managing anti-hypertensive treatment with sphygmocor xcel · 2013-05-22 · managing...

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: 106/72Central Aortic pressure: 95/72Central Pulse Pressure: 23mmHgAIx = 28%HR=72 beats per minute



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

managing anti-hypertensive treatment with sphygmocor xcel · 2013-05-22 · managing...

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