Digital pulse plethysmography (DPG) in studies of the hemodynamic response to nitrates — A survey of recording methods and principles of analysis

Lund, F

doi:10.1111/j.1600-0773.1986.tb02551.x

Cited by 28 publications

(7 citation statements)

References 32 publications

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“…The position of the dicrotic notch in the peripheral blood flow signal, estimated as PAR, reflected the general vascular tone in young adults (Klemsdal et al 1996 ). Nitrate decreased the PAR at rest suggesting that a decrease in peripheral vascular tone (Bahra et al 2012 ) was caused by nitrate or subsequent metabolites (Lund 1986 ). Previous experiments demonstrate that this effect is dependent upon nitric oxide or potential metabolites as arterial infusion of nitric oxide synthase inhibitors blunted arterial elasticity that was restored by arginine infusion (McVeigh et al 2001 ).…”

Section: Discussionmentioning

confidence: 99%

Oral nitrate and citrulline decrease blood pressure and increase vascular conductance in young adults: a potential therapy for heart failure

Alsop

Hui‐Kang

2016

Eur J Appl Physiol

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PurposeBoth inorganic nitrate and citrulline are known to alter the arginine–nitric oxide–nitrate system to increase the bioavailability of nitric oxide with potential benefits in the treatment of heart failure. However, their effects on cardiac electrical activity, vascular compliance and peripheral conductance are less well understood. This study examined the effect of nitrate and citrulline on cardiac electrical activity and blood flow.MethodsYoung adult subjects (n = 12) were recruited to investigate the effects of acute oral nitrate consumption (8 mg/kg) and chronic citrulline consumption (3 g/day) on cardiac electrical activity measured by ECG recording and blood pressure. Blood flow and vascular compliance were measured by IR-plethysmography at the thumb and the hallux.ResultsNitrate (p < 0.05) and citrulline (p < 0.01) consumption both decreased diastolic blood pressure but had no effect on either pulse pressure or rate-pressure product (NS for both). Citrulline also decreased systolic pressure (p < 0.01). Nitrate and citrulline both decreased vascular compliance (p < 0.05 for both) prior to isometric grip exercise, but this was increased for nitrate following exercise (NS). Citrulline decreased R–R interval 9 % (p < 0.05) at rest and increased heart rate (p < 0.05) in addition to significantly decreasing pulse transit duration (6 %; p < 0.05). QRS duration was also decreased by 5 % for citrulline (p < 0.05) with the reduction in R–R interval.ConclusionBoth nitrate and citrulline supplementation decreased vascular tone at rest but citrulline also altered sympathovagal balance to increase sympathetic tone. We suggest that both oral nitrate and citrulline may be suitable adjuvants for patients with heart failure to improve peripheral tissue oxygenation.

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Section: Discussionmentioning

confidence: 99%

Oral nitrate and citrulline decrease blood pressure and increase vascular conductance in young adults: a potential therapy for heart failure

Alsop

Hui‐Kang

2016

Eur J Appl Physiol

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“…The potential for PPG assessments to assess vasodilatation has been demonstrated using haemodynamic responses to nitroglycerin (NTG) therapy (Lund 1986). A well-considered PPG measurement protocol was described whereby changes in the dicrotic notch feature of the finger and toe pulse were studied over several hours to give information about the degree and length of vasodilatation with vasoactive drug.…”

Section: Endothelial Functionmentioning

confidence: 99%

Photoplethysmography and its application in clinical physiological measurement

2007

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Photoplethysmography (PPG) is a simple and low-cost optical technique that can be used to detect blood volume changes in the microvascular bed of tissue. It is often used non-invasively to make measurements at the skin surface. The PPG waveform comprises a pulsatile ('AC') physiological waveform attributed to cardiac synchronous changes in the blood volume with each heart beat, and is superimposed on a slowly varying ('DC') baseline with various lower frequency components attributed to respiration, sympathetic nervous system activity and thermoregulation. Although the origins of the components of the PPG signal are not fully understood, it is generally accepted that they can provide valuable information about the cardiovascular system. There has been a resurgence of interest in the technique in recent years, driven by the demand for low cost, simple and portable technology for the primary care and community based clinical settings, the wide availability of low cost and small semiconductor components, and the advancement of computer-based pulse wave analysis techniques. The PPG technology has been used in a wide range of commercially available medical devices for measuring oxygen saturation, blood pressure and cardiac output, assessing autonomic function and also detecting peripheral vascular disease. The introductory sections of the topical review describe the basic principle of operation and interaction of light with tissue, early and recent history of PPG, instrumentation, measurement protocol, and pulse wave analysis. The review then focuses on the applications of PPG in clinical physiological measurements, including clinical physiological monitoring, vascular assessment and autonomic function.

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“…It has been known for over a century that nitrovasodilators alter the shape of the peripheral pulse wave, in particular by lowering and exaggerating the point of inflection, termed the dicrotic notch, which occurs on the downslope, between the systolic and diastolic peaks (Murrell, 1879; Dillon & Hertzman, 1941; Imhof et al 1980; Lund, 1986). The subsequent discovery that nitrovasodilators act after being metabolized to NO within blood vessels gave rise to the suggestion that analysis of the peripheral pulse waveform, which may be measured easily and cheaply by plethysmography, might form the basis of a simple method to determine NO bioactivity.…”

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Evidence for a specific influence of the nitrergic pathway on the peripheral pulse waveform in rabbits

Nier¹,

Harrington²,

Carrier³

et al. 2008

Experimental Physiology

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The height of the dicrotic notch between the systolic and diastolic peaks of the peripheral pulse wave, expressed as a fraction of the overall amplitude of the wave, is sensitive to nitric oxide (NO) bioactivity. This phenomenon might form the basis of a simple, non-invasive method for determining endothelial function in vivo. We assessed whether the phenomenon is specific to the NO pathway or whether other vasoactive agents have similar effects. The relative height of the dicrotic notch (RHDN) was determined by photoplethysmography in the rabbit ear. It was dose-dependently decreased by acetylcholine, a stimulator of endothelial NO synthesis, and increased by N G -nitro-L-arginine methyl ester (L-NAME), an inhibitor of NO synthesis. There was no effect on RHDN of the α-adrenergic blocker phentolamine or the β-adrenergic blocker propranolol. The cyclo-oxygenase inhibitor indomethacin dose-dependently decreased RHDN but this effect was blocked by L-NAME, suggesting it was mediated by cross-talk with the NO pathway. Changes in RHDN appeared to be independent of heart rate and of the delay between the systolic peak and the notch, but were associated with changes in the slope of the dicrotic limb. Both L-NAME and phentolamine produced multiple diastolic peaks, indicative of wave reflections in the vasculature. These data support the view that changes in RHDN are specific to the NO pathway and provide additional information about the mechanisms involved.

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Digital pulse plethysmography (DPG) in studies of the hemodynamic response to nitrates — A survey of recording methods and principles of analysis

Cited by 28 publications

References 32 publications

Oral nitrate and citrulline decrease blood pressure and increase vascular conductance in young adults: a potential therapy for heart failure

Oral nitrate and citrulline decrease blood pressure and increase vascular conductance in young adults: a potential therapy for heart failure

Photoplethysmography and its application in clinical physiological measurement

Evidence for a specific influence of the nitrergic pathway on the peripheral pulse waveform in rabbits

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