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The consequences of high-flexion postures on arterial wave reflections

Journal of Human Hypertension volume 40, pages 18–22 (2026)Cite this article

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Abstract

Although central wave reflections are critical for aortic pressure regulation, the control mechanisms involved in humans are understudied. This study investigated the impact of upper- and lower-limb high-flexion postures on central arterial wave reflections. Twenty-two healthy adults (11 females, aged 25 ±  3 years) underwent three randomized and counter-balanced positions to evaluate the effect on central wave reflection: supine legs and arms in the anatomical position; supine two legs bent and arms straight; and supine two arms bent and legs straight. Characteristic impedance, forward and backward pressure waves, and pulse characteristics were measured via the central pressure-flow relationship in the frequency domain at the end of each posture hold. Central diastolic blood pressure increased during arm flexion only (67 ± 9 mmHg vs. 62 ± 9 mmHg; p < 0.01). Central systolic blood pressure, augmentation index, forward wave amplitude, reflected wave amplitude, central wave reflection magnitude, and characteristic impedance were unaffected by varying limb flexion positions (all p > 0.05). Acutely bending the arms and legs did not influence central wave reflections, likely related to a minimal effect of conduit artery bending, versus microvascular involvement, as suggested in previous studies. These findings underscore the importance of identifying the specific vascular regions responsible for wave reflection generation and support the need to refine central pressure augmentation models to accurately localize the dominant sources of wave reflection in humans.

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Fig. 1: A representative example of body positioning for the experimental protocol.
Fig. 2: Central wave reflection outcomes in the different body positions.

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Data availability

Data are available upon reasonable request to the authors.

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Funding

This work was funded by the Natural Sciences and Engineering Research Council of Canada (RGPIN-2021-02563).

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Authors and Affiliations

  1. Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Canada

    Aida Zaheer, Kimberly H. Peckett, Tania J. Pereira, Stacey M. Acker & Jason S. Au

Authors
  1. Aida Zaheer
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  2. Kimberly H. Peckett
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  3. Tania J. Pereira
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  4. Stacey M. Acker
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  5. Jason S. Au
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Contributions

AZ, KP, SA and JA were involved in the conceptualization and initial drafting of the project. AZ, KP and TP were involved in the data curation, formal analysis, and investigation of the manuscript. JA was involved in the funding acquisition, resources, software, and supervision of the manuscript. All authors were involved in the methodology, project administration, visualization, and writing of the manuscript.

Corresponding author

Correspondence to Jason S. Au.

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Competing interests

The authors declare no competing interests.

Ethical approval

This study received ethics clearance from the University of Waterloo Research Ethics Committee (ORE #45481) and adhered to the recommendations outlined in the Declaration of Helsinki for human participants, except for registration in a database. All participants provided written informed consent prior to engaging in any study protocols. Consent was obtained to publish participant photos in Fig. 1.

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Zaheer, A., Peckett, K.H., Pereira, T.J. et al. The consequences of high-flexion postures on arterial wave reflections. J Hum Hypertens 40, 18–22 (2026). https://doi.org/10.1038/s41371-025-01088-4

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