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Association between invasively measured aortic pulse pressure and orthostatic hypotension in patients undergoing invasive coronary angiography. J Hypertens 2019; 37:1966-1973. [PMID: 31356400 DOI: 10.1097/hjh.0000000000002113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Underlying pathophysiology of orthostatic hypotension has been poorly understood. We hypothesized that aortic pulse pressure (APP) reflecting aortic stiffness may be involved in the development of orthostatic hypotension. METHODS A total of 200 patients (age 64.3 ± 10.9 years, 62.5% men) who underwent invasive coronary angiography (ICA) were prospectively recruited. Orthostatic hypotension was defined as SBP drop at least 20 mmHg or DBP drop at least 10 mmHg within 3 min of the standing position compared with the supine position. Hemodynamic parameters were measured at the ascending aorta using a pig-tail catheter immediately before ICA. APP was calculated as a difference between the aortic peak systolic pressure and the end-diastolic pressure. RESULTS A total of 156 patients (78.0%) had obstructive coronary artery disease on ICA. Orthostatic hypotension was present in 58 patients (29.0%). Diabetes mellitus was more prevalent in patients with orthostatic hypotension than those without (48.3% vs. 23.2%; P < 0.001). Other clinical parameters including age, cardiovascular risk factors, laboratory findings and concomitant medications were not different between patients with and without orthostatic hypotension (P > 0.05 for each). In hemodynamic parameters, APP was higher in patients with orthostatic hypotension than those without (78.4 ± 25.8 vs. 68.3 ± 21.3 mmHg; P = 0.005). Higher APP was significantly associated with the presence of orthostatic hypotension even after controlling for potential confounders (odds ratio, 2.99; 95% confidence interval 1.15-7.78; P = 0.025). CONCLUSION In patients undergoing ICA, APP was associated with increased risk of orthostatic hypotension. Central aortic stiffness may play a role in the development of orthostatic hypotension.
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Climie RE, van Sloten TT, Bruno RM, Taddei S, Empana JP, Stehouwer CD, Sharman JE, Boutouyrie P, Laurent S. Macrovasculature and Microvasculature at the Crossroads Between Type 2 Diabetes Mellitus and Hypertension. Hypertension 2019; 73:1138-1149. [DOI: 10.1161/hypertensionaha.118.11769] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Rachel E. Climie
- From the INSERM, U970, Paris Cardiovascular Research Center (PARCC), France (R.E.C., T.T.v.S., R.-M.B., J.-P.E.)
- Baker Heart and Diabetes Institute, Melbourne, Australia (R.E.C.)
- Menzies Institute for Medical Research, University of Tasmanian, Hobart, Australia (R.E.C., J.E.S.)
| | - Thomas T. van Sloten
- From the INSERM, U970, Paris Cardiovascular Research Center (PARCC), France (R.E.C., T.T.v.S., R.-M.B., J.-P.E.)
- Department of Internal Medicine, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, the Netherlands (T.T.v.S., C.D.A.S.)
| | - Rosa-Maria Bruno
- From the INSERM, U970, Paris Cardiovascular Research Center (PARCC), France (R.E.C., T.T.v.S., R.-M.B., J.-P.E.)
- Department of Clinical and Experimental Medicine, University of Pisa, Italy (R.-M.B., S.T.)
| | - Stefano Taddei
- Department of Clinical and Experimental Medicine, University of Pisa, Italy (R.-M.B., S.T.)
| | - Jean-Philippe Empana
- From the INSERM, U970, Paris Cardiovascular Research Center (PARCC), France (R.E.C., T.T.v.S., R.-M.B., J.-P.E.)
| | - Coen D.A. Stehouwer
- Department of Internal Medicine, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, the Netherlands (T.T.v.S., C.D.A.S.)
| | - James E. Sharman
- Menzies Institute for Medical Research, University of Tasmanian, Hobart, Australia (R.E.C., J.E.S.)
| | - Pierre Boutouyrie
- INSERM, U970, APHP. Paris Descartes University, Paris, France (P.B., S.L.)
| | - Stéphane Laurent
- INSERM, U970, APHP. Paris Descartes University, Paris, France (P.B., S.L.)
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Zanoli L, Lentini P, Briet M, Castellino P, House AA, London GM, Malatino L, McCullough PA, Mikhailidis DP, Boutouyrie P. Arterial Stiffness in the Heart Disease of CKD. J Am Soc Nephrol 2019; 30:918-928. [PMID: 31040188 DOI: 10.1681/asn.2019020117] [Citation(s) in RCA: 115] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
CKD frequently leads to chronic cardiac dysfunction. This complex relationship has been termed as cardiorenal syndrome type 4 or cardio-renal link. Despite numerous studies and reviews focused on the pathophysiology and therapy of this syndrome, the role of arterial stiffness has been frequently overlooked. In this regard, several pathogenic factors, including uremic toxins (i.e., uric acid, phosphates, endothelin-1, advanced glycation end-products, and asymmetric dimethylarginine), can be involved. Their effect on the arterial wall, direct or mediated by chronic inflammation and oxidative stress, results in arterial stiffening and decreased vascular compliance. The increase in aortic stiffness results in increased cardiac workload and reduced coronary artery perfusion pressure that, in turn, may lead to microvascular cardiac ischemia. Conversely, reduced arterial stiffness has been associated with increased survival. Several approaches can be considered to reduce vascular stiffness and improve vascular function in patients with CKD. This review primarily discusses current understanding of the mechanisms concerning uremic toxins, arterial stiffening, and impaired cardiac function, and the therapeutic options to reduce arterial stiffness in patients with CKD.
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Affiliation(s)
| | - Paolo Lentini
- Division of Nephrology and Dialysis, St. Bassiano Hospital, Bassano del Grappa, Italy
| | - Marie Briet
- Institut National de la Santé et de la Recherche Médicale U1083, National Center for Scientific Research Joint Research Unit 6214, Centre Hospitalo-Universitaire d'Angers, Université d'Angers, Angers, France
| | - Pietro Castellino
- Internal Medicine, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Andrew A House
- Department of Medicine, University of Western Ontario, London, Ontario, Canada
| | - Gerard M London
- Institut National de la Santé et de la Recherche Médicale U970, Paris, France
| | - Lorenzo Malatino
- Internal Medicine, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Peter A McCullough
- Department of Medicine, Baylor University Medical Center, Baylor Heart and Vascular Institute, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas
| | | | - Pierre Boutouyrie
- Institut National de la Santé et de la Recherche Médicale U970, Paris, France.,Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France; and.,Department of Pharmacology, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
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Blood pressure variability in individuals with and without (pre)diabetes: The Maastricht Study. J Hypertens 2019; 36:259-267. [PMID: 28885385 DOI: 10.1097/hjh.0000000000001543] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The mechanisms associating (pre)diabetes and cardiovascular disease (CVD) are incompletely understood. We hypothesize that greater blood pressure variability (BPV) may underlie this association, due to its association with (incident) CVD. Therefore, we investigated the association between (pre)diabetes and very short-term to mid-term BPV, that is within-visit, 24-h and 7-day BPV. METHODS Cross-sectional data from The Maastricht Study [normal glucose metabolism (NGM), n = 1924; prediabetes, n = 511; type 2 diabetes mellitus (T2DM), n = 975; 51% men, aged 60 ± 8 years]. We determined SD for within-visit BPV (n = 3244), average real variability for 24-h BPV (n = 2699) day (0900-2100 h) and night (0100-0600 h) separately, and SD for 7-day BPV (n = 2259). Differences in BPV as compared with NGM were assessed by multiple linear regressions with adjustment for potential confounders. RESULTS In T2DM, the average systolic/diastolic values of within-visit, 24-h and 7-day BPV were 4.8/2.6, 10.5/7.3 and 10.4/6.5 mmHg, respectively, and in prediabetes 4.9/2.6, 10.3/7.0 and 9.4/5.9 mmHg, respectively. T2DM was associated with greater nocturnal systolic BPV [0.42 mmHg (95% confidence interval: 0.05-0.80)], and greater 7-day systolic [0.76 mmHg (0.32-1.19)] and diastolic BPV [0.65 mmHg (0.29-1.01)], whereas prediabetes was associated with greater within-visit systolic BPV only [0.35 mmHg (0.06-0.65)], as compared with NGM. CONCLUSION Both T2DM and prediabetes are associated with slightly greater very short-term to mid-term BPV, which may, according to previous literature, explain a small part of the increased CVD risk seen in (pre)diabetes. Nevertheless, these findings do not detract from the fact that very short-term to mid-term BPV is substantial and important in individuals with and without (pre)diabetes.
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Papaioannou TG, Fasoulis R, Toumpaniaris P, Tsioufis C, Dilaveris P, Soulis D, Koutsouris D, Tousoulis D. Assessment of arterial baroreflex sensitivity by different computational analyses of pressure wave signals alone. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2019; 172:25-34. [PMID: 30902125 DOI: 10.1016/j.cmpb.2019.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 01/28/2019] [Accepted: 02/01/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND AND OBJECTIVE Baroreflex sensitivity (BRS) is an important indicator of the functionality of the arterial baroreceptors, and its assessment may have major research and clinical implications. An important requirement for its quantification is the continuous recording of electrocardiography (ECG) signal, so as to extract the RR interval, in parallel with continuous beat-to-beat blood pressure recording. We aimed to accurately calculate the RR Interval from pressure wave recordings per se, namely, the Pulse Interval (PI) using various arterial pulse wave analysis algorithms and to evaluate the precision and accuracy of BRS values calculated with the PI compared to BRS values calculated with the RR Interval. METHODS We analyzed the open access data of the Eurobavar study, which contains a set of ECG and arterial blood pressure (BP) wave signals recorded at 11 European centers. Pressure waveforms were continuously recorded by the Finapres apparatus which uses a finger cuff. The cuff pressure around the finger is dynamically adjusted by a servo-system to equal intra-arterial pressure, thus allowing the continuous recording of beat-to-beat BP waves. RR Interval was calculated from the ECG, whereas, PI was extracted from the arterial pulse waveforms, using 4 different methods (minimum, maximum, maximum 1st derivative and intersecting tangents method). BRS values were estimated by time domain and frequency domain methods. In order to compare agreement, accuracy, precision, variability, and the association between the reference BRS using the RR Interval and the BRS values using PI, standard statistical methods (i.e. intraclass correlation coefficients, RMSE, regression analysis) and Bland-Altman methods were performed. RESULTS We found that analysis of pressure waves alone by frequency-based (i.e. spectral) methods, provides the most accurate results of BRS estimation compared to time-domain methods (ICC > 0.9, R > 0.9, RMSE > 0.8 ms/mmHg). Concerning the spectral method, any algorithm for PI calculation is sufficient, as all show excellent agreement with the respective RR-intervals determined by ECG time series. Only the intersecting tangents and the maximum 1st derivative methods for PI calculation produce the most accurate results in time domain BRS estimation. CONCLUSION BRS estimation by proper analysis of pressure wave signals alone is feasible and accurate. Further studies are needed to investigate the clinical validity and relevance of the different BRS estimations in diagnostic, prognostic and therapeutic levels.
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Affiliation(s)
- Theodore G Papaioannou
- First Department of Cardiology, Units of Biomedical Engineering (TGP, DS), Hypertension (KT), e-Cardiology (PD), Hippokration Hospital, Medical School, National and Kapodistrian University of Athens. 114 Vas. Sophias ave., Athens 11527, Greece.
| | - Romanos Fasoulis
- First Department of Cardiology, Units of Biomedical Engineering (TGP, DS), Hypertension (KT), e-Cardiology (PD), Hippokration Hospital, Medical School, National and Kapodistrian University of Athens. 114 Vas. Sophias ave., Athens 11527, Greece; Biomedical Engineering Laboratory, School of Electrical and Computer Engineering, National Technical University of Athens. 9, Iroon Polytechniou Str., Athens 15780, Greece
| | - Petros Toumpaniaris
- Biomedical Engineering Laboratory, School of Electrical and Computer Engineering, National Technical University of Athens. 9, Iroon Polytechniou Str., Athens 15780, Greece
| | - Constantinos Tsioufis
- First Department of Cardiology, Units of Biomedical Engineering (TGP, DS), Hypertension (KT), e-Cardiology (PD), Hippokration Hospital, Medical School, National and Kapodistrian University of Athens. 114 Vas. Sophias ave., Athens 11527, Greece
| | - Polychronis Dilaveris
- First Department of Cardiology, Units of Biomedical Engineering (TGP, DS), Hypertension (KT), e-Cardiology (PD), Hippokration Hospital, Medical School, National and Kapodistrian University of Athens. 114 Vas. Sophias ave., Athens 11527, Greece
| | - Dimitrios Soulis
- First Department of Cardiology, Units of Biomedical Engineering (TGP, DS), Hypertension (KT), e-Cardiology (PD), Hippokration Hospital, Medical School, National and Kapodistrian University of Athens. 114 Vas. Sophias ave., Athens 11527, Greece
| | - Dimitrios Koutsouris
- Biomedical Engineering Laboratory, School of Electrical and Computer Engineering, National Technical University of Athens. 9, Iroon Polytechniou Str., Athens 15780, Greece
| | - Dimitrios Tousoulis
- First Department of Cardiology, Units of Biomedical Engineering (TGP, DS), Hypertension (KT), e-Cardiology (PD), Hippokration Hospital, Medical School, National and Kapodistrian University of Athens. 114 Vas. Sophias ave., Athens 11527, Greece
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Affiliation(s)
- Athanase Benetos
- From the Department of Geriatrics and FHU CARTAGE, CHU de Nancy and INSERM 1116, Université de Lorraine, France (A.B.)
| | - Mirko Petrovic
- Department of Geriatrics, Ghent University Hospital, and Ghent University, Belgium (M.P.)
| | - Timo Strandberg
- University of Helsinki, Clinicum, and Helsinki University Hospital, Finland (T.S.)
- Center for Life Course Health Research, University of Oulu, Finland (T.S.)
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de Oliveira Gois M, Porta A, Simões RP, Kunz VC, Driusso P, Hirakawa HS, De Maria B, Catai AM. The additional impact of type 2 diabetes on baroreflex sensitivity of coronary artery disease patients might be undetectable in presence of deterioration of mechanical vascular properties. Med Biol Eng Comput 2019; 57:1405-1415. [PMID: 30843124 DOI: 10.1007/s11517-019-01966-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 02/21/2019] [Indexed: 01/14/2023]
Abstract
Both deterioration of the mechanical vascular properties of barosensitive vessels and autonomic derangement lead to modification of baroreflex sensitivity (BRS) in coronary artery disease (CAD) individuals. Type 2 diabetes (T2D) reduces BRS as well even in absence of cardiac autonomic neuropathy. The aim of the study is to clarify whether, assigned the degree of mechanical vascular impairment and without cardiac autonomic neuropathy, the additional autonomic dysfunction imposed in CAD patients by T2D (CAD-T2D) decreases BRS further. We considered CAD (n = 18) and CAD-T2D (n = 19) males featuring similar increases of average carotid intima media thickness (ACIMT) and we compared them to age- and gender-matched healthy (H, n = 19) subjects. BRS was computed from spontaneous beat-to-beat variability of heart period (HP) and systolic arterial pressure (SAP) at supine resting (REST) and during active standing (STAND). BRS was estimated via methods including time domain, spectral, cross-spectral, and model-based techniques. We found that (i) at REST BRS was lower in CAD and CAD-T2D groups than in H subjects but no difference was detected between CAD and CAD-T2D individuals; (ii) STAND induced an additional decrease of BRS visible in all the groups but again BRS estimates of CAD and CAD-T2D patients were alike; (iii) even though with different statistical power, BRS markers reached similar conclusions with the notable exception of the BRS computed via model-based approach that did not detect the BRS decrease during STAND. In presence of a mechanical vascular impairment, indexes estimating BRS from spontaneous HP and SAP fluctuations might be useless to detect the additional derangement of the autonomic control in CAD-T2D without cardiac autonomic neuropathy compared to CAD, thus limiting the applications of cardiovascular variability analysis to typify CAD-T2D individuals. Graphical abstract Graphical representation of the baroreflex sensitivity (BRS) estimated from spontaneous fluctuations of heart period and systolic arterial pressure via transfer function (TF) in low frequency (LF) band (from 0.04 to 0.15 Hz). BRS was reported as a function of the group (i.e., healthy (H), coronary artery disease (CAD) and CAD with type 2 diabetes (CAD-T2D) groups) at REST (black bars) and during STAND (white bars). Values are shown as mean plus standard deviation. The symbol "*" indicates a significant difference between conditions within the same group (i.e., H, CAD, or CAD-T2D) and the symbol "§" indicates a significant difference between groups within the same experimental condition (i.e., REST or STAND). BRS cannot distinguish CAD and CAD-T2D groups both at REST and during STAND, while it is useful to distinguish experimental conditions and separate pathological groups from H subjects.
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Affiliation(s)
| | - Alberto Porta
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
- Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.
| | | | - Vandeni Clarice Kunz
- Adventist University Center of São Paulo, Campus Engenheiro Coelho, São Paulo, Brazil
| | - Patricia Driusso
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | | | | | - Aparecida Maria Catai
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil
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Cooper LL, Mitchell GF. Incorporation of Novel Vascular Measures into Clinical Management: Recent Insights from the Framingham Heart Study. Curr Hypertens Rep 2019; 21:19. [PMID: 30790125 DOI: 10.1007/s11906-019-0919-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW The review discusses evidence from the Framingham Heart Study that supports the assessment and utility of novel vascular and blood pressure measures to inform clinical management of blood pressure-related cardiovascular disease. RECENT FINDINGS Recent Framingham Heart Study investigations provide new insights into the associations of novel and traditional vascular and blood pressure measures, such as measures of aortic stiffness, components of blood pressure waves, and orthostatic change in blood pressure, with cardiovascular disease events and brain structure and function. Novel vascular measures provide opportunities for additional investigation and potential development of new interventions that are more precisely targeted at underlying pathophysiology. Inclusion of novel vascular measures should be considered in clinical practice to screen for early, subclinical disease and to stratify high-risk individuals for targeted therapies.
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Affiliation(s)
- Leroy L Cooper
- Biology Department, Vassar College, 124 Raymond Ave., Box 70, Poughkeepsie, NY, 12604, USA.
| | - Gary F Mitchell
- Cardiovascular Engineering, Inc., 1 Edgewater Drive, Suite 201A, Norwood, MA, 02062, USA.
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Krassioukov AV, Currie KD, Hubli M, Nightingale TE, Alrashidi AA, Ramer L, Eng JJ, Ginis KAM, MacDonald MJ, Hicks A, Ditor D, Oh P, Verrier MC, Craven BC. Effects of exercise interventions on cardiovascular health in individuals with chronic, motor complete spinal cord injury: protocol for a randomised controlled trial [Cardiovascular Health/Outcomes: Improvements Created by Exercise and education in SCI (CHOICES) Study]. BMJ Open 2019; 9:e023540. [PMID: 30612110 PMCID: PMC6326283 DOI: 10.1136/bmjopen-2018-023540] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Recent studies demonstrate that cardiovascular diseases and associated complications are the leading cause of morbidity and mortality in individuals with spinal cord injury (SCI). Abnormal arterial stiffness, defined by a carotid-to-femoral pulse wave velocity (cfPWV) ≥10 m/s, is a recognised risk factor for heart disease in individuals with SCI. There is a paucity of studies assessing the efficacy of conventional training modalities on arterial stiffness and other cardiovascular outcomes in this population. Therefore, this study aims to compare the efficacy of arm cycle ergometry training (ACET) and body weight-supported treadmill training (BWSTT) on reducing arterial stiffness in individuals with chronic motor complete, high-level (above the sixth thoracic segment) SCI. METHODS AND ANALYSIS This is a multicentre, randomised, controlled, clinical trial. Eligible participants will be randomly assigned (1:1) into either ACET or BWSTT groups. Sixty participants with chronic (>1 year) SCI will be recruited from three sites in Canada (Vancouver, Toronto and Hamilton). Participants in each group will exercise three times per week up to 30 min and 60 min for ACET and BWSTT, respectively, over the period of 6 months. The primary outcome measure will be change in arterial stiffness (cfPWV) from baseline. Secondary outcome measures will include comprehensive assessments of: (1) cardiovascular parameters, (2) autonomic function, (3) body composition, (4) blood haematological and metabolic profiles, (5) cardiorespiratory fitness and (6) quality of life (QOL) and physical activity outcomes. Outcome measures will be assessed at baseline, 3 months, 6 months and 12 months (only QOL and physical activity outcomes). Statistical analyses will apply linear-mixed modelling to determine the training (time), group (ACET vs BWSTT) and interaction (time × group) effects on all outcomes. ETHICS AND DISSEMINATION Ethical approval was obtained from all three participating sites. Primary and secondary outcome data will be submitted for publication in peer-reviewed journals and widely disseminated. TRIAL REGISTRATION NUMBER NCT01718977; Pre-results. TRIAL STATUS Recruitment for this study began on January 2013 and the first participant was randomized on April 2013. Recruitment stopped on October 2018.
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Affiliation(s)
- Andrei V Krassioukov
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
- Faculty of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, British Columbia, Canada
- GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Katharine D Currie
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA
| | - Michèle Hubli
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
- Balgrist University Hospital, University of Zurich, Zurich, Swaziland
| | - Tom E Nightingale
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
- Faculty of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Abdullah A Alrashidi
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
- Faculty of Medicine, Experimental Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Physical Therapy Department, King Fahd Medical City, Riyadh, Saudi Arabia
| | - Leanne Ramer
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
- Biomedical Physiology and Kinesiology, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Janice J Eng
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
- GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, British Columbia, Canada
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kathleen A Martin Ginis
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
- Southern Medical Program, School of Health & Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | | | - Audrey Hicks
- Spinal Cord Injury Centre, McMaster University, Hamilton, Ontario, Canada
| | - Dave Ditor
- Department of Kinesiology, Faculty of Applied Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | - Paul Oh
- Department of Medicine University Health Network, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
| | - Molly C Verrier
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Beverly Catharine Craven
- Department of Medicine University Health Network, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
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Zanotto T, Mercer TH, van der Linden ML, Traynor JP, Petrie CJ, Doyle A, Chalmers K, Allan N, Price J, Oun H, Shilliday I, Koufaki P. Baroreflex function, haemodynamic responses to an orthostatic challenge, and falls in haemodialysis patients. PLoS One 2018; 13:e0208127. [PMID: 30521545 PMCID: PMC6283578 DOI: 10.1371/journal.pone.0208127] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 11/12/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Stage 5 chronic kidney disease patients on haemodialysis (HD) often present with dizziness and pre-syncopal events as a result of the combined effect of HD therapy and cardiovascular disease. The dysregulation of blood pressure (BP) during orthostasis may be implicated in the aetiology of falls in these patients. Therefore, we explored the relationship between baroreflex function, the haemodynamic responses to a passive orthostatic challenge, and falls in HD patients. METHODS Seventy-six HD patients were enrolled in this cross-sectional study. Participants were classified as "fallers" and "non-fallers" and completed a passive head up tilting to 60o (HUT-60°) test on an automated tilt table. ECG signals, continuous and oscillometric BP measurements and impedance cardiography were recorded. The following variables were derived from these measurements: heart rate (HR) stroke volume (SV), cardiac output (CO), total peripheral resistance (TPR), number of baroreceptor events, and baroreceptor effectiveness index (BEI). RESULTS The forty-four participants who were classified as fallers (57.9%) had a lower number of baroreceptor events (6.5±8.5 vs 14±16.7, p = .027) and BEI (20.8±24.2% vs 33.4±23.3%, p = .025). In addition, fallers experienced a significantly larger drop in systolic (-6.4±10.9 vs -0.4±7.7 mmHg, p = .011) and diastolic (-2.7±7.3 vs 1.8±6 mmHg, p = .027) oscillometric BP from supine to HUT-60° compared with non-fallers. None of the variables taken for the analysis were significantly associated with falls in multivariate logistic regression analysis. CONCLUSIONS This cross-sectional comparison indicates that, at rest, HD patients with a positive history of falls present with a lower count of baroreceptor sequences and BEI. Short-term BP regulation warrants further investigation as BP drops during a passive orthostatic challenge may be implicated in the aetiology of falls in HD.
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Affiliation(s)
- Tobia Zanotto
- Queen Margaret University, Centre of Health, Activity and Rehabilitation Research, Edinburgh, United Kingdom
- * E-mail:
| | - Thomas H. Mercer
- Queen Margaret University, Centre of Health, Activity and Rehabilitation Research, Edinburgh, United Kingdom
| | - Marietta L. van der Linden
- Queen Margaret University, Centre of Health, Activity and Rehabilitation Research, Edinburgh, United Kingdom
| | - Jamie P. Traynor
- Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Colin J. Petrie
- Department of Cardiology, Monklands Hospital, Airdrie, United Kingdom
| | - Arthur Doyle
- Renal Unit, Victoria Hospital, Kirkcaldy, United Kingdom
| | - Karen Chalmers
- Renal Unit, Victoria Hospital, Kirkcaldy, United Kingdom
| | - Nicola Allan
- Renal Unit, Victoria Hospital, Kirkcaldy, United Kingdom
| | | | - Hadi Oun
- Renal Unit, Monklands Hospital, Airdrie, United Kingdom
| | | | - Pelagia Koufaki
- Queen Margaret University, Centre of Health, Activity and Rehabilitation Research, Edinburgh, United Kingdom
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Zhou TL, Henry RM, Stehouwer CD, van Sloten TT, Reesink KD, Kroon AA. Blood Pressure Variability, Arterial Stiffness, and Arterial Remodeling. Hypertension 2018; 72:1002-1010. [DOI: 10.1161/hypertensionaha.118.11325] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Tan Lai Zhou
- From the Department of Internal Medicine (T.L.Z., R.M.A.H., C.D.A.S., A.A.K.), Maastricht University Medical Centre +, The Netherlands
- Cardiovascular Research Institute Maastricht (T.L.Z., R.M.A.H., C.D.A.S., T.T.v.S., K.D.R., A.A.K.), Maastricht University, The Netherlands
| | - Ronald M.A. Henry
- From the Department of Internal Medicine (T.L.Z., R.M.A.H., C.D.A.S., A.A.K.), Maastricht University Medical Centre +, The Netherlands
- Cardiovascular Research Institute Maastricht (T.L.Z., R.M.A.H., C.D.A.S., T.T.v.S., K.D.R., A.A.K.), Maastricht University, The Netherlands
| | - Coen D.A. Stehouwer
- From the Department of Internal Medicine (T.L.Z., R.M.A.H., C.D.A.S., A.A.K.), Maastricht University Medical Centre +, The Netherlands
- Cardiovascular Research Institute Maastricht (T.L.Z., R.M.A.H., C.D.A.S., T.T.v.S., K.D.R., A.A.K.), Maastricht University, The Netherlands
| | - Thomas T. van Sloten
- Cardiovascular Research Institute Maastricht (T.L.Z., R.M.A.H., C.D.A.S., T.T.v.S., K.D.R., A.A.K.), Maastricht University, The Netherlands
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, France (T.T.v.S.)
- INSERM, UMR-S970, Paris Cardiovascular Research Center, Department of Epidemiology and Department of Arterial Mechanics, France (T.T.v.S.)
| | - Koen D. Reesink
- Cardiovascular Research Institute Maastricht (T.L.Z., R.M.A.H., C.D.A.S., T.T.v.S., K.D.R., A.A.K.), Maastricht University, The Netherlands
- Department of Biomedical Engineering (K.D.R.), Maastricht University, The Netherlands
| | - Abraham A. Kroon
- From the Department of Internal Medicine (T.L.Z., R.M.A.H., C.D.A.S., A.A.K.), Maastricht University Medical Centre +, The Netherlands
- Heart and Vascular Centre (A.A.K.), Maastricht University Medical Centre +, The Netherlands
- Cardiovascular Research Institute Maastricht (T.L.Z., R.M.A.H., C.D.A.S., T.T.v.S., K.D.R., A.A.K.), Maastricht University, The Netherlands
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Kosinski SA, Carlson BE, Hummel SL, Brook RD, Beard DA. Computational model-based assessment of baroreflex function from response to Valsalva maneuver. J Appl Physiol (1985) 2018; 125:1944-1967. [PMID: 30236047 DOI: 10.1152/japplphysiol.00095.2018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Functional metrics of autonomic control of heart rate, including baroreflex sensitivity, have been shown to be strongly associated with cardiovascular risk. A decrease in baroreflex sensitivity with aging is hypothesized to represent a contributing causal factor in the etiology of primary hypertension. To assess baroreflex function in human subjects, two complementary methods to simulate the response in heart rate elicited by the Valsalva maneuver were developed and applied to data obtained from a cohort of healthy normal volunteers. The first method is based on representing the baroreflex arc as a simple linear filter, transforming changes in arterial pressure to changes in R-R interval. The second method invokes a physiologically based model for arterial mechanics, afferent baroreceptor strain-dependent firing, and control of heart rate via central autonomic response to changes in afferent inputs from aortic and carotid sensors. Analysis based on the linear filter model reveals that the effective response time of the baroreflex arc tends to increase with age in healthy subjects and that the response time/response rate is a predictor of resting systolic pressure. Similar trends were obtained based on the physiologically based model. Analysis of the Valsalva response using the physiologically based model further reveals that different afferent inputs from the carotid sinus and the aortic arch baroreceptors govern different parts of the heart rate response. The observed relationship between baroreflex sensitivity and systolic pressure is surprising because hypertensive subjects were excluded from the study, and there was no observed relationship between arterial pressure and age. NEW & NOTEWORTHY We introduce two methods to assess baroreflex function from data recorded from human subjects performing the Valsalva maneuver. Results demonstrate that the baroreflex response time tends to increase with age in healthy subjects, that response time represents a predictor of resting systolic pressure, and that the Valsalva response reveals different effects mediated by baroreceptors in the carotid sinus compared with those in the aortic arch.
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Affiliation(s)
- Samuel A Kosinski
- Molecular and Integrative Physiology, University of Michigan , Ann Arbor, Michigan
| | - Brian E Carlson
- Molecular and Integrative Physiology, University of Michigan , Ann Arbor, Michigan
| | - Scott L Hummel
- Internal Medicine and Cardiology, University of Michigan , Ann Arbor, Michigan.,Ann Arbor Veterans Affairs Health System, Ann Arbor, Michigan
| | - Robert D Brook
- Internal Medicine and Cardiology, University of Michigan , Ann Arbor, Michigan
| | - Daniel A Beard
- Molecular and Integrative Physiology, University of Michigan , Ann Arbor, Michigan
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Sarafidis PA, Loutradis C, Karpetas A, Tzanis G, Bikos A, Raptis V, Syrgkanis C, Liakopoulos V, Papagianni A, Bakris G, Parati G. The association of interdialytic blood pressure variability with cardiovascular events and all-cause mortality in haemodialysis patients. Nephrol Dial Transplant 2018; 34:515-523. [DOI: 10.1093/ndt/gfy247] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 06/19/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Pantelis A Sarafidis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Charalampos Loutradis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Georgios Tzanis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Athanasios Bikos
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | | - Vassilios Liakopoulos
- Section of Nephrology and Hypertension, 1st Department of Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aikaterini Papagianni
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Bakris
- Department of Medicine, American Society of Hypertension Comprehensive Hypertension Center, The University of Chicago Medicine, Chicago, IL, USA
| | - Gianfranco Parati
- Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS S.Luca Hospital, Istituto Auxologico Italiano, Milan, Italy
- Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
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AbdelWahab MA, Farrag HMA, Saied CE. 24-Hour blood pressure variability as a predictor of short-term echocardiographic changes in normotensive women with past history of preeclampsia/eclampsia. Pregnancy Hypertens 2018; 13:72-78. [DOI: 10.1016/j.preghy.2018.04.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 04/22/2018] [Accepted: 04/27/2018] [Indexed: 12/20/2022]
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Testa G, Ceccofiglio A, Mussi C, Bellelli G, Nicosia F, Bo M, Riccio D, Curcio F, Martone AM, Noro G, Landi F, Ungar A, Abete P. Hypotensive Drugs and Syncope Due to Orthostatic Hypotension in Older Adults with Dementia (Syncope and Dementia Study). J Am Geriatr Soc 2018; 66:1532-1537. [DOI: 10.1111/jgs.15421] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 03/28/2018] [Accepted: 04/01/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Gianluca Testa
- Department of Translational Medical Sciences; University of Naples, Federico II; Naples Italy
| | - Alice Ceccofiglio
- Syncope Unit, Geriatric Cardiology and Medicine; University of Florence; Florence Italy
- Azienda Ospedaliero Universitaria Careggi; Florence Italy
| | - Chiara Mussi
- Centro di Valutazione e Ricerca Gerontologica; University of Modena and Reggio Emilia; Modena Italy
| | - Giuseppe Bellelli
- Department of Health Sciences; University of Milano Bicocca; Milan Italy
- Acute Geriatric Unit; San Gerardo Hospital; Monza Italy
- Milan Center for Neuroscience; Milan Italy
| | - Franco Nicosia
- Medicine and Geriatric Unit; Spedali Civili of Brescia; Brescia Italy
| | - Mario Bo
- SCDU Geriatria e Malattie Metaboliche dell'Osso; Città della Salute e della Scienza-Molinette-Torino; Turin Italy
| | - Daniela Riccio
- Geriatric Department; SS. Trinità Hospital; Cagliari Italy
| | - Francesco Curcio
- Department of Translational Medical Sciences; University of Naples, Federico II; Naples Italy
| | - Anna Maria Martone
- Department of Geriatrics, Neurosciences and Orthopedics; Catholic University of the Sacred Heart; Rome ITaly
| | | | - Francesco Landi
- Department of Geriatrics, Neurosciences and Orthopedics; Catholic University of the Sacred Heart; Rome ITaly
| | - Andrea Ungar
- Syncope Unit, Geriatric Cardiology and Medicine; University of Florence; Florence Italy
- Azienda Ospedaliero Universitaria Careggi; Florence Italy
| | - Pasquale Abete
- Department of Translational Medical Sciences; University of Naples, Federico II; Naples Italy
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Silva RMFLD, Miranda CEDS, Barbosa MT, Bicalho MAC. Heart Rate and its Variability Assessed by Spectral Analysis in Elderly Subjects with Orthostatic Hypotension: A Case-Control Study. Arq Bras Cardiol 2018; 110:303-311. [PMID: 29561965 PMCID: PMC5941951 DOI: 10.5935/abc.20180043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 11/09/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The prevalence of orthostatic hypotension (OH) increases with age and is associated with changes in autonomic regulation of blood pressure (BP) and heart rate (HR). OBJECTIVE to assess HR and HR variability (HRV) in elderly subjects with OH and determine OH predictors. METHODS a total of 105 patients aged ≥ 60 years, 39 with OH (case group) and 66 without OH (control group) (age-matched) were studied. Patients underwent clinical assessment, electrocardiogram, biochemistry tests and Holter monitoring for spectral analysis of HRV (Fourier transform) in the supine and orthostatism positions to identify low frequency (LF) and high frequency (HF) components, as well as the LF/HF ratio. RESULTS median age was 73.0 years, 64 patients were women. In all participants, there was a reduction in HF (133.0 versus 76.0 ms2, p = 0.001) and increase in LF/HF (1.6 vs 2.1; p < 0.001) and no change in LF (233.0 versus 218.0 ms2, p = 0.080). Between-group comparisons revealed significant differences in the median values of HR in the supine position (62.0 vs. 69.0 bpm, p = 0.001) and LF in the supine position (157.0 in case group vs. 275.0 ms2 in the control group, p = 0.014). Spearman's correlation coefficient of 0.27 was found between the groups. Multivariate analysis revealed that HR in the supine position was an independent variable for OH (p = 0.001- 95%CI = -0.022 and -0.006). Using the operating characteristic curve, the best cutoff point was 61 bpm, with a sensitivity of 77.3% and specificity of 51.3%, positive predictive value of 61.3%, and negative predictive value 69.3%. Odds ratio was 3.23 for OH in patients with a HR lower than 61 bpm. CONCLUSIONS lower LF and HR in the supine position were found in patients with OH, regardless of age and gender. The independent predictor for OH was HR in the supine position, with an odds ratio of 3.23 for values lower than 61 bpm.
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Krüerke D, Simões-Wüst AP, Kaufmann C, Frank M, Faldey A, Heusser P, von Bonin D. Can Speech-Guided Breathing Influence Cardiovascular Regulation and Mood Perception in Hypertensive Patients? J Altern Complement Med 2018; 24:254-261. [DOI: 10.1089/acm.2017.0158] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Affiliation(s)
- Daniel Krüerke
- Research Department, Clinic Arlesheim, Arlesheim, Switzerland
| | - Ana Paula Simões-Wüst
- Research Department, Clinic Arlesheim, Arlesheim, Switzerland
- Research Department, Paracelsus-Hospital Richterswil, Richterswil, Switzerland
| | | | - Martina Frank
- Therapy Departments, Clinic Arlesheim, Arlesheim, Switzerland
| | | | - Peter Heusser
- Department of Medicine, Institute of Integrative Medicine, University Witten/Herdecke, Herdecke, Germany
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Katzelnick CG, Weir JP, Chiaravalloti ND, Wylie GR, Dyson-Hudson TA, Bauman WA, Wecht JM. Impact of Blood Pressure, Lesion Level, and Physical Activity on Aortic Augmentation Index in Persons with Spinal Cord Injury. J Neurotrauma 2017; 34:3407-3415. [DOI: 10.1089/neu.2017.5065] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Caitlyn G. Katzelnick
- VA RR&D National Center for Medication Consequences of Spinal Cord Injury, James J Peters VA Medical Center, Bronx, New York
- Department of Research, Kessler Foundation, West Orange, New Jersey
| | - Joseph P. Weir
- Department of Health, Sport, and Exercise Science, University of Kansas, Lawrence, Kansas
| | - Nancy D. Chiaravalloti
- Department of Research, Kessler Foundation, West Orange, New Jersey
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Glenn R. Wylie
- Department of Research, Kessler Foundation, West Orange, New Jersey
- The War Related Illness and Injury Study Center, VA New Jersey Health Care System, East Orange, New Jersey
| | - Trevor A. Dyson-Hudson
- Department of Research, Kessler Foundation, West Orange, New Jersey
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey
| | - William A. Bauman
- VA RR&D National Center for Medication Consequences of Spinal Cord Injury, James J Peters VA Medical Center, Bronx, New York
- Department of Medicine, The Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jill M. Wecht
- VA RR&D National Center for Medication Consequences of Spinal Cord Injury, James J Peters VA Medical Center, Bronx, New York
- Department of Medicine, The Icahn School of Medicine at Mount Sinai, New York, New York
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Lacolley P, Regnault V, Segers P, Laurent S. Vascular Smooth Muscle Cells and Arterial Stiffening: Relevance in Development, Aging, and Disease. Physiol Rev 2017; 97:1555-1617. [DOI: 10.1152/physrev.00003.2017] [Citation(s) in RCA: 332] [Impact Index Per Article: 47.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 05/15/2017] [Accepted: 05/26/2017] [Indexed: 12/18/2022] Open
Abstract
The cushioning function of large arteries encompasses distension during systole and recoil during diastole which transforms pulsatile flow into a steady flow in the microcirculation. Arterial stiffness, the inverse of distensibility, has been implicated in various etiologies of chronic common and monogenic cardiovascular diseases and is a major cause of morbidity and mortality globally. The first components that contribute to arterial stiffening are extracellular matrix (ECM) proteins that support the mechanical load, while the second important components are vascular smooth muscle cells (VSMCs), which not only regulate actomyosin interactions for contraction but mediate also mechanotransduction in cell-ECM homeostasis. Eventually, VSMC plasticity and signaling in both conductance and resistance arteries are highly relevant to the physiology of normal and early vascular aging. This review summarizes current concepts of central pressure and tensile pulsatile circumferential stress as key mechanical determinants of arterial wall remodeling, cell-ECM interactions depending mainly on the architecture of cytoskeletal proteins and focal adhesion, the large/small arteries cross-talk that gives rise to target organ damage, and inflammatory pathways leading to calcification or atherosclerosis. We further speculate on the contribution of cellular stiffness along the arterial tree to vascular wall stiffness. In addition, this review provides the latest advances in the identification of gene variants affecting arterial stiffening. Now that important hemodynamic and molecular mechanisms of arterial stiffness have been elucidated, and the complex interplay between ECM, cells, and sensors identified, further research should study their potential to halt or to reverse the development of arterial stiffness.
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Affiliation(s)
- Patrick Lacolley
- INSERM, U1116, Vandœuvre-lès-Nancy, France; Université de Lorraine, Nancy, France; IBiTech-bioMMeda, Department of Electronics and Information Systems, Ghent University, Gent, Belgium; Department of Pharmacology, European Georges Pompidou Hospital, Assistance Publique Hôpitaux de Paris, France; PARCC INSERM, UMR 970, Paris, France; and University Paris Descartes, Paris, France
| | - Véronique Regnault
- INSERM, U1116, Vandœuvre-lès-Nancy, France; Université de Lorraine, Nancy, France; IBiTech-bioMMeda, Department of Electronics and Information Systems, Ghent University, Gent, Belgium; Department of Pharmacology, European Georges Pompidou Hospital, Assistance Publique Hôpitaux de Paris, France; PARCC INSERM, UMR 970, Paris, France; and University Paris Descartes, Paris, France
| | - Patrick Segers
- INSERM, U1116, Vandœuvre-lès-Nancy, France; Université de Lorraine, Nancy, France; IBiTech-bioMMeda, Department of Electronics and Information Systems, Ghent University, Gent, Belgium; Department of Pharmacology, European Georges Pompidou Hospital, Assistance Publique Hôpitaux de Paris, France; PARCC INSERM, UMR 970, Paris, France; and University Paris Descartes, Paris, France
| | - Stéphane Laurent
- INSERM, U1116, Vandœuvre-lès-Nancy, France; Université de Lorraine, Nancy, France; IBiTech-bioMMeda, Department of Electronics and Information Systems, Ghent University, Gent, Belgium; Department of Pharmacology, European Georges Pompidou Hospital, Assistance Publique Hôpitaux de Paris, France; PARCC INSERM, UMR 970, Paris, France; and University Paris Descartes, Paris, France
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Torjesen A, Cooper LL, Rong J, Larson MG, Hamburg NM, Levy D, Benjamin EJ, Vasan RS, Mitchell GF. Relations of Arterial Stiffness With Postural Change in Mean Arterial Pressure in Middle-Aged Adults: The Framingham Heart Study. Hypertension 2017; 69:685-690. [PMID: 28264924 DOI: 10.1161/hypertensionaha.116.08116] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 07/20/2016] [Accepted: 01/29/2017] [Indexed: 11/16/2022]
Abstract
Impaired regulation of blood pressure on standing can lead to adverse outcomes, including falls, syncope, and disorientation. Mean arterial pressure (MAP) typically increases on standing; however, an insufficient increase or a decline in MAP on standing may result in decreased cerebral perfusion. Orthostatic hypotension has been reported in older people with increased arterial stiffness, whereas the association between orthostatic change in MAP and arterial stiffness in young- to middle-aged individuals has not been examined. We analyzed orthostatic blood pressure response and comprehensive hemodynamic data in 3205 participants (1693 [53%] women) in the Framingham Heart Study Third Generation cohort. Participants were predominantly middle aged (mean age: 46±9 years). Arterial stiffness was assessed using carotid-femoral pulse wave velocity, forward pressure wave amplitude, and characteristic impedance of the aorta. Adjusting for standard cardiovascular disease risk factors, orthostatic change in MAP (6.9±7.7 mm Hg) was inversely associated with carotid-femoral pulse wave velocity (partial correlation, rp=-0.084; P<0.0001), forward wave amplitude (rp=-0.129; P<0.0001), and characteristic impedance (rp=-0.094; P<0.0001). The negative relation between forward wave amplitude and change in MAP on standing was accentuated in women (P=0.002 for sex interaction). Thus, higher aortic stiffness was associated with a blunted orthostatic increase in MAP, even in middle age. The clinical implications of these findings warrant further study.
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Affiliation(s)
- Alyssa Torjesen
- From the Cardiovascular Engineering, Inc, Norwood, MA (A.T., L.L.C., G.F.M.); Cardiovascular Research Center, Rhode Island Hospital, W. Alpert Medical School of Brown University, Providence (L.L.C.); National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA (J.R., M.G.L., D.L., E.J.B., R.S.V.); Department of Biostatistics, Boston University School of Public Health, MA (M.G.L.); Evans Department of Medicine (N.M.H., E.J.B., R.S.V.), Whitaker Cardiovascular Institute (N.M.H., E.J.B., R.S.V.), and Preventive Medicine and Cardiology Sections (E.J.B., R.S.V.), Boston University School of Medicine, MA; and National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.)
| | - Leroy L Cooper
- From the Cardiovascular Engineering, Inc, Norwood, MA (A.T., L.L.C., G.F.M.); Cardiovascular Research Center, Rhode Island Hospital, W. Alpert Medical School of Brown University, Providence (L.L.C.); National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA (J.R., M.G.L., D.L., E.J.B., R.S.V.); Department of Biostatistics, Boston University School of Public Health, MA (M.G.L.); Evans Department of Medicine (N.M.H., E.J.B., R.S.V.), Whitaker Cardiovascular Institute (N.M.H., E.J.B., R.S.V.), and Preventive Medicine and Cardiology Sections (E.J.B., R.S.V.), Boston University School of Medicine, MA; and National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.)
| | - Jian Rong
- From the Cardiovascular Engineering, Inc, Norwood, MA (A.T., L.L.C., G.F.M.); Cardiovascular Research Center, Rhode Island Hospital, W. Alpert Medical School of Brown University, Providence (L.L.C.); National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA (J.R., M.G.L., D.L., E.J.B., R.S.V.); Department of Biostatistics, Boston University School of Public Health, MA (M.G.L.); Evans Department of Medicine (N.M.H., E.J.B., R.S.V.), Whitaker Cardiovascular Institute (N.M.H., E.J.B., R.S.V.), and Preventive Medicine and Cardiology Sections (E.J.B., R.S.V.), Boston University School of Medicine, MA; and National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.)
| | - Martin G Larson
- From the Cardiovascular Engineering, Inc, Norwood, MA (A.T., L.L.C., G.F.M.); Cardiovascular Research Center, Rhode Island Hospital, W. Alpert Medical School of Brown University, Providence (L.L.C.); National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA (J.R., M.G.L., D.L., E.J.B., R.S.V.); Department of Biostatistics, Boston University School of Public Health, MA (M.G.L.); Evans Department of Medicine (N.M.H., E.J.B., R.S.V.), Whitaker Cardiovascular Institute (N.M.H., E.J.B., R.S.V.), and Preventive Medicine and Cardiology Sections (E.J.B., R.S.V.), Boston University School of Medicine, MA; and National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.)
| | - Naomi M Hamburg
- From the Cardiovascular Engineering, Inc, Norwood, MA (A.T., L.L.C., G.F.M.); Cardiovascular Research Center, Rhode Island Hospital, W. Alpert Medical School of Brown University, Providence (L.L.C.); National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA (J.R., M.G.L., D.L., E.J.B., R.S.V.); Department of Biostatistics, Boston University School of Public Health, MA (M.G.L.); Evans Department of Medicine (N.M.H., E.J.B., R.S.V.), Whitaker Cardiovascular Institute (N.M.H., E.J.B., R.S.V.), and Preventive Medicine and Cardiology Sections (E.J.B., R.S.V.), Boston University School of Medicine, MA; and National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.)
| | - Daniel Levy
- From the Cardiovascular Engineering, Inc, Norwood, MA (A.T., L.L.C., G.F.M.); Cardiovascular Research Center, Rhode Island Hospital, W. Alpert Medical School of Brown University, Providence (L.L.C.); National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA (J.R., M.G.L., D.L., E.J.B., R.S.V.); Department of Biostatistics, Boston University School of Public Health, MA (M.G.L.); Evans Department of Medicine (N.M.H., E.J.B., R.S.V.), Whitaker Cardiovascular Institute (N.M.H., E.J.B., R.S.V.), and Preventive Medicine and Cardiology Sections (E.J.B., R.S.V.), Boston University School of Medicine, MA; and National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.)
| | - Emelia J Benjamin
- From the Cardiovascular Engineering, Inc, Norwood, MA (A.T., L.L.C., G.F.M.); Cardiovascular Research Center, Rhode Island Hospital, W. Alpert Medical School of Brown University, Providence (L.L.C.); National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA (J.R., M.G.L., D.L., E.J.B., R.S.V.); Department of Biostatistics, Boston University School of Public Health, MA (M.G.L.); Evans Department of Medicine (N.M.H., E.J.B., R.S.V.), Whitaker Cardiovascular Institute (N.M.H., E.J.B., R.S.V.), and Preventive Medicine and Cardiology Sections (E.J.B., R.S.V.), Boston University School of Medicine, MA; and National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.)
| | - Ramachandran S Vasan
- From the Cardiovascular Engineering, Inc, Norwood, MA (A.T., L.L.C., G.F.M.); Cardiovascular Research Center, Rhode Island Hospital, W. Alpert Medical School of Brown University, Providence (L.L.C.); National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA (J.R., M.G.L., D.L., E.J.B., R.S.V.); Department of Biostatistics, Boston University School of Public Health, MA (M.G.L.); Evans Department of Medicine (N.M.H., E.J.B., R.S.V.), Whitaker Cardiovascular Institute (N.M.H., E.J.B., R.S.V.), and Preventive Medicine and Cardiology Sections (E.J.B., R.S.V.), Boston University School of Medicine, MA; and National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.)
| | - Gary F Mitchell
- From the Cardiovascular Engineering, Inc, Norwood, MA (A.T., L.L.C., G.F.M.); Cardiovascular Research Center, Rhode Island Hospital, W. Alpert Medical School of Brown University, Providence (L.L.C.); National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA (J.R., M.G.L., D.L., E.J.B., R.S.V.); Department of Biostatistics, Boston University School of Public Health, MA (M.G.L.); Evans Department of Medicine (N.M.H., E.J.B., R.S.V.), Whitaker Cardiovascular Institute (N.M.H., E.J.B., R.S.V.), and Preventive Medicine and Cardiology Sections (E.J.B., R.S.V.), Boston University School of Medicine, MA; and National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.).
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Borner A, Murray K, Trotter C, Pearson J. Baseline aortic pulse wave velocity is associated with central and peripheral pressor responses during the cold pressor test in healthy subjects. Physiol Rep 2017; 5:5/14/e13357. [PMID: 28733312 PMCID: PMC5532490 DOI: 10.14814/phy2.13357] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 06/20/2017] [Indexed: 11/24/2022] Open
Abstract
Cold environmental temperatures increase sympathetic nerve activity and blood pressure, and increase the risk of acute cardiovascular events in aged individuals. The acute risk of cardiovascular events increases with aortic pulse wave velocity as well as elevated central and peripheral pulse pressures. The aim of this study was to examine the independent influence of aortic pulse wave velocity upon central and peripheral pressor responses to sympathetic activation via the cold pressor test (CPT). Twenty‐two healthy subjects (age: 18–73 years) completed a CPT with the left hand immersed in 2–4°C water for 3 min. During the CPT, central (from: 36 ± 7 to: 51 ± 12 mmHg) and peripheral pulse pressure increased (from: 54 ± 7 to: 66 ± 11; both P < 0.05). In all subjects the increase in central pulse pressure during the CPT was independently associated with baseline aortic pulse wave velocity (r2 = 0.221, P = 0.027) but not age (P > 0.05). In a subset of subjects with higher arterial stiffness, the increase in peripheral pulse pressure during the CPT was independently associated with baseline aortic pulse wave velocity (r2 = 0.415, P = 0.032) but not age (P > 0.05). These data indicate that central and peripheral pulse pressure responses during sympathetic activation are positively and independently associated with aortic pulse wave velocity through a wide age range. Decreasing aortic pulse wave velocity in aged individuals with elevated arterial stiffness may help reduce the incidence of acute cardiovascular events upon exposure to cold environmental temperatures.
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Affiliation(s)
- Anastasiya Borner
- Department of Biology, University of Colorado Colorado Springs, Colorado Springs, Colorado
| | - Kyle Murray
- Department of Biology, University of Colorado Colorado Springs, Colorado Springs, Colorado
| | - Claire Trotter
- Department of Biology, University of Colorado Colorado Springs, Colorado Springs, Colorado
| | - James Pearson
- Department of Biology, University of Colorado Colorado Springs, Colorado Springs, Colorado
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72
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Chorepsima S, Eleftheriadou I, Tentolouris A, Moyssakis I, Protogerou A, Kokkinos A, Sfikakis PP, Tentolouris N. Pulse wave velocity and cardiac autonomic function in type 2 diabetes mellitus. BMC Endocr Disord 2017; 17:27. [PMID: 28526073 PMCID: PMC5438530 DOI: 10.1186/s12902-017-0178-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Accepted: 05/15/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Increased carotid-femoral pulse wave velocity (PWV) has been associated with incident cardiovascular disease, independently of traditional risk factors. Cardiac autonomic dysfunction is a common complication of diabetes and has been associated with reduced aortic distensibility. However, the association of cardiac autonomic dysfunction with PWV is not known. In this study we examined the association between cardiac autonomic function and PWV in subjects with type 2 diabetes mellitus. METHODS A total of 290 patients with type 2 diabetes were examined. PWV was measured at the carotid-femoral segment with applanation tonometry. Central mean arterial blood pressure (MBP) was determined by the same apparatus. Participants were classified as having normal (n = 193) or abnormal (n = 97) PWV values using age-corrected values. Cardiac autonomic nervous system activity was determined by measurement of parameters of heart rate variability (HRV). RESULTS Subjects with abnormal PWV were older, had higher arterial blood pressure and higher heart rate than those with normal PWV. Most of the values of HRV were significantly lower in subjects with abnormal than in those with normal PWV. Multivariate analysis, after controlling for various confounding factors, demonstrated that abnormal PWV was associated independently only with peripheral MBP [odds ratio (OR) 1.049, 95% confidence intervals (CI) 1.015-1.085, P = 0.005], central MBP (OR 1.052, 95% CI 1.016-1.088, P = 0.004), log total power (OR 0.490, 95% CI 0.258-0.932, P = 0.030) and log high frequency power (OR 0.546, 95% CI 0.301-0.991, P = 0.047). CONCLUSIONS In subjects with type 2 diabetes, arterial blood pressure and impaired cardiac autonomic function is associated independently with abnormal PWV.
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Affiliation(s)
- Stamatina Chorepsima
- First Department of Propaedeutic and Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 17 Agiou Thoma St, 11527 Athens, Greece
| | - Ioanna Eleftheriadou
- First Department of Propaedeutic and Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 17 Agiou Thoma St, 11527 Athens, Greece
| | - Anastasios Tentolouris
- First Department of Propaedeutic and Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 17 Agiou Thoma St, 11527 Athens, Greece
| | | | - Athanasios Protogerou
- First Department of Propaedeutic and Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 17 Agiou Thoma St, 11527 Athens, Greece
| | - Alexandros Kokkinos
- First Department of Propaedeutic and Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 17 Agiou Thoma St, 11527 Athens, Greece
| | - Petros P. Sfikakis
- First Department of Propaedeutic and Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 17 Agiou Thoma St, 11527 Athens, Greece
| | - Nikolaos Tentolouris
- First Department of Propaedeutic and Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 17 Agiou Thoma St, 11527 Athens, Greece
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73
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Canney M, O'Connell MDL, Sexton DJ, O'Leary N, Kenny RA, Little MA, O'Seaghdha CM. Graded Association Between Kidney Function and Impaired Orthostatic Blood Pressure Stabilization in Older Adults. J Am Heart Assoc 2017; 6:JAHA.117.005661. [PMID: 28473404 PMCID: PMC5524105 DOI: 10.1161/jaha.117.005661] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background Impaired orthostatic blood pressure (BP) stabilization is highly prevalent in older adults and is a predictor of end‐organ injury, falls, and mortality. We sought to characterize the relationship between postural BP responses and the kidney. Methods and Results We performed a cross‐sectional analysis of 4204 participants from The Irish Longitudinal Study on Ageing, a national cohort of community‐dwelling adults aged ≥50 years. Beat‐to‐beat systolic and diastolic BP were measured during a 2‐minute active stand test. The primary predictor was cystatin C estimated glomerular filtration rate (eGFR) categorized as follows (mL/min per 1.73 m2): ≥90 (reference, n=1414); 75 to 89 (n=1379); 60 to 74 (n=942); 45 to 59 (n=337); <45 (n=132). We examined the association between eGFR categories and (1) sustained orthostatic hypotension, defined as a BP drop exceeding consensus thresholds (systolic BP drop ≥20 mm Hg±diastolic BP drop ≥10 mm Hg) at each 10‐second interval from 60 to 110 seconds inclusive; (2) pattern of BP stabilization, characterized as the difference from baseline in mean systolic BP/diastolic BP at 10‐second intervals. The mean age of subjects was 61.6 years; 47% of subjects were male, and the median eGFR was 82 mL/min per 1.73 m2. After multivariable adjustment, participants with eGFR <60 mL/min per 1.73 m2 were approximately twice as likely to have sustained orthostatic hypotension (P=0.008 for trend across eGFR categories). We observed a graded association between eGFR categories and impaired orthostatic BP stabilization, particularly within the first minute of standing. Conclusions We report a novel, graded relationship between diminished eGFR and impaired orthostatic BP stabilization. Mapping the postural BP response merits further study in kidney disease as a potential means of identifying those at risk of hypotension‐related events.
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Affiliation(s)
- Mark Canney
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin 2, Ireland .,Trinity Health Kidney Centre, Tallaght Hospital, Dublin 24, Ireland
| | - Matthew D L O'Connell
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin 2, Ireland
| | - Donal J Sexton
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin 2, Ireland.,Trinity Health Kidney Centre, Tallaght Hospital, Dublin 24, Ireland
| | - Neil O'Leary
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin 2, Ireland
| | - Rose Anne Kenny
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin 2, Ireland
| | - Mark A Little
- Trinity Health Kidney Centre, Tallaght Hospital, Dublin 24, Ireland
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74
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Grillo A, Lonati LM, Guida V, Parati G. Cardio-ankle vascular stiffness index (CAVI) and 24 h blood pressure profiles. Eur Heart J Suppl 2017. [DOI: 10.1093/eurheartj/suw060] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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75
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Brandão AA, Amodeo C, Alcântara C, Barbosa E, Nobre F, Pinto F, Vilela-Martin JF, Bastos JM, Yugar-Toledo JC, Mota-Gomes MA, Neves MFT, Malachias MVB, Rodrigues MDC, Passarelli O, Jardim PCBV, Cunha PG, Póvoa R, Fonseca T, Dias VP, Barroso WS, Oigman W. I Luso-Brazilian Positioning on Central Arterial Pressure. Arq Bras Cardiol 2017; 108:100-108. [PMID: 28327876 PMCID: PMC5344653 DOI: 10.5935/abc.20170011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 11/10/2016] [Indexed: 01/30/2023] Open
Affiliation(s)
- Andréa A Brandão
- Departamento de Hipertensão Arterial da Sociedade Brasileira de Cardiologia, Rio de Janeiro, RJ - Brazil
| | - Celso Amodeo
- Departamento de Hipertensão Arterial da Sociedade Brasileira de Cardiologia, Rio de Janeiro, RJ - Brazil
| | | | - Eduardo Barbosa
- Departamento de Hipertensão Arterial da Sociedade Brasileira de Cardiologia, Rio de Janeiro, RJ - Brazil
| | - Fernando Nobre
- Departamento de Hipertensão Arterial da Sociedade Brasileira de Cardiologia, Rio de Janeiro, RJ - Brazil
| | | | | | | | - Juan Carlos Yugar-Toledo
- Departamento de Hipertensão Arterial da Sociedade Brasileira de Cardiologia, Rio de Janeiro, RJ - Brazil
| | - Marco Antônio Mota-Gomes
- Departamento de Hipertensão Arterial da Sociedade Brasileira de Cardiologia, Rio de Janeiro, RJ - Brazil
| | - Mario Fritsch Toros Neves
- Departamento de Hipertensão Arterial da Sociedade Brasileira de Cardiologia, Rio de Janeiro, RJ - Brazil
| | | | | | - Oswaldo Passarelli
- Departamento de Hipertensão Arterial da Sociedade Brasileira de Cardiologia, Rio de Janeiro, RJ - Brazil
| | - Paulo César B Veiga Jardim
- Departamento de Hipertensão Arterial da Sociedade Brasileira de Cardiologia, Rio de Janeiro, RJ - Brazil
| | | | - Rui Póvoa
- Departamento de Hipertensão Arterial da Sociedade Brasileira de Cardiologia, Rio de Janeiro, RJ - Brazil
| | | | | | - Weimar Sebba Barroso
- Departamento de Hipertensão Arterial da Sociedade Brasileira de Cardiologia, Rio de Janeiro, RJ - Brazil
| | - Wille Oigman
- Departamento de Hipertensão Arterial da Sociedade Brasileira de Cardiologia, Rio de Janeiro, RJ - Brazil
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76
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Mileva-Popova R, Stoynev N, Belova N. Applanation tonometry for evaluation of the haemodynamic response to the active orthostatic test. Artery Res 2017. [DOI: 10.1016/j.artres.2017.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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77
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Wong A, Alvarez-Alvarado S, Kinsey AW, Figueroa A. Whole-Body Vibration Exercise Therapy Improves Cardiac Autonomic Function and Blood Pressure in Obese Pre- and Stage 1 Hypertensive Postmenopausal Women. J Altern Complement Med 2016; 22:970-976. [DOI: 10.1089/acm.2016.0124] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alexei Wong
- Department of Health and Human Performance, Marymount University, Arlington, VA
| | - Stacey Alvarez-Alvarado
- Department of Nutrition, Food and Exercise Sciences, The Florida State University, Tallahassee, FL
| | - Amber W. Kinsey
- Nutrition Obesity Research Center, Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL
| | - Arturo Figueroa
- Department of Nutrition, Food and Exercise Sciences, The Florida State University, Tallahassee, FL
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78
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Velilla-Zancada SM, Prieto-Díaz MA, Escobar-Cervantes C, Manzano-Espinosa L. [Orthostatic hypotension; that great unknown]. Semergen 2016; 43:501-510. [PMID: 27865581 DOI: 10.1016/j.semerg.2016.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 09/14/2016] [Accepted: 09/20/2016] [Indexed: 12/01/2022]
Abstract
Orthostatic hypotension is an anomaly of growing interest in scientific research. Although certain neurogenic diseases are associated with this phenomenon, it can also be associated with non-neurological causes. Although orthostatic hypotension is defined by consensus as a decrease in the systolic blood pressure of at least 20mmHg, or a decrease in diastolic blood pressure of at least 10mmHg, within 3min of standing, the studies differ on how to diagnose it. Orthostatic hypotension is associated with certain cardiovascular risk factors and with drug treatment, but the results are contradictory. The purpose of this review is to update the knowledge about orthostatic hypotension and its treatment, as well as to propose a method to standardise its diagnosis.
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Affiliation(s)
- S M Velilla-Zancada
- Centro de Salud Espartero, Logroño, La Rioja, España; Grupo de trabajo de Hipertensión Arterial y Enfermedad Cardiovascular de SEMERGEN, España.
| | - M A Prieto-Díaz
- Grupo de trabajo de Hipertensión Arterial y Enfermedad Cardiovascular de SEMERGEN, España; Centro de Salud Vallobín-La Florida, Oviedo, Asturias, España
| | - C Escobar-Cervantes
- Grupo de trabajo de Hipertensión Arterial y Enfermedad Cardiovascular de SEMERGEN, España; Departamento de Cardiología, Hospital La Paz, Madrid, España
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79
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Bonne SL, Livingston DH. Changes in Organ Physiology in the Aging Adult. CURRENT TRAUMA REPORTS 2016. [DOI: 10.1007/s40719-016-0069-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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80
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Wolters FJ, Mattace-Raso FUS, Koudstaal PJ, Hofman A, Ikram MA. Orthostatic Hypotension and the Long-Term Risk of Dementia: A Population-Based Study. PLoS Med 2016; 13:e1002143. [PMID: 27727284 PMCID: PMC5058559 DOI: 10.1371/journal.pmed.1002143] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 09/02/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Orthostatic hypotension (OH) is a common cause of transient cerebral hypoperfusion in the population. Cerebral hypoperfusion is widely implicated in cognitive impairment, but whether OH contributes to cognitive decline and dementia is uncertain. We aimed to determine the association between OH and the risk of developing dementia in the general population. METHODS AND FINDINGS Between 4 October 1989 and 17 June 1993, we assessed OH in non-demented, stroke-free participants of the population-based Rotterdam Study. OH was defined as a ≥20 mm Hg drop in systolic blood pressure (SBP) or ≥10 mm Hg drop in diastolic blood pressure (DBP) within 3 min from postural change. We furthermore calculated within participant variability in SBP related to postural change, expressed as coefficient of variation. Follow-up for dementia was conducted until 1 January 2014. We determined the risk of dementia in relation to OH and SBP variability, using a Cox regression model, adjusted for age; sex; smoking status; alcohol intake; SBP; DBP; cholesterol:high-density lipoprotein ratio; diabetes; body mass index; use of antihypertensive, lipid-lowering, or anticholinergic medication; and apolipoprotein E genotype. Finally, we explored whether associations varied according to compensatory increase in heart rate. Among 6,204 participants (mean ± standard deviation [SD] age 68.5 ± 8.6 y, 59.7% female) with a median follow-up of 15.3 y, 1,176 developed dementia, of whom 935 (79.5%) had Alzheimer disease and 95 (8.1%) had vascular dementia. OH was associated with an increased risk of dementia (adjusted hazard ratio [aHR] 1.15, 95% CI 1.00-1.34, p = 0.05), which was similar for Alzheimer disease and vascular dementia. Similarly, greater SBP variability with postural change was associated with an increased risk of dementia (aHR per SD increase 1.08, 95% CI 1.01-1.16, p = 0.02), which was similar when excluding those who fulfilled the formal criteria for OH (aHR 1.08, 95% CI 1.00-1.17, p = 0.06). The risk of dementia was particularly increased in those with OH who lacked a compensatory increase in heart rate (within lowest quartile of heart rate response: aHR 1.39, 95% CI 1.04-1.85, p-interaction = 0.05). Limitations of this study include potential residual confounding despite rigorous adjustments, and potentially limited generalisability to populations not of European descent. CONCLUSIONS In this population predominantly of European descent, OH was associated with an increase in long-term risk of dementia.
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Affiliation(s)
- Frank J. Wolters
- Department of Epidemiology, Erasmus Medical Centre, Rotterdam, the Netherlands
- Department of Neurology, Erasmus Medical Centre, Rotterdam, the Netherlands
| | | | - Peter J. Koudstaal
- Department of Neurology, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Albert Hofman
- Department of Epidemiology, Erasmus Medical Centre, Rotterdam, the Netherlands
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - M. Arfan Ikram
- Department of Epidemiology, Erasmus Medical Centre, Rotterdam, the Netherlands
- Department of Neurology, Erasmus Medical Centre, Rotterdam, the Netherlands
- Department of Radiology, Erasmus Medical Centre, Rotterdam, the Netherlands
- * E-mail:
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81
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Tahvanainen AM, Tikkakoski AJ, Koskela JK, Nordhausen K, Viitala JM, Leskinen MH, Kähönen MAP, Kööbi T, Uitto MT, Viik J, Mustonen JT, Pörsti IH. The type of the functional cardiovascular response to upright posture is associated with arterial stiffness: a cross-sectional study in 470 volunteers. BMC Cardiovasc Disord 2016; 16:101. [PMID: 27216309 PMCID: PMC4877753 DOI: 10.1186/s12872-016-0281-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 05/14/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In a cross-sectional study we examined whether the haemodynamic response to upright posture could be divided into different functional phenotypes, and whether the observed phenotypes were associated with known determinants of cardiovascular risk. METHODS Volunteers (n = 470) without medication with cardiovascular effects were examined using radial pulse wave analysis, whole-body impedance cardiography, and heart rate variability analysis. Based on the passive head-up tilt induced changes in systemic vascular resistance and cardiac output, the principal determinants of blood pressure, a cluster analysis was performed. RESULTS The haemodynamic response could be clustered into 3 categories: upright increase in vascular resistance and decrease in cardiac output were greatest in the first (+45 % and -27 %, respectively), smallest in the second (+2 % and -2 %, respectively), and intermediate (+22 % and -13 %, respectively) in the third group. These groups were named as 'constrictor' (n = 109), 'sustainer' (n = 222), and 'intermediate' (n = 139) phenotypes, respectively. The sustainers were characterized by male predominance, higher body mass index, blood pressure, and also by higher pulse wave velocity, an index of large arterial stiffness, than the other groups (p < 0.01 for all). Heart rate variability analysis showed higher supine and upright low frequency/high frequency (LF/HF) ratio in the sustainers than constrictors, indicating increased sympathovagal balance. Upright LF/HF ratio was also higher in the sustainer than intermediate group. In multivariate analysis, independent explanatory factors for higher pulse wave velocity were the sustainer (p < 0.022) and intermediate phenotypes (p < 0.046), age (p < 0.001), body mass index (p < 0.001), and hypertension (p < 0.001). CONCLUSIONS The response to upright posture could be clustered to 3 functional phenotypes. The sustainer phenotype, with smallest upright decrease in cardiac output and highest sympathovagal balance, was independently associated with increased large arterial stiffness. These results indicate an association of the functional haemodynamic phenotype with an acknowledged marker of cardiovascular risk. TRIAL REGISTRATION ClinicalTrials.gov NCT01742702.
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Affiliation(s)
- Anna M Tahvanainen
- School of Medicine, University of Tampere, Tampere, Finland. .,School of Medicine / Internal Medicine, FIN-33014 University of Tampere, Tampere, Finland.
| | | | | | - Klaus Nordhausen
- Department of Mathematics and Statistics, University of Turku, Turku, Finland
| | - Jani M Viitala
- School of Medicine, University of Tampere, Tampere, Finland
| | | | - Mika A P Kähönen
- School of Medicine, University of Tampere, Tampere, Finland.,Department of Clinical Physiology, Tampere University Hospital, P.O. Box 2000, Tampere, 33521, Finland
| | - Tiit Kööbi
- Department of Clinical Physiology, Tampere University Hospital, P.O. Box 2000, Tampere, 33521, Finland
| | - Marko T Uitto
- School of Medicine, University of Tampere, Tampere, Finland.,Department of Electronics and Communication Engineering, Tampere University of Technology, BioMediTech, Tampere, Finland
| | - Jari Viik
- Department of Electronics and Communication Engineering, Tampere University of Technology, BioMediTech, Tampere, Finland
| | - Jukka T Mustonen
- School of Medicine, University of Tampere, Tampere, Finland.,Department of Internal Medicine, Tampere University Hospital, P.O. Box 2000, Tampere, 33521, Finland
| | - Ilkka H Pörsti
- School of Medicine, University of Tampere, Tampere, Finland.,Department of Internal Medicine, Tampere University Hospital, P.O. Box 2000, Tampere, 33521, Finland
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82
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Moonen JEF, Foster-Dingley JC, de Ruijter W, van der Grond J, de Craen AJM, van der Mast RC. Effect of discontinuation of antihypertensive medication on orthostatic hypotension in older persons with mild cognitive impairment: the DANTE Study Leiden. Age Ageing 2016; 45:249-55. [PMID: 26758532 DOI: 10.1093/ageing/afv199] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 12/02/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND the relationship between antihypertensive medication and orthostatic hypotension in older persons remains ambiguous, due to conflicting observational evidence and lack of data of clinical trials. OBJECTIVE to assess the effect of discontinuation of antihypertensive medication on orthostatic hypotension in older persons with mild cognitive impairment. METHODS a total of 162 participants with orthostatic hypotension were selected from the Discontinuation of Antihypertensive Treatment in Elderly people (DANTE) Study. This randomised clinical trial included community-dwelling participants aged ≥75 years, with mild cognitive impairment, using antihypertensive medication and without serious cardiovascular disease. Participants were randomised to discontinuation or continuation of antihypertensive treatment (ratio 1:1). Orthostatic hypotension was defined as a drop of at least 20 mmHg in systolic blood pressure and/or 10 mmHg in diastolic blood pressure on standing from a seated position. Outcome was the absence of orthostatic hypotension at 4-month follow-up. Relative risks (RR) were calculated by intention-to-treat and per-protocol analyses. RESULTS at follow-up, according to intention-to-treat analyses, of the 86 persons assigned to discontinuation of antihypertensive medication, 43 (50%) were free from orthostatic hypotension, compared with 29 (38%) of the 76 persons assigned to continuation of medication [RR 1.31 (95% confidence interval (CI) 0.92-1.87); P = 0.13]. Per-protocol analysis showed that recovery from orthostatic hypotension was significantly higher in persons who completely discontinued all antihypertensive medication (61%) compared with the continuation group (38%) [RR 1.60 (95% CI 1.10-2.31); P = 0.01]. CONCLUSION in older persons with mild cognitive impairment and orthostatic hypotension receiving antihypertensive medication, discontinuation of antihypertensive medication may increase the probability of recovery from orthostatic hypotension.
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Affiliation(s)
- Justine E F Moonen
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Wouter de Ruijter
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jeroen van der Grond
- Department of Radiology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
| | - Anton J M de Craen
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Roos C van der Mast
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium
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83
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Estimated aortic stiffness is independently associated with cardiac baroreflex sensitivity in humans: role of ageing and habitual endurance exercise. J Hum Hypertens 2016; 30:513-20. [PMID: 26911535 PMCID: PMC4981524 DOI: 10.1038/jhh.2016.3] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 12/30/2015] [Accepted: 01/11/2016] [Indexed: 12/25/2022]
Abstract
We hypothesized that differences in cardiac baroreflex sensitivity (BRS) would be independently associated with aortic stiffness and augmentation index (AI), clinical biomarkers of cardiovascular disease (CVD) risk, among young sedentary and middle-aged/older sedentary and endurance-trained adults. A total of 36 healthy middle-aged/older (age 55-76 years, n=22 sedentary; n=14 endurance-trained) and 5 young sedentary (age 18-31 years) adults were included in a cross-sectional study. A subset of the middle-aged/older sedentary adults (n=12) completed an 8-week aerobic exercise intervention. Invasive brachial artery blood pressure waveforms were used to compute spontaneous cardiac BRS (via sequence technique) and estimated aortic pulse wave velocity (PWV) and AI (AI, via brachial-aortic transfer function and wave separation analysis). In the cross-sectional study, cardiac BRS was 71% lower in older compared with young sedentary adults (P<0.05), but only 40% lower in older adults who performed habitual endurance exercise (P=0.03). In a regression model that included age, sex, resting heart rate, mean arterial pressure (MAP), body mass index and maximal exercise oxygen uptake, estimated aortic PWV (β±SE = −5.76 ± 2.01, P=0.01) was the strongest predictor of BRS (Model R2=0.59, P<0.001). The 8 week exercise intervention improved BRS by 38% (P=0.04) and this change in BRS was associated with improved aortic PWV (r=−0.65, P=0.044, adjusted for changes in MAP). Age- and endurance exercise-related differences in cardiac BRS are independently associated with corresponding alterations in aortic PWV among healthy adults, consistent with a mechanistic link between variations in the sensitivity of the baroreflex and aortic stiffness with age and exercise.
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84
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Wang Y, Yang Y, Wang A, An S, Li Z, Zhang W, Liu X, Ruan C, Liu X, Guo X, Zhao X, Wu S. Association of long-term blood pressure variability and brachial-ankle pulse wave velocity: a retrospective study from the APAC cohort. Sci Rep 2016; 6:21303. [PMID: 26892486 PMCID: PMC4759569 DOI: 10.1038/srep21303] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 01/21/2016] [Indexed: 11/09/2022] Open
Abstract
We investigated associations between long-term blood pressure variability (BPV) and brachial-ankle pulse wave velocity (baPWV). Within the Asymptomatic Polyvascular Abnormalities Community (APAC) study, we retrospectively collected long-term BPV and baPWV measures. Long-term BPV was calculated using the mean and standard deviation of systolic blood pressure (SBP) across 4 years based on annual values of SBP. In total, 3,994 subjects (2,284 men) were eligible for inclusion in this study. We stratified the study population into four SBP quartiles. Left and right baPWV was higher in participants with long-term SBPV in the fourth quartile compared with the first quartile (left: 1,725 ± 488 vs. 1,461 ± 340 [p < 0.001]; right: 1,722 ± 471 vs. 1,455 ± 341 [p < 0.001], respectively). We obtained the same result for total baPWV (fourth vs. first quartile: 1,772 ± 429 vs. 1,492 ± 350 [p < 0.001]). Furthermore, there was a trend for gradually increased baPWV (≥1,400 cm/s) with increased SBPV (p < 0.001). After multivariable adjustment, baPWV was positively correlated with long-term BPV (p < 0.001). In conclusion, long-term BPV is significantly associated with arterial stiffness as assessed by baPWV.
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Affiliation(s)
- Yang Wang
- Graduate School, North China University of Science and Technology, Tangshan, China
| | - Yuling Yang
- Graduate School, North China University of Science and Technology, Tangshan, China
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.,Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
| | - Shasha An
- Graduate School, North China University of Science and Technology, Tangshan, China
| | - Zhifang Li
- Graduate School, North China University of Science and Technology, Tangshan, China
| | - Wenyan Zhang
- Graduate School, North China University of Science and Technology, Tangshan, China
| | - Xuemei Liu
- Graduate School, North China University of Science and Technology, Tangshan, China
| | - Chunyu Ruan
- Graduate School, North China University of Science and Technology, Tangshan, China
| | - Xiaoxue Liu
- Department of Cardiology,Tangshan People's Hospital, Tangshan, China
| | - Xiuhua Guo
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Shouling Wu
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, Tangshan, China
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85
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Kaur M, Chandran DS, Jaryal AK, Bhowmik D, Agarwal SK, Deepak KK. Baroreflex dysfunction in chronic kidney disease. World J Nephrol 2016; 5:53-65. [PMID: 26788464 PMCID: PMC4707168 DOI: 10.5527/wjn.v5.i1.53] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 10/04/2015] [Accepted: 11/25/2015] [Indexed: 02/06/2023] Open
Abstract
Chronic kidney disease (CKD) patients have high cardiovascular mortality and morbidity. The presence of traditional and CKD related risk factors results in exaggerated vascular calcification in these patients. Vascular calcification is associated with reduced large arterial compliance and thus impaired baroreflex sensitivity (BRS) resulting in augmented blood pressure (BP) variability and hampered BP regulation. Baroreflex plays a vital role in short term regulation of BP. This review discusses the normal baroreflex physiology, methods to assess baroreflex function, its determinants along with the prognostic significance of assessing BRS in CKD patients, available literature on BRS in CKD patients and the probable patho-physiology of baroreflex dysfunction in CKD.
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86
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Blood pressure variability predicts cardiovascular events independently of traditional cardiovascular risk factors and target organ damage. J Hypertens 2015; 33:2422-30. [DOI: 10.1097/hjh.0000000000000739] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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87
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Rossignol P, Massy ZA, Azizi M, Bakris G, Ritz E, Covic A, Goldsmith D, Heine GH, Jager KJ, Kanbay M, Mallamaci F, Ortiz A, Vanholder R, Wiecek A, Zoccali C, London GM, Stengel B, Fouque D. The double challenge of resistant hypertension and chronic kidney disease. Lancet 2015; 386:1588-98. [PMID: 26530623 DOI: 10.1016/s0140-6736(15)00418-3] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Resistant hypertension is defined as blood pressure above goal despite adherence to a combination of at least three optimally dosed antihypertensive medications, one of which is a diuretic. Chronic kidney disease is the most frequent of several patient factors or comorbidities associated with resistant hypertension. The prevalence of resistant hypertension is increased in patients with chronic kidney disease, while chronic kidney disease is associated with an impaired prognosis in patients with resistant hypertension. Recommended low-salt diet and triple antihypertensive drug regimens that include a diuretic, should be complemented by the sequential addition of other antihypertensive drugs. New therapeutic innovations for resistant hypertension, such as renal denervation and carotid barostimulation, are under investigation especially in patients with advanced chronic kidney disease. We discuss resistant hypertension in chronic kidney disease stages 3-5 (ie, patients with an estimated glomerular filtration rate below 60 mL/min per 1·73 m(2) and not on dialysis), in terms of worldwide epidemiology, outcomes, causes and pathophysiology, evidence-based treatment, and a call for action.
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Affiliation(s)
- Patrick Rossignol
- INSERM Centre d'Investigations Cliniques (CIC)-1433, and INSERM U1116, Nancy, France; Institut Lorrain du Cœur et des Vaisseaux, CHU Nancy, Vandoeuvre lès Nancy, France; Université de Lorraine, Nancy, France; Association Lorraine pour le Traitement de l'Insuffisance Rénale, Vandoeuvre lès Nancy, France.
| | - Ziad A Massy
- Division of Nephrology, Ambroise Paré University Hospital (APHP), University of Paris Ouest-Versailles-Saint-Quentin-en-Yvelines (UVSQ), Boulogne-Billancourt, Paris, France; INSERM U1018, Research Centre in Epidemiology and Population Health (CESP), UVSQ, Villejuif, France
| | - Michel Azizi
- APHP, Hôpital Européen Georges Pompidou, Unité d'Hypertension artérielle, Paris, France; Université Paris Descartes, Paris, France; INSERM CIC-1418, Paris, France
| | - George Bakris
- Department of Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Eberhard Ritz
- Department Internal Medicine, Ruperto Carola University of Heidelberg, Germany
| | - Adrian Covic
- Parhon University Hospital, Grigore T Popa University of Medicine, Iasi, Romania
| | - David Goldsmith
- Renal and Transplantation Department, Guy's and St Thomas' Hospitals, London, UK
| | - Gunnar H Heine
- Internal Medicine IV-Nephrology and Hypertension, Saarland University Medical Centre, Homburg, Germany
| | - Kitty J Jager
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Mehmet Kanbay
- Department of Medicine, Division of Nephrology, Koc University School of Medicine, Istanbul, Turkey
| | - Francesca Mallamaci
- Nephrology, Hypertension and Renal Transplantation Unit, Ospedali Riuniti, Reggio Calabria, Italy; CNR (National Research Council of Italy) Institute of Clinical Physiology (IFC), Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, Ospedali Riuniti, Reggio Calabria, Italy
| | - Alberto Ortiz
- Division of Nephrology, IIS-Fundacion Jimenez Diaz, Madrid, Spain; School of Medicine, Universidad Autonoma de Madrid, Madrid, Spain; Red de Investigacion Renal (REDINREN), Madrid, Spain; Insituto Reina Sofia de Investigaciones Nefrológicas (IRSIN), Madrid, Spain
| | - Raymond Vanholder
- Nephrology Section, Department of Internal Medicine, University Hospital Ghent, Belgium
| | - Andrzej Wiecek
- Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia, Katowice, Poland
| | - Carmine Zoccali
- CNR (National Research Council of Italy) Institute of Clinical Physiology (IFC), Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, Ospedali Riuniti, Reggio Calabria, Italy
| | | | | | - Denis Fouque
- Department of Nephrology, Nutrition, and Dialysis, Centre Hospitalier Lyon Sud, Carmen-CENS, Université de Lyon, Lyon, France
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88
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Takahashi M, Miyai N, Nagano S, Utsumi M, Oka M, Yamamoto M, Shiba M, Uematsu Y, Nishimura Y, Takeshita T, Arita M. Orthostatic Blood Pressure Changes and Subclinical Markers of Atherosclerosis. Am J Hypertens 2015; 28:1134-40. [PMID: 25673039 DOI: 10.1093/ajh/hpu301] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 12/19/2014] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Using a simple standing-up test in normotensive subjects, we evaluated orthostatic upright postural blood pressure (BP) changes and autonomic nervous function, as well as the relationship between orthostatic BP changes and subclinical markers of atherosclerosis. METHODS A total of 515 normotensive subjects aged 35-75 years (58.4±10.0 years) were enrolled. We measured body mass index (BMI), systolic BP (SBP) and diastolic BP (DBP), serum lipids, hemoglobin A1c (HbA1c), high-sensitivity C-reactive protein (hs-CRP), and urinary albumin-to-creatinine ratio. Brachial to ankle pulse wave velocity (baPWV) and carotid mean intima-media thickness (IMT) were measured. Participants underwent a simple standing-up test involving sitting then standing for 2 minutes each, followed again by sitting. To evaluate autonomic fluctuations, we calculated the coefficient of variation of the R-R interval, the ratio of low to high frequency heart rate variability (LF/HF), and the coefficient of component variance of high frequency. RESULTS SBP and DBP decreased when standing, with a reduction of SBP when changing position of -8.0±10.2mm Hg. Orthostatic hypotension (OH) produced a significantly higher SBP than without OH. The baPWV was significantly higher in OH than in without OH. Stepwise regression analysis adjusted for age, sex, BMI, baseline SBP, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, fasting glucose, HbA1c, hs-CRP, IMT, late systolic peak of the pressure wave form (SBP2), and baPWV confirmed that baPWV, SBP2, and triglycerides were independently related to orthostatic BP changes. Multiple regression analyses showed that a decrease in SBP as well as baseline SBP, age, BMI, and fasting glucose were independent determinants of PWV. CONCLUSIONS We have shown that increased arterial stiffness was associated with OH during a standing-up test. Arterial stiffness may contribute to greater BP responses to postural changes from standing.
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Affiliation(s)
- Maasa Takahashi
- School of Health and Nursing Sciences, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Nobuyuki Miyai
- School of Health and Nursing Sciences, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Shiori Nagano
- School of Health and Nursing Sciences, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Miyoko Utsumi
- School of Health and Nursing Sciences, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Mayumi Oka
- School of Health and Nursing Sciences, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Mio Yamamoto
- School of Health and Nursing Sciences, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Mitsuru Shiba
- School of Health and Nursing Sciences, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Yuji Uematsu
- School of Health and Nursing Sciences, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Yoshiko Nishimura
- School of Health and Nursing Sciences, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Tatsuya Takeshita
- Department of Public Health, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Mikio Arita
- School of Health and Nursing Sciences, Wakayama Medical University, Wakayama City, Wakayama, Japan;
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89
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Bahrainwala J, Patel A, Diaz KM, Veerabhadrappa P, Cohen DL, Cucchiara A, Townsend RR. Ambulatory Arterial Stiffness Index and circadian blood pressure variability. ACTA ACUST UNITED AC 2015; 9:705-10. [PMID: 26260424 DOI: 10.1016/j.jash.2015.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Revised: 06/20/2015] [Accepted: 07/01/2015] [Indexed: 11/17/2022]
Abstract
The manner in which the circulation accommodates each heartbeat may underlie blood pressure (BP) variability. We used the Ambulatory Arterial Stiffness Index (AASI), which reflects this ventricular-vascular interaction, in untreated individuals with prehypertension and Stage 1 hypertension to evaluate two different measures of BP variability using the brachial pulse pressure (PP) obtained over 24 hours. We enrolled 64 untreated adults with systolic BP between 130-159 mm Hg and diastolic values of <100 mm Hg who underwent 24-hour ambulatory BP monitoring with calculation of 24-hour AASIs. Variability in brachial PP was determined using the standard deviation of the measurements over 24 hours and the average real variability. The 24-hour AASI correlated with both measures of 24-hour PP variability (P < .001 for both). Subdividing the 24-hour stiffness index into daytime and nighttime components showed modest differences in their relationship to PP variability, with the daytime being significantly different from 24-hour AASI and the standard deviation of the brachial PP consistently having a higher correlation to the AASI when compared with the average real variability. These observations may be useful to understand differences in variability measures of BP measurements, such as PP, to measures like the AASI as reported in longitudinal studies.
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Affiliation(s)
- Jehan Bahrainwala
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Ami Patel
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Keith M Diaz
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | | | - Debbie L Cohen
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Andrew Cucchiara
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Raymond R Townsend
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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90
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Townsend RR, Wilkinson IB, Schiffrin EL, Avolio AP, Chirinos JA, Cockcroft JR, Heffernan KS, Lakatta EG, McEniery CM, Mitchell GF, Najjar SS, Nichols WW, Urbina EM, Weber T. Recommendations for Improving and Standardizing Vascular Research on Arterial Stiffness: A Scientific Statement From the American Heart Association. Hypertension 2015; 66:698-722. [PMID: 26160955 DOI: 10.1161/hyp.0000000000000033] [Citation(s) in RCA: 947] [Impact Index Per Article: 105.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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91
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Parati G, Ochoa JE, Torlasco C, Salvi P, Lombardi C, Bilo G. Aging, High Altitude, and Blood Pressure: A Complex Relationship. High Alt Med Biol 2015; 16:97-109. [DOI: 10.1089/ham.2015.0010] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Gianfranco Parati
- Cardiovascular Medicine, Department of Health Sciences, University of Milan-Bicocca, Milan, Italy
- Department of Cardiovascular Neural and Metabolic Sciences, San Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Juan Eugenio Ochoa
- Department of Cardiovascular Neural and Metabolic Sciences, San Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Camilla Torlasco
- Cardiovascular Medicine, Department of Health Sciences, University of Milan-Bicocca, Milan, Italy
- Department of Cardiovascular Neural and Metabolic Sciences, San Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Paolo Salvi
- Department of Cardiovascular Neural and Metabolic Sciences, San Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Carolina Lombardi
- Department of Cardiovascular Neural and Metabolic Sciences, San Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Grzegorz Bilo
- Department of Cardiovascular Neural and Metabolic Sciences, San Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy
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92
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Increased nocturnal heart rate and wave reflection are early markers of cardiovascular disease in Williams–Beuren syndrome children. J Hypertens 2015; 33:804-9; discussion 809. [DOI: 10.1097/hjh.0000000000000454] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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93
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Imaizumi Y, Eguchi K, Taketomi A, Tsuchihashi T, Kario K. Exaggerated blood pressure variability in patients with pneumoconiosis: a pilot study. Am J Hypertens 2014; 27:1456-63. [PMID: 24851869 DOI: 10.1093/ajh/hpu073] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Chronic hypoxia is a risk factor for cardiovascular disease, but its association with blood pressure (BP) remains unclear. We performed this study to clarify the hypothesis that chronic hypoxia is associated with abnormal BP variability in patients with pneumoconiosis. METHODS We recruited 19 patients with pneumoconiosis and 30 age- and BP level-matched control subjects. We used simultaneous pulse oximetry and ambulatory BP monitoring for all subjects. We evaluated their BP levels and variability by determining the SD and coefficient of variation (CV) of the BP data. The dipper pattern was defined as nocturnal BP fall ≥10%; the nondipper pattern was defined as nocturnal BP fall ≥0% but <10%; the riser pattern was defined as nocturnal BP fall <0%. Pearson and Spearman correlation coefficients were used to calculate the correlations between parameters. RESULTS In patients with pneumoconiosis, the daytime systolic BP (SBP) level was lower, the CV in 24-hour SBP (P < 0.05) and diastolic BP (P < 0.001) were higher than that in control subjects. And although not statistically significant (P = 0.13), the odds ratio of riser pattern was 3.73 in patients with pneumoconiosis, and their nighttime pulse rate was significantly higher (P < 0.05) than that in control subjects. The median daytime pulse oximetry oxygen saturation was inversely associated with mean (r = -0.30; P < 0.01) and SD (r = -0.38; P < 0.001) in daytime SBP. The median nighttime pulse oximetry oxygen saturation was inversely associated (r = -0.55; P < 0.001) and the mean nighttime pulse rate was associated (r = 0.51; P < 0.001) with CV in nighttime SBP. Partial pressure of oxygen was inversely associated with CV in daytime SBP (r = -0.24; P < 0.05). CONCLUSIONS Exaggerated BP variability was seen in patients with pneumoconiosis, and the measures of hypoxia were associated with large fluctuations in ambulatory BP. Chronic and intermittent hypoxia could be the contributing factors of these findings. CLINICAL TRIAL REGISTRATION Clinical Trial Number UMIN000000894 (University Hospital Medical Information Network Clinical Trials Registry website).
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Affiliation(s)
- Yuki Imaizumi
- Munakata Oshima Clinic, Fukuoka, Japan; Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Kazuo Eguchi
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | | | | | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University, Tochigi, Japan;
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Sung SH, Chen ZY, Tseng TW, Lu DY, Yu WC, Cheng HM, Chen CH. Wave reflections, arterial stiffness, and orthostatic hypotension. Am J Hypertens 2014; 27:1446-55. [PMID: 24815677 DOI: 10.1093/ajh/hpu063] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The effect of wave reflections on blood pressure change associated with posture remains unclear. We therefore applied a wave separation technique to investigate the relations of the backward pressure wave amplitude with orthostatic pressure changes and orthostatic hypotension (OH). METHODS We analyzed data from 613 subjects who had participated in our hemodynamic studies. Measurements of brachial systolic (SBP) and diastolic blood pressures (DBP), carotid-femoral pulse wave velocity (cf-PWV), and backward pressure wave amplitude from a decomposed carotid pressure wave (Pb) were obtained at supine position. SBP and DBP were measured again 3 minutes after standing. OH was defined as a fall of ≥20 mm Hg in SBP and/or ≥10 mm Hg in DBP. RESULTS Subjects with OH (n = 100) were characterized with significantly higher supine SBP and DBP and significantly lower standing SBP and DBP when compared with subjects without OH. Subjects with OH were also characterized with significantly higher cf-PWV and Pb. cf-PWV and Pb separately were significantly associated with the orthostatic SBP change in univariable and multivariable analyses. Also, cf-PWV and Pb separately were significant predictors of OH in univariable and multivariable analyses. cf-PWV predicted OH in the younger but less so in the older subgroup, whereas Pb demonstrated similar prediction in both subgroups. In a final multivariable model, both cf-PWV and Pb were significant independent predictors of OH. CONCLUSIONS Wave reflections are an independent determinant of orthostatic SBP change and OH in both younger and older subjects.
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Affiliation(s)
| | - Zu-Yin Chen
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Medicine, National Yang-Ming University Hospital, Yilan, Taiwan
| | - Tzu-Wei Tseng
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Cardiology, Taipei City Hospital, Yang-Ming Branch, Taipei, Taiwan
| | - Dai-Yin Lu
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Publich Health, National Yang-Ming University, Taipei, Taiwan
| | - Wen-Chung Yu
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hao-Min Cheng
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan. Department of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chen-Huan Chen
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan.
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95
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Finucane C, O’Connell MD, Fan CW, Savva GM, Soraghan CJ, Nolan H, Cronin H, Kenny RA. Age-Related Normative Changes in Phasic Orthostatic Blood Pressure in a Large Population Study. Circulation 2014; 130:1780-9. [DOI: 10.1161/circulationaha.114.009831] [Citation(s) in RCA: 149] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
In this report, we provide the first normative reference data and prevalence estimates of impaired orthostatic blood pressure (BP) stabilization, initial orthostatic hypotension, and orthostatic hypotension based on beat-to-beat blood pressure methods in a population-representative sample.
Methods and Results—
Participants were recruited from a nationally representative cohort study (≥50 years). Beat-to-beat systolic BP, diastolic BP, and heart rate records were analyzed among those who underwent an active stand test (n=4475). Normograms were estimated by use of generalized additive models for location, shape, and scale with Box-Cox power exponential distribution. Prevalence estimates of impaired BP stabilization, initial orthostatic hypotension, and orthostatic hypotension are reported. Orthostatic BP responses in adults aged 50 to 59 years stabilized within 30 seconds of standing, with older groups taking 30 seconds or longer. The total prevalence of impaired BP stabilization was 15.6% (95% confidence interval [CI], 14.1%–17.1%), increasing with age to 41.2% (95% CI, 30.0%–52.4%) in people ≥80 years old. Initial orthostatic hypotension occurred in 32.9% (95% CI, 31.2%–34.6%) of the population aged ≥50 years, with no age gradient evident. The prevalence of orthostatic hypotension was 6.9% (95% CI, 5.9%–7.8%) in the total population, increasing to 18.5% (95% CI, 9.0%–28.0%) in those aged ≥80 years old.
Conclusions—
Significant age-related differences exist in the time course of postural BP responses, with abnormal responses taking longer than 30 seconds to stabilize. Impaired BP stabilization is more common as we age, affecting more than two-fifths of the population aged ≥80 years, and may play a future role in the management of falls and syncope.
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Affiliation(s)
- Ciarán Finucane
- From The Irish Longitudinal Study on Ageing (TILDA), Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland (C.F., M.D.L. O., H.N., H.C., R.A.K.); Department of Medical Physics and Bioengineering, St. James’s Hospital, Dublin, Ireland (C.F., C.J.S.); Department of Medical Gerontology, Mater Hospital, Dublin, Ireland (C.W.F.); and School of Health Sciences, University of East Anglia, Norwich, United Kingdom (G.M.S.)
| | - Matthew D.L. O’Connell
- From The Irish Longitudinal Study on Ageing (TILDA), Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland (C.F., M.D.L. O., H.N., H.C., R.A.K.); Department of Medical Physics and Bioengineering, St. James’s Hospital, Dublin, Ireland (C.F., C.J.S.); Department of Medical Gerontology, Mater Hospital, Dublin, Ireland (C.W.F.); and School of Health Sciences, University of East Anglia, Norwich, United Kingdom (G.M.S.)
| | - Chie Wei Fan
- From The Irish Longitudinal Study on Ageing (TILDA), Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland (C.F., M.D.L. O., H.N., H.C., R.A.K.); Department of Medical Physics and Bioengineering, St. James’s Hospital, Dublin, Ireland (C.F., C.J.S.); Department of Medical Gerontology, Mater Hospital, Dublin, Ireland (C.W.F.); and School of Health Sciences, University of East Anglia, Norwich, United Kingdom (G.M.S.)
| | - George M. Savva
- From The Irish Longitudinal Study on Ageing (TILDA), Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland (C.F., M.D.L. O., H.N., H.C., R.A.K.); Department of Medical Physics and Bioengineering, St. James’s Hospital, Dublin, Ireland (C.F., C.J.S.); Department of Medical Gerontology, Mater Hospital, Dublin, Ireland (C.W.F.); and School of Health Sciences, University of East Anglia, Norwich, United Kingdom (G.M.S.)
| | - Christopher J. Soraghan
- From The Irish Longitudinal Study on Ageing (TILDA), Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland (C.F., M.D.L. O., H.N., H.C., R.A.K.); Department of Medical Physics and Bioengineering, St. James’s Hospital, Dublin, Ireland (C.F., C.J.S.); Department of Medical Gerontology, Mater Hospital, Dublin, Ireland (C.W.F.); and School of Health Sciences, University of East Anglia, Norwich, United Kingdom (G.M.S.)
| | - Hugh Nolan
- From The Irish Longitudinal Study on Ageing (TILDA), Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland (C.F., M.D.L. O., H.N., H.C., R.A.K.); Department of Medical Physics and Bioengineering, St. James’s Hospital, Dublin, Ireland (C.F., C.J.S.); Department of Medical Gerontology, Mater Hospital, Dublin, Ireland (C.W.F.); and School of Health Sciences, University of East Anglia, Norwich, United Kingdom (G.M.S.)
| | - Hilary Cronin
- From The Irish Longitudinal Study on Ageing (TILDA), Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland (C.F., M.D.L. O., H.N., H.C., R.A.K.); Department of Medical Physics and Bioengineering, St. James’s Hospital, Dublin, Ireland (C.F., C.J.S.); Department of Medical Gerontology, Mater Hospital, Dublin, Ireland (C.W.F.); and School of Health Sciences, University of East Anglia, Norwich, United Kingdom (G.M.S.)
| | - Rose Anne Kenny
- From The Irish Longitudinal Study on Ageing (TILDA), Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland (C.F., M.D.L. O., H.N., H.C., R.A.K.); Department of Medical Physics and Bioengineering, St. James’s Hospital, Dublin, Ireland (C.F., C.J.S.); Department of Medical Gerontology, Mater Hospital, Dublin, Ireland (C.W.F.); and School of Health Sciences, University of East Anglia, Norwich, United Kingdom (G.M.S.)
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96
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Abstract
Ageing is associated with a progressive degeneration of the tissues, which has a negative impact on the structure and function of vital organs and is among the most important known risk factors for most chronic diseases. Since the proportion of the world's population aged >60 years will double in the next four decades, this will be accompanied by an increased incidence of chronic age-related diseases that will place a huge burden on healthcare resources. There is increasing evidence that many chronic inflammatory diseases represent an acceleration of the ageing process. Chronic pulmonary diseases represents an important component of the increasingly prevalent multiple chronic debilitating diseases, which are a major cause of morbidity and mortality, particularly in the elderly. The lungs age and it has been suggested that chronic obstructive pulmonary disease (COPD) is a condition of accelerated lung ageing and that ageing may provide a mechanistic link between COPD and many of its extrapulmonary effects and comorbidities. In this article we will describe the physiological changes and mechanisms of ageing, with particular focus on the pulmonary effects of ageing and how these may be relevant to the development of COPD and its major extrapulmonary manifestations.
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Affiliation(s)
- William MacNee
- ELEGI Colt Research Laboratories, MRC Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - Roberto A Rabinovich
- ELEGI Colt Research Laboratories, MRC Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - Gourab Choudhury
- ELEGI Colt Research Laboratories, MRC Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
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97
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Trait anxiety mimics age-related cardiovascular autonomic modulation in young adults. J Hum Hypertens 2014; 29:274-80. [DOI: 10.1038/jhh.2014.72] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 06/25/2014] [Accepted: 07/10/2014] [Indexed: 11/08/2022]
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98
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Lu DY, Sung SH, Yu WC, Cheng HM, Chuang SY, Chen CH. Wave reflections, arterial stiffness, heart rate variability and orthostatic hypotension. Hypertens Res 2014; 37:1056-61. [DOI: 10.1038/hr.2014.127] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 06/16/2014] [Accepted: 07/03/2014] [Indexed: 11/09/2022]
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99
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Association between orthostatic hypotension and cardiovascular risk, cerebrovascular risk, cognitive decline and falls as well as overall mortality. J Hypertens 2014; 32:1562-71; discussion 1571. [PMID: 24879490 DOI: 10.1097/hjh.0000000000000235] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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100
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Figueroa A, Wong A, Kalfon R. Effects of watermelon supplementation on aortic hemodynamic responses to the cold pressor test in obese hypertensive adults. Am J Hypertens 2014; 27:899-906. [PMID: 24572702 DOI: 10.1093/ajh/hpt295] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Cold-induced increases in aortic blood pressure (BP) may cause adverse cardiac events in hypertensives by increasing ventricular afterload. L-citrulline supplementation reduces BP at baseline and during the cold pressor test (CPT), but the effect on wave reflection (augmentation pressure (AP) and index (AIx)) is controversial. Our aim was to assess the effect of L-citrulline-rich watermelon supplementation on aortic hemodynamic responses to CPT in hypertensive adults. METHODS Brachial systolic BP (bSBP) and aortic systolic BP (aSBP), AP, AIx, AIx adjusted to 75 beats/min (AIx75), reflection time (Tr), first (P1) and second systolic peak (P2; wave reflection magnitude), heart rate (HR), and systolic time index (STI; myocardial oxygen demand) at baseline and during CPT and magnitude of the response from baseline to CPT were evaluated in 13 individuals (10 women; 57±1 year; bSBP 151±5 mm Hg). Participants were randomized to a 6-week watermelon or placebo supplementation in a crossover design. RESULTS Watermelon reduced (P < 0.05) bSBP, aSBP, P1, and P2 at baseline and CPT compared with placebo; thus, increases from baseline to CPT were unaffected. Watermelon did not affect AP, AIx, AIx75, and STI at baseline but decreased (P < 0.05) AP and STI during CPT and the increases in AP (~5mm Hg) and AIx75 (~7.3%) from baseline to CPT. CONCLUSIONS Watermelon supplementation reduced aortic BP and myocardial oxygen demand during CPT and the magnitude of the cold-induced increase in wave reflection in obese adults with hypertension. Watermelon may provide cardioprotection by attenuating cold-induced aortic hemodynamic responses. CLINICAL TRIALS REGISTRATION Clinicaltrial.gov register, NCT01185041.
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Affiliation(s)
- Arturo Figueroa
- Department of Nutrition, Food and Exercise Sciences, The Florida State University, Tallahassee, Florida.
| | - Alexei Wong
- Department of Nutrition, Food and Exercise Sciences, The Florida State University, Tallahassee, Florida
| | - Roy Kalfon
- Department of Nutrition, Food and Exercise Sciences, The Florida State University, Tallahassee, Florida
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