dose of vasodialating antihypertensive medication.
1. Reducing Periferal Stiffness
Brachial pressure: 152/94Central Aortic pressure: 143/95Central Pulse Pressure: 58mmHgAIx = 38%
Brachial pressure: 185/90Central Aortic pressure: 179/90Central Pulse Pressure: 89mmHgAIx = 31%HR = 49 beats per minute
Brachial pressure: 188/76Central Aortic pressure: 176/76Central Pulse Pressure: 100mmHgAIx = 45%HR=72 beats per minute
Brachial pressure: 160/95Central Aortic pressure: 148/95Central Pulse Pressure: 53mmHgAIx = 28%
Brachial pressure: 118/83Central Aortic pressure: 106/83Central Pulse Pressure: 35mmHgAIx = 25%
Brachial pressure: 106/72Central Aortic pressure: 95/72Central Pulse Pressure: 23mmHgAIx = 28%HR=72 beats per minute
Brachial pressure: 120/75Central Aortic pressure: 102/75Central Pulse Pressure: 27mmHgAIx = 2%
Brachial pressure: 138/85Central Aortic pressure: 121/85Central Pulse Pressure: 36mmHgAIx = 14%
2. Titrating the Level of Medication
3. Using central aortic pressure in anti-hypertensive treatment
4. Improving Compliance
BEFORE BEFORE
BEFOREBEFORE
AFTER AFTER
AFTERAFTER
Pulse Wave Velocity – Critical in Understanding Aortic Stiffening
• 2 groups of ESRD patients, survivors and non survivors, taking perindropril.
• In survivors, BP was reduced and PWV was also reduced [from average of 13m/s to <10m/s]
• In non survivors, BP reduced by a similar amount, but PWV increased.
Reducing PWV can have an effect independent of the BP reduction
Measuring carotid femoral PWV with SphygmoCor XCEL
SphygmoCor EXCEL
• Gold standard carotid to femoral PWV
• Simultaneous measurement with cuff and high fidelity tonometer
• PWV measurements in 60 seconds
• Data equvalency with earlier SphygmoCor systems
o Average difference 0.05m/so Correlation of r=0.91o Standard deviation of .59 m/s
• No undressing required
• Suitable for screening and epidemiology clinical trials
• Comparison to Healthy and normal ranges
Aortic stiffness risk stratification
SphygmoCor XCEL Specifications
Options SphygmoCor XCEL CBP SphygmoCor XCEL PWV SphygmoCor XCEL CBP and PWV
Operating Ambient +15°C to 40°C (59°F to 104°F)Temperature
Operating Relative 15% to 95% non-condensingHumidity
External Power 100-240 VAC, 50-60HzSupply (use only AtCor part number 1-00877)
Physical Specifications Enclosure Material | Polycarbonate Weight | 0.7 kg (1.5 lbs) Dimensions | 9.9 (l) x 19 (w) x 17.2 (h) cm
Range NIBP, PWV | Sys: 50 - 260 mmHg Dia: 40 - 200 mmHg
Heart rate | 30 - 220 beats per minute
Non invasive BP measurements provided by Suntech Advantage Mini validated to BHS and IEC standards
Laptop Specifications
Type IBM Compatible PC
Processor Intel or compatible, 32 bits
Nominal Speed 2GHz minimum
Memory 1GB RAM minimum
Hard Disk 2GB for Installation 10GB for database
Accessories DVD drive
Printer Drivers Standard
Communications USB port
Minimum Display 1024 x 768 pixelsResolution Operating SystemsWindows XP Professional + SP3, or Windows 7 Professional
Contact Information
Head Office
AtCor Medical Pty Ltd
West Ryde Corporate CentreSuite 11, 1059-1063 Victoria Rd.West Ryde NSW 2114Sydney, AustraliaTelephone: + (61) 2 9874 8761Facsimile: + (61) 2 9874 9022Email:[email protected]
USA Office
AtCor Medical Inc
One Pierce Place, Suite 225-West,Itasca, IL, 60143, USATelephone: + (1) 630 228 8871Facsimile: + (1) 630 228 8872Email: [email protected]
European Office
Email: [email protected]
Web: www.atcormedical.com
Managing Medication with SphygmoCor XCEL – 101353