Share this article on:

Misclassification of studies in ‘Brachial artery tonometry and the Popeye phenomenon’

Cameron, James D.a; Dart, Anthony M.b

doi: 10.1097/HJH.0b013e32835a874c

aMonash Cardiovascular Research Centre, Monash Medical Centre, Clayton, Victoria, Australia

bAlfred Heart Centre and Baker IDI Medical Research Institute, Prahran, Victoria, Australia

Correspondence to James Donald Cameron, MD, MBBS, BE, MengSc, FCSANZ, Department of Medicine (Southern Clinical School), Monash Heart and Monash University, Clayton, Victoria, 3168, Australia. Tel: +61 0 3 9594 2726; fax: +61 0 3 9594 6939; e-mail:

We refer to the recent article by Adji and O’Rourke [1] on the topic of ‘Brachial artery tonometry and the Popeye phenomenon’. Adji and O’Rourke [1] seem to have undertaken a selective analysis to cast a ‘serious doubt on the major epidemiological, clinical and therapeutic studies in which brachial artery tonometry has been applied’ [1] and quote 20 supporting references of varying relevance. Three of these studies are from our group [2–4] (their references 26–28). Unfortunately, Adji and O’Rourke [1] have misclassified our work. We have never employed brachial tonometry in any of our studies. This misclassification by Adji and O’Rourke [1] applies to the two studies quoted by us [3,4] (their references 26,27) and also to the work by Ahimastos et al. [2] (their reference 28).

Adji and O’Rourke [1] base the entire premise of their discussion and conclusion on the relevance of differences in calibration technique between the studies they list in their Tables 1 and 6. Their Table 6 purports to show reported outcome studies that used brachial tonometry for central pressure calibration in cardiovascular outcome studies. As two of only three studies they quote (our work [3,4], their references 26,27) are incorrectly classified as having employed brachial tonometry, we suggest that Adji and O’Rourke [1] appear in fact to have no actual basis upon which to proffer their conclusions, in particular (see their concluding paragraph) ‘that their [i.e. the studies listed in their Table 6] presence in the literature taints meta-analysis’. It is entirely fallacious for Adji and O’Rourke [1] to arbitrarily exclude two studies [3,4] from their analysis of central haemodynamics and cardiovascular outcome or to claim that such studies ‘taint’ the previous meta-analyses published by others [Vlachopoulos et al. [5], their reference 116].

We agree with Adji and O’Rourke [1] that ‘tainting’ of meta-analyses is to be avoided, and obviously, this is less likely to occur in cases in which clear statements of inclusion criteria and search methods are provided and studies correctly classified. We were unable to find clear detail of any predefined inclusion criteria or search method associated with the analysis in their current publication [1].

Back to Top | Article Outline


Conflicts of interest

The authors have not declared any conflicts of interest.

Back to Top | Article Outline


1. Adji A, O’Rourke M. Brachial artery tonometry and the Popeye phenomenon: explanation of anomalies in generating central from upper limb pressure waveforms. J Hypertens 2012; 30:1540–1551.
2. Ahimastos A, Dart A, Lawler A, Blombery P, Kingwell B. Reduced arterial stiffness may contribute to angiotensin converting enzyme inhibitor improvements in walking time in peripheral arterial disease patients. J Hypertens 2008; 26:1037–1042.
3. Dart AM, Cameron JD, Gatzka CD, Willson K, Liang YL, Berry KL, et al. Similar effects of treatment on central and brachial blood pressures in older hypertensive subjects in the Second Australian National Blood Pressure Trial. Hypertension 2007; 49:1242–1247.
4. Dart AM, Gatzka CD, Kingwell BA, Willson K, Cameron JD, Liang YL, et al. Brachial blood pressure but not carotid arterial waveforms predict cardiovascular events in elderly female hypertensives. Hypertension 2006; 47:785–790.
5. Vlachopoulos C, Aznaouridis K, O’Rourke M, Safar M, Baou K, Stefanadis C. Prediction of cardiovascular events and all-cause mortality with central haemodynamics: a systemic review and meta-analysis. Eur Heart J 2010; 31:1865–1871.
© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins