Validity and reliability of diastolic pulse contour analysis (Windkessel model) in humans

The present study assessed ( I) the impact of the measurement site (lower versus upper extremity) on the corresponding compliance variables and (2) the overall reliability of diastolic pulse contour (Windkessel-derived) analysis in normal and hypertensive subjects. Arterial tonograms were recorded in the supine position from the radial and posterior tibial arteries in 20 normotensive (116 +/- 12/68 +/- 8 mm Hg) and 27 essential hypertensive subjects (160 +/- 16/94 +/- 14 mm Hg). Ensemble-averaged data for each subject were fitted to a first-order lumped-parameter model (basic Windkessel) to compute whole-body arterial compliance (C-A) and to a third-order lumped-parameter model (modified Windkessel) to compute proximal compliance (C-1) and distal compliance (C-2). Despite high-fidelity waveforms in each subject, the first-order Windkessel model did not yield interpretable (positive) values for C-A in 50% of normotensives and 41% of hypertensives, whereas the third-order model failed to yield interpretable C-1 or C-2 results in 15% of normotensives and 41% of hypertensives. No between-site correlations were found for the first-order time constant, 2 of the 3 third-order model curve-fitting constants, or C-A, C-1, or C-2 (P>0.50). Mean values for all 3 compliance variables were higher for the leg than the arm (P<0.05 each). We conclude that differences in Windkessel-derived compliance values in the arm and leg invalidate whole-body model assumptions and suggest a strong influence of regional circulatory properties. The validity and utility of Windkessel-derived variables is further diminished by the absence of between-site correlations and the common occurrence of uninterpretable values in hypertensive subjects.