Managing anti-hypertensive treatment with SphygmoCor XCEL

Transcription

1 Managing anti-hypertensive treatment with SphygmoCor XCEL Measurement of Central aortic BP may provide valuable information on antihypertensive drug action that is not apparent with assessment of Brachial pressure Franklin, SSJ an Soc Hypertens 2008:\; 2(3):

2 Central aortic pressure vital in assessing drug effects SphygmoCor XCEL Medication can effect central and bracial pressure differently The CAFE Study 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 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 validation vs. SphygmoCor with tonometer waveform capture Central Systolic Blood pressure Average difference 0.5 mmhg ± 1.8 mmhg R value (correlation) r=.99 Central Aortic Pulse Pressure Average difference 0.5 mmhg ± 1.5 mmhg R value (correlation) r=.99 Central Augmentation index Average difference 1.8% ± 7% R value (correlation) r=.91 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

3 Using central aortic pressure in anti-hypertensive treatment 1. Reducing Periferal Stiffness 3. Using central aortic pressure in anti-hypertensive treatment Brachial pressure: 152/94 Central Aortic pressure: 143/95 58mmHg AIx = 38% Brachial pressure: 118/83 Central Aortic pressure: 106/83 35mmHg AIx = 25% 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. Brachial pressure: 185/90 Central Aortic pressure: 179/90 89mmHg AIx = 31% HR = 49 beats per minute Brachial pressure: 106/72 Central Aortic pressure: 95/72 23mmHg AIx = 28% HR=72 beats per minute Traditional betablockers 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 2. Titrating the Level of Medication 4. Improving Compliance Waveform shape provides visual information about reduction in reflected wave after a higher dose of vasodialating antihypertensive medication. Dramatic positive changes in waveform shape may motivate patient compliance Brachial pressure: 160/95 Central Aortic pressure: 148/95 53mmHg AIx = 28% Brachial pressure: 138/85 Central Aortic pressure: 121/85 36mmHg AIx = 14% Brachial pressure: 188/76 Central Aortic pressure: 176/76 100mmHg AIx = 45% HR=72 beats per minute Brachial pressure: 120/75 Central Aortic pressure: 102/75 27mmHg AIx = 2%

4 Pulse Wave Velocity Critical in Understanding Aortic Stiffening Measuring carotid femoral PWV with SphygmoCor XCEL Reducing PWV can have an effect independent of the BP reduction 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/s o Correlation of r=0.91 o Standard deviation of.59 m/s No undressing required Suitable for screening and epidemiology clinical trials Comparison to Healthy and normal ranges 2 groups of ESRD patients, survivors and non survivors, taking perindropril. Aortic stiffness risk stratification 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.

5 SphygmoCor XCEL Specifications Contact Information Options SphygmoCor XCEL CBP SphygmoCor XCEL PWV SphygmoCor XCEL CBP and PWV Head Office AtCor Medical Pty Ltd Operating Ambient Temperature Operating Relative Humidity External Power Supply (use only AtCor part number ) Physical Specifications +15 C to 40 C (59 F to 104 F) 15% to 95% non-condensing VAC, 50-60Hz 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: mmhg Dia: mmhg Heart rate beats per minute West Ryde Corporate Centre Suite 11, Victoria Rd. West Ryde NSW 2114 Sydney, Australia Telephone: + (61) Facsimile: + (61) inquiry@atcormedical.com USA Office AtCor Medical Inc One Pierce Place, Suite 225-West, Itasca, IL, 60143, USA Telephone: + (1) Facsimile: + (1) atcorusa@atcormedical.com Non invasive BP measurements provided by Suntech Advantage Mini validated to BHS and IEC standards Laptop Specifications European Office contact.europe@atcormedical.com Web: Type Processor Nominal Speed Memory Hard Disk Accessories Printer Drivers Communications Minimum Display Resolution IBM Compatible PC Intel or compatible, 32 bits 2GHz minimum 1GB RAM minimum 2GB for Installation 10GB for database DVD drive Standard USB port 1024 x 768 pixels Operating SystemsWindows XP Professional + SP3, or Windows 7 Professional Managing Medication with SphygmoCor XCEL