Model for post-occlusive reactive hyperemia as measured noninvasively with pressure pulse waveform

Post-occlusive reactive hyperemia is a noninvasive maneuver to assess microvascular reactivity related to the bioavailability and/or bioactivity of endothelial-derived factors. The inability to respond to endogenous vasodilator substances is mostly described by a low peak flow after an event associated with a peak flow. The aim of this study is to propose a model to describe post-occlusive responses observed in the pressure waveforms after occlusion release. Model variables were investigated in search of those representatives of the endothelial response to the ischemic process. Radial pressure pulse waveforms were acquired in the anterior region of the wrist, superficial to the radial artery, using a piezoelectric transducer acquired by a 12 bits acquisition board model at a sampling rate of 1.0 kHz to increase the temporal resolution. The occlusion maneuver was performed using an arm-cuff placed over the brachial artery. A time series of pulse pressure (PP) values, calculated from successive values of beat-to-beat systolic and diastolic pressures, was found to be a useful variable representing blood pressure signal in the model. This data time series of the pulse pressure presents reduced initial values compared with the baseline measurement, and an increasing value until a steady state behavior was sustained after approximately 60 s. This behavior for the pulse pressure series was described by a hyperbolic tangent model with parameters K (rate of change of PP), PP0 (first value of PP after cuff release), and ΔPP (change in PP). The model was applied to pulse pressure signals from normotensive and hypertensive subjects. The observed responses between groups suggest that PP0 and ΔPP are related to an endothelial response to the ischemic process and could be used as a clinical tool to assess endothelial function in hypertension.