Objective:

To summarize the theoretical foundations, signal-processing framework, methodological developments, and clinical applications of radial pulse harmonic analysis for non-invasive assessment of cardiovascular and metabolic physiology.

Approach:

• Methodology Overview: The review discusses the decomposition of radial pressure pulse waveforms into harmonic components to provide insights into arterial compliance, wave reflection, vascular resistance, and ventricular–arterial coupling.
• Clinical Applications: Emphasis is placed on the assessment of hypertension, diabetes mellitus, coronary artery disease, vascular aging, and autonomic dysfunction.
• Technological Integration: The review highlights the integration of emerging computational cardiovascular technologies with harmonic analysis.

Key Findings:

• Harmonic parameters are associated with arterial stiffness, endothelial dysfunction, autonomic dysregulation, vascular remodeling, and age-related hemodynamic alterations.
• Advancements in sensor technology and signal-processing algorithms have improved the reproducibility and translational potential of harmonic analysis.
• Emerging approaches such as Reservoir-Excess Pressure Analysis and wearable sensing technologies may enhance the clinical utility of pulse waveform analysis.

Interpretation:

Harmonic analysis offers a quantitative framework for non-invasive cardiovascular assessment and may complement existing cardiovascular biomarkers.

Limitations:

• Further methodological standardization is required.
• Mechanistic validation and large-scale prospective studies are needed before broader clinical implementation.

Conclusion:

Radial pulse harmonic analysis represents a promising approach for evaluating vascular function and systemic hemodynamics in cardiometabolic health.