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Physiological and clinical insights from reservoir-excess pressure analysis

Journal of Human Hypertension volume 35, pages 758–768 (2021)Cite this article

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Abstract

There is a growing body of evidence indicating that reservoir-excess pressure model parameters provide physiological and clinical insights above and beyond standard blood pressure (BP) and pulse waveform analysis. This information has never been collectively examined and was the aim of this review. Cardiovascular disease is the leading cause of mortality worldwide, with BP as the greatest cardiovascular disease risk factor. However, brachial systolic and diastolic BP provide limited information on the underlying BP waveform, missing important BP-related cardiovascular risk. A comprehensive analysis of the BP waveform is provided by parameters derived via the reservoir-excess pressure model, which include reservoir pressure, excess pressure, and systolic and diastolic rate constants and Pinfinity. These parameters, derived from the arterial BP waveform, provide information on the underlying arterial physiology and ventricular–arterial interactions otherwise missed by conventional BP and waveform indices. Application of the reservoir-excess pressure model in the clinical setting may facilitate a better understanding and earlier identification of cardiovascular dysfunction associated with disease. Indeed, reservoir-excess pressure parameters have been associated with sub-clinical markers of end-organ damage, cardiac and vascular dysfunction, and future cardiovascular events and mortality beyond conventional risk factors. In the future, greater understanding is needed on how the underlying physiology of the reservoir-excess pressure parameters informs cardiovascular disease risk prediction over conventional BP and waveform indices. Additional consideration should be given to the application of the reservoir-excess pressure model in clinical practice using new technologies embedded into conventional BP assessment methods.

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Fig. 1: Conventional blood pressure (BP) assessment methods employ the automated or manual auscultatory method to derive values for systolic and diastolic BP and provide little information on the underlying arterial BP waveform.
Fig. 2: Intra-arterial aortic blood pressure measured continuously over one cardiac cycle and overlaid with parameters derived via conventional pulse-wave analysis.
Fig. 3: Parameters derived from an ensemble averaged intra-arterial aortic blood pressure waveform via reservoir excess pressure analysis.
Fig. 4: Relationship of reservoir pressure (dashed line) derived via the reservoir-excess pressure model and aortic volume measured via ultrasound in nine individuals undergoing coronary artery bypass surgery (left).

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Funding

MGS is supported by a National Health and Medical Research Council Early Research Career Fellowship (reference 1104731). ADH receives support from the British Heart Foundation (CS/13/1/30327, PG/13/6/29934, PG/15/75/31748, CS/15/6/31468, PG/17/90/33415, IG/18/5/33958), the National Institute for Health Research University College London Hospitals Biomedical Research Centre, the UK Medical Research Council (MR/P023444/1) and works in a unit that receives support from the UK Medical Research Council (MC_UU_12019/1). DSP is supported by a Menzies Community Postdoctoral Fellowship.

Author contributions

MA—Conception, data interpretation and manuscript preparation and revision. MS—Data interpretation and critical manuscript revision. AH—Data interpretation and critical manuscript revision. DP—Data interpretation and critical manuscript revision. JS—Conception, data interpretation and critical manuscript revision.

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  1. Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia

    Matthew K. Armstrong, Martin G. Schultz, Dean S. Picone & James E. Sharman

  2. MRC Unit for Lifelong Health & Aging, Institute of Cardiovascular Science, University College London, London, UK

    Alun D. Hughes

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Correspondence to James E. Sharman.

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Armstrong, M.K., Schultz, M.G., Hughes, A.D. et al. Physiological and clinical insights from reservoir-excess pressure analysis. J Hum Hypertens 35, 758–768 (2021). https://doi.org/10.1038/s41371-021-00515-6

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