Direct measurement of blood pressure using a fluid-filled catheter and an electromechanical transducer is widely accepted in clinical practice. However, errors associated with the measurement are often not appreciated and these catheter-manometer systems are frequently unable to accurately reproduce applied pressures. To assess the accuracy of catheter-manometer systems used for invasive arterial blood pressure measurements, in vitro and in vivo evaluations were performed. The frequency response (described in terms of damped natural frequency and damping factor) for a variety of cannulae, pressure tubing and stopcocks (and combinations thereof) and their dependence on various parameters (catheter length, lumen diameter, fluid temperature and catheter material) were measured using an hydraulic pressure generator. The design and construction details of the pressure generator are presented. It was found that the damped natural frequency of the catheter-manometer system is directly proportional to lumen diameter of the pressure tubing/catheter. Furthermore, damping factor is inversely related to the damped natural frequency and stiffer catheter material (for identical radius ratios) results in higher damped natural frequency. Catheter length is inversely related to damped natural frequency and the resonant frequency decreases for an increase in fluid operating temperature. It was established that all catheter-manometer systems tested were under-damped (0.15 < β < 0.37) and that the damped natural frequency ranged from 10.5 Hz for 1500 mm to 27.0 Hz for pressure tubing of 300 mm in length. Furthermore, catheter-manometer systems which had pressure tubing in excess of 300 mm in length did not comply with the bandwidth requirements for accurate dynamic blood pressure measurement. For the in vivo assessment of the catheter-manometer system, the blood pressure waveform was analysed in the time and frequency domains. It was established that in 60 percent of the cases, the systolic pressure peak was higher when measured by a narrow bandwidth catheter-manometer system compared to that measured by a wide bandwidth system. Furthermore, values of dp/dt maximum were lower for wide bandwidth catheter-manometer systems than those measured by narrow bandwidth systems for heart rates above 90 beats per minute. In the frequency domain analysis, artifact was sometimes found to occur at frequencies higher than the bandwidth of the catheter-manometer system. This high frequency artifact was found to distort the blood pressure waveform and resulted in false high dp/dt and peak systolic pressures.

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Yes / Inter-arm differences (IAD) ≥10mmHg in systolic blood pressure (BP) are associated with greater incidence of cardiovascular disease. The effect of ethnicity and the white coat effect (WCE) on significant systolic inter-arm differences (ssIADs) are not well understood. Methods: Differences in BP by ethnicity for different methods of BP measurement were examined in 770 people (300 White British, 241 South Asian, 229 African-Caribbean). Repeated clinic measurements were obtained simultaneously in the right and left arm using two BP-Tru monitors and comparisons made between the first reading, mean of second and third and mean of second to sixth readings for patients with, and without known hypertension. All patients had ambulatory monitoring (ABPM). WCE was defined as systolic Clinic BP ≥10mmHg higher than daytime ABPM. Results: No significant differences were seen in the prevalence of ssIAD between ethnicities whichever combinations of BP measurement were used and regardless of hypertensive status. ssIADs fell between the 1st measurement (161, 22%), 2nd/3rd (113, 16%) and 2nd-6th (78, 11%) (1st vs 2nd/3rd and 2nd-6th, p<0.001). Hypertensives with a WCE were more likely to have ssIADs on 1st, (OR 1.73 (95% CI 1.04-2.86), 2nd/3rd, (OR 3.05 (1.68-5.53) and 2nd-6th measurements, (OR 2.58 (1.22-5.44). Non-hypertensive participants with a WCE were more likely to have a ssIAD on their first measurement (OR 3.82 (1.77 -8.25) only. Conclusion: ssIAD prevalence does not vary with ethnicity regardless of hypertensive status but is affected by the number of readings, suggesting the influence of WCE. Multiple readings should be used to confirm ssIADs. / This report presents independent research funded by the National Institute for Health Research (NIHR).

Photoplethysmography (PPG) is a simple means of measuring the pulse wave in humans, exploitable for the purposes of timing the arrival of the pulse at a particular point in the arterial tree, and for pulse contour analysis. This thesis describes a methodology for measuring arterial pulse transit time (PTT) from cardiac ejection to pulse arrival at the finger. It describes the effect on PTT of drug and exercise induced changes in BP. The nature of the relationship between the PPG and arterial pressure is also examined, and the PTT technique extended to assessment of conduit vessel pulse wave velocity (PWV) during exercise. PTT measured from ECG R-wave to PPG finger wave (rPTT) had a negative correlation (R2=0.39) with systolic BP (SBP), unaffected by vasoactive drugs in some but not all persons. rPTT showed similar beat-to-beat variability to SBP, unaffected by drugs. rPTT correlated weakly with diastolic (DBP) and mean (MAP) pressure. Cardiac pre-ejection period (PEP) formed a substantial and variable part of rPTT (12% to 35%). Transit time adjusted for PEP (pPTT) correlated better with DBP (R2=0.41) and MAP (R2=0.45), than with SBP. The PPG wave tracked changes in the peripheral pressure wave. Drugs had little effect on the generalised transfer function (GTF) describing the association between arterial and PPG waves. Strenuous exercise induced a large decrease in rPTT, mainly accounted for by decreases in PEP (53% of the total change in rPTT) and in transit time from aorta to distal brachial artery (33%). In contrast, minimal change in transit time from wrist to finger tip occurred with exercise. Simultaneous ear-finger PPG signals were used to measure conduit artery PWV during exercise. Ear-finger PWV (PWVef) overestimated carotid-radial PWV throughout exertion (overall bias 0.81±1.05ms-1, p<0.001), but the degree of difference remained constant. The increase in PWVef with exercise, was greater (1.18±0.54ms-1, p=0.035) in healthy subjects with a positive cardiovascular family history compared to those without. PPG enables analysis of the pulse contour during exercise, but estimation of the radial pressure wave from finger PPG by use of a GTF derived at rest, resulted in inaccuracy following exertion. These effects were variable and relatively short-lived. Furthermore, a resting GTF used to determine central pressure from the peripheral wave, resulted in underestimation of SBP (-5.9±2.1mmHg) and central pressure augmentation index (-8.3±2.9%), which persisted for 10 minutes post-exercise. rPTT had a negative linear association with SBP (R2=0.94) during strenuous exercise, slightly stronger than during recovery (R2=0.85). Differences existed in area-undercurve of the rPTT/SBP relationship between exercise and recovery, due to discrepancies in rate and degree of recovery of SBP and PEP. The linear relationship between the rPTT/SBP during exercise was affected by aerobic capacity, and the regression slope was less in the anaerobic compared to aerobic phase of exercise due to minimal change in PEP during anaerobic exertion. The correlation between rPTT/SBP did not change with prolonged aerobic exercise. Finally, measures of baroreflex sensitivity during exercise, were not significantly different between actual beat-to-beat SBP and SBP estimated using rPTT. In conclusion, absolute BP cannot be reliably estimated by measurement of rPTT following administration of drugs and during exercise. However, rPTT may have a role in measuring BP variability and in the assessing exercise capacity. PPG may also be useful in determining the effects of exercise on arterial stiffness, and for estimating the pressure wave contour, although its use during exercise for the latter purpose must be treated with caution.

Effects of sulfadiazine, sulfathiazole, and sulfapyridine on the thyroid gland and blood pressure were investigated in the rat. Thiouracil, a known potent anti-thyroid substance, was employed as a standard with which the drugs were compared. Four groups of young male albino rats were injected with graded doses of thiouracil, sulfadiazine, sulfathiazole, and sulfapyridine, suspended in distilled water, over a '6-dsy period, respectively. A 0.027' solution of the drug was incorporated into the drinking water daily. A control group was injected with physiological saline and a 0.02" solution of the saline solution was incorporated into the drinking water. Thiouracil and the sulfenamiaes acted as anti-thyroid agents. Goiterous conditions developed, including thyroid hypertrophy, reduced food intake, as well as an increase in body weight concomitantly with reduced oxygen consumption and reduction in the level of iodinated compounds in the blood. A slight increase in the systolic blood pressure was also noted. Results were obtained by means of spectrophotometry, oxygen consumption rates, blood pressure determinations, and gross analyses of the thyroid glands.

Blood pressure has previously been associated with decline in memory over time, though the exact mechanism behind this effect is uncertain. Infections, which can lead to systemic inflammation have also been linked to some cardiovascular damage to the brain, known as microbleeds, which have themselves been linked to greater declines in cognition in old age. The present study investigates whether blood pressure, a self-reported history of infection, and an indirect measure of inflammation known as the erythrocyte sedimentation rate have any association with on episodic and semantic memory and visuospatial skills in the Betula study, a Swedish longitudinal population study. The effect of elevated blood pressure (over 140 mm Hg systolic and/or 90 mm Hg diastolic), high blood sedimentation (top 33% against bottom 33% of participants), and self-reported infection were all found to not have any significant effect on episodic memory, semantic memory or visuospatial skills. Some of the possible explanations are elaborated in the discussion. / Högt blodtryck har associerats med minnesnedsättning men den exakta mekanismen hur ett samband kan förstås är dock oklar. Infektioner har visat sig ge systematiska inflammationer och har också satts i samband med vissa kardiovaskulära förändringar i hjärnan, så kallade mikroblödningar, vilka i sig har associerats med ökad risk för kognitive nedsättning i hög ålder. Denna uppsats syftar till att undersöka om blodtryck och infektion (självrapporterad infektion samt infektion indirekt mätt genom sänkereaktion) kan relateras till episodiskt och semantisk minne samt visuospatial förmåga i Betula studien, som är en svensk longitudinell populationsbaserad studie. Resultatet visade att varken högt blodtryck (över 140 mm Hg systoliskt eller 90 mm Hg diastoliskt), hög sänkereaktion (de 33 % med högst värde jämfört med de 33 % med lägst värde) eller självrapporterad infektion hade någon signifikant effekt för episodiskt minne, semantiskt minne eller visuospatial förmåga. Några möjliga förklaringar till detta resultat utvecklas i diskussionen. / The Betula Study

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abstract / Medicine / Doctoral / Doctor of Philosophy

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