Pulse Wave Analysis and Pulse Wave Velocity

momanometer that provides arterial pressures (brachial systolic and diastolic pressure) is coming under question. The concerns extend well beyond the familiar issue of “white coat” hypertension, home and 24-h blood pressure recordings, and the phase-out of mercury based instruments. These concerns relate to the inaccuracy of all cuff devices for measuring pressure within the brachial artery, the difference between pressures in the brachial artery and central aorta, and the interpretation of systolic, diastolic, mean and pulse pressure (PP).1 The present questions can be seen in context when one considers the history of hypertensive disease and its assessment by clinicians over the past 2 centuries. Richard Bright was the first to study “high arterial tension” and its relationship with kidney disease, cardiac failure and stroke.2 His assessment was made from the palpation of the pulse at the wrist, and the clinical recognition of a condition where the pulse required considerable force to obliterate and the pulse wave was sustained in late systole. Graphic methods to record the radial pulse were introduced in the late 19th century, and used in clinical practice (and life insurance exams) by English pioneers of cardiology such as Mackenzie and Lewis. But these were hard to use and were quickly