Contour of the toe pulse, reactive hyperemia, and pulse transmission velocity: group and repeat variability, effect of age, exercise, and disease.

Abstract 1. 1. In 170 normal young men, 270 normal middle-aged men, 57 patients with arterial hypertension, and 36 patients with peripheral vascular disease, the toe pulse was photoelectrically recorded before and for vive minutes after arterial occlusion (reactive hyperemia). The following items were measured: absolute and relative crest time (per cent of cycle length); relative amplitude (per cent of peak amplitude) at one-fourth and one-half of the diastolic phase; amplitude changes during reactive hyperemia (in per cent of amplitude before arterial occlusion). 2. 2. There was an initial drop of the amplitude ten seconds after release of arterial occlusion in the normal groups and in the patients with peripheral vascular disease, but not in the hypertensive patients. 3. 3. The reactive hyperemia was not significantly different in the normal younger and older age groups but was much weaker and delayed in patients with peripheral vascular disease; in the more advanced cases it was entirely absent. The maximum increase of the amplitude during reactive hyperemia was moderately decreased also in the hypertensive patients. 4. 4. There was a statistically highly significant increase of the absolute and relative crest time, and slowing of the decline in the diastolic phase with age. 5. 5. The hypertensive patients showed no significant differences in the crest time, but a significantly slower diastolic decline as compared to normals. 6. 6. The rise as well as the decline of the pulse was significantly slower in patients with peripheral vascular disease. 7. 7. The separation of the patients with peripheral vascular disease from normals, investigated by distribution analysis, was excellent for all items of the contours analysis, particularly for the relative crest time and relative amplitude at one-fourth of the diastolic phase, and superior to the separation by means of reactive hyperemia. 8. 8. In about 10 per cent of hyperentsive patients the crest time and the diastolic decline were significantly delayed, even in the absence of clinical peripheral arteriosclerosis. 9. 9. The deviation of pulse contour and reactive hyperemia in patients with peripheral vascular disease depends on the degree of impairment rather than on the type of disease. 10. 10. The highly significant separation between the groups with all items of contour analysis is contrasted by a relatively poor consistency in repeat experiments in twenty-six normal young men. 11. 11. The pulse transmission velocity was determined in meters per second from the interval first heart sound to footpoint of the pulse, a correction for the isometric phase of contraction, and the distance from heart to toe. The values are in general agreement with earlier observations. The increase of the pulse transmission velocity with age and in hypertension, and the decrease in perpheral vascular disease were statistically highly significant. 12. 12. There was no interindividual correlation between blood pressure and pulse transmission time in the normal groups, but there was a significant correlation between intraindividual variations of blood pressure and pulse wave transmission time. In hypertensive patients, there was a significant inter-individual correlation. 13. 13. The effect of exercise on pulse transmission velocity, contour of the toe pulse, and reactive hyperemia was studied in seven normal young men. 14. 14. The results substantiate the diagnostic value of analysis of the digital pulse for early recognition of vascular degeneration with age or in disease, and normal limits for separation of normal and abnormal are suggested.