A pulse wave theory and model of the human brachial arterial system is developed that predicts the changes in the arterial pressure waveforms as it traverses the vasculature - increased pulse, sharper main wave, disappearance of the aortic incisura, and appearance of a diastolic dicrotic wave. It also predicts the observed modulation of the waveform during phenylephrine - induced vasoconstriction and nitroglycerin - induced vasodilation. The model considers the brachial arterial system as a tapered distensible tube ending in a loop, with side branch networks represented by distributed Windkessels, and it uses verifiable values for realistic parameters. We found that the vertical modulation of the dicrotic wave in people decreased with advancing age and with high blood pressure, the model explaining these finding in terms of increasing vascular rigidity and decreasing small vessel vasodilator responsiveness. We noted a significant negative correlation between the arterial level of plasma norepinephrine and the amount of modulation of the dicrotic wave after nitroglycerin among subjects 40 years old or younger, suggesting a sympathetic neurogenic contribution to the vascular abnormalities observed in relatively young patients with essential hypertension.
