Background: Obtaining pulse pressure non-invasively from applanation tonometry requires the calibration of pressure waveform with brachial systolic and diastolic blood pressure. In literature, several calibration methodologies are applied and clinical studies do not agree about the predictive value of central hemodynamic parameters.

Objective: To compare 4 calibration methodologies and assess the usefulness of pulse pressure amplification as an index independent of calibration.

Methods: We investigated 108 subjects with tonometry in carotid, femoral, brachial, radial and dorsalis pedis arteries; pulse pressure amplification between arterial waveforms was calculated. Four methods to calibrate the waveforms were compared: the 1/3 rule, the 40% rule, the integral of radial and brachial waveforms. Pulse pressure amplification in 5 arterial territories was studied (carotid-femoral, carotid-brachial, carotid-radial and carotid-pedis amplifications; femoral-pedis amplification).

Results: Pulse pressure can non-invasively be measured in 5 arteries. Pulse pressure strictly depends on calibration, with differences up to 18 mmHg between methodologies. When pulse pressure amplification was calculated, calibration method effect disappeared. Furthermore, pulse pressure amplifications in 5 arterial territories presented a peculiar pattern of clinical/biological determinants: heart rate and body height were common determinants of carotid to brachial, radial and femoral amplifications; diabetes was related to carotid to brachial amplification and pulse wave velocity to femoral to pedis amplification.

Conclusion: The calibration method can influence the results from clinical trials and that pulse pressure amplification can evade this issue. We also suggest that the alteration of amplification in each arterial territory might be considered as a signal for the discovery of clinical/subclinical damage.