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Hamilton PK, Lockhart CJ, Quinn CE, McVeigh GE. Arterial stiffness: clinical relevance, measurement and treatment. Clin Sci (Lond) 2007; 113:157-70. [PMID: 17623012 DOI: 10.1042/cs20070080] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Most traditional cardiovascular risk factors alter the structure and/or function of arteries. An assessment of arterial wall integrity could therefore allow accurate prediction of cardiovascular risk in individuals. The term 'arterial stiffness' denotes alterations in the mechanical properties of arteries, and much effort has focused on how best to measure this. Pulse pressure, pulse wave velocity, pulse waveform analysis, localized assessment of blood vessel mechanics and other methods have all been used. We review the methodology underlying each of these measures, and present an evidence-based critique of their relative merits and limitations. An overview is also given of the drug therapies that may prove useful in the treatment of patients with altered arterial mechanics.
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Affiliation(s)
- Paul K Hamilton
- Department of Therapeutics and Pharmacology, Queen's University Belfast, Whitla Medical Building, Belfast, UK.
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102
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Levy D, Larson MG, Benjamin EJ, Newton-Cheh C, Wang TJ, Hwang SJ, Vasan RS, Mitchell GF. Framingham Heart Study 100K Project: genome-wide associations for blood pressure and arterial stiffness. BMC MEDICAL GENETICS 2007; 8 Suppl 1:S3. [PMID: 17903302 PMCID: PMC1995621 DOI: 10.1186/1471-2350-8-s1-s3] [Citation(s) in RCA: 205] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND About one quarter of adults are hypertensive and high blood pressure carries increased risk for heart disease, stroke, kidney disease and death. Increased arterial stiffness is a key factor in the pathogenesis of systolic hypertension and cardiovascular disease. Substantial heritability of blood-pressure (BP) and arterial-stiffness suggests important genetic contributions. METHODS In Framingham Heart Study families, we analyzed genome-wide SNP (Affymetrix 100K GeneChip) associations with systolic (SBP) and diastolic (DBP) BP at a single examination in 1971-1975 (n = 1260), at a recent examination in 1998-2001 (n = 1233), and long-term averaged SBP and DBP from 1971-2001 (n = 1327, mean age 52 years, 54% women) and with arterial stiffness measured by arterial tonometry (carotid-femoral and carotid-brachial pulse wave velocity, forward and reflected pressure wave amplitude, and mean arterial pressure; 1998-2001, n = 644). In primary analyses we used generalized estimating equations in models for an additive genetic effect to test associations between SNPs and phenotypes of interest using multivariable-adjusted residuals. A total of 70,987 autosomal SNPs with minor allele frequency > or = 0.10, genotype call rate > or = 0.80, and Hardy-Weinberg equilibrium p > or = 0.001 were analyzed. We also tested for association of 69 SNPs in six renin-angiotensin-aldosterone pathway genes with BP and arterial stiffness phenotypes as part of a candidate gene search. RESULTS In the primary analyses, none of the associations attained genome-wide significance. For the six BP phenotypes, seven SNPs yielded p values < 10(-5). The lowest p-values for SBP and DBP respectively were rs10493340 (p = 1.7 x 10(-6)) and rs1963982 (p = 3.3 x 10(-6)). For the five tonometry phenotypes, five SNPs had p values < 10(-5); lowest p-values were for reflected wave (rs6063312, p = 2.1 x 10(-6)) and carotid-brachial pulse wave velocity (rs770189, p = 2.5 x 10(-6)) in MEF2C, a regulator of cardiac morphogenesis. We found only weak association of SNPs in the renin-angiotensin-aldosterone pathway with BP or arterial stiffness. CONCLUSION These results of genome-wide association testing for blood pressure and arterial stiffness phenotypes in an unselected community-based sample of adults may aid in the identification of the genetic basis of hypertension and arterial disease, help identify high risk individuals, and guide novel therapies for hypertension. Additional studies are needed to replicate any associations identified in these analyses.
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Affiliation(s)
- Daniel Levy
- The National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA, USA
- The National Heart, Lung, and Blood Institute, Bethesda, MD, USA
- Boston University School of Medicine, Boston MA, USA
| | - Martin G Larson
- The National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA, USA
- Department of Mathematics, Boston University, Boston, MA, USA
| | - Emelia J Benjamin
- The National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA, USA
- Boston University School of Medicine, Boston MA, USA
- Division of Cardiology, Boston Medical Center, Boston, MA, USA
| | - Christopher Newton-Cheh
- The National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA, USA
- Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Thomas J Wang
- The National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA, USA
- Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Shih-Jen Hwang
- The National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA, USA
- The National Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | - Ramachandran S Vasan
- The National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA, USA
- Boston University School of Medicine, Boston MA, USA
- Division of Cardiology, Boston Medical Center, Boston, MA, USA
| | - Gary F Mitchell
- The National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA, USA
- Cardiovascular Engineering Inc., Waltham, MA, USA
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103
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Schillaci G, Parati G, Pirro M, Pucci G, Mannarino MR, Sperandini L, Mannarino E. Response to Dipping Deeper Into the Ambulatory Arterial Stiffness Index. Hypertension 2007. [DOI: 10.1161/hypertensionaha.107.095398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Giuseppe Schillaci
- Unit of Internal Medicine, Angiology and Arteriosclerosis, University of Perugia, Perugia, Italy
| | - Gianfranco Parati
- Department of Clinical Medicine and Prevention, University of Milano-Bicocca and, Department of Cardiology, San Luca Hospital, IRCCS, Istituto Auxologico Italiano, Milan, Italy
| | - Matteo Pirro
- Unit of Internal Medicine, Angiology and Arteriosclerosis, University of Perugia, Perugia, Italy
| | - Giacomo Pucci
- Unit of Internal Medicine, Angiology and Arteriosclerosis, University of Perugia, Perugia, Italy
| | - Massimo R. Mannarino
- Unit of Internal Medicine, Angiology and Arteriosclerosis, University of Perugia, Perugia, Italy
| | - Laura Sperandini
- Unit of Internal Medicine, Angiology and Arteriosclerosis, University of Perugia, Perugia, Italy
| | - Elmo Mannarino
- Unit of Internal Medicine, Angiology and Arteriosclerosis, University of Perugia, Perugia, Italy
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104
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Qureshi G, Lazar JM, Javaid H, Weber M, Salciccioli L. Self–measured (blood pressure) arterial stiffness index: A promising new measure of arterial stiffness. ACTA ACUST UNITED AC 2007; 1:347-52. [DOI: 10.1016/j.jash.2007.05.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2007] [Revised: 05/15/2007] [Accepted: 05/31/2007] [Indexed: 10/22/2022]
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105
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Guzman RJ. Clinical, cellular, and molecular aspects of arterial calcification. J Vasc Surg 2007; 45 Suppl A:A57-63. [PMID: 17544025 PMCID: PMC2435088 DOI: 10.1016/j.jvs.2007.02.049] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2007] [Accepted: 02/17/2007] [Indexed: 11/24/2022]
Abstract
Arterial calcification is a complex and independently regulated process with risk factors similar to those for atherosclerotic occlusive disease. It may develop either within the atherosclerotic intima or in the media. When calcification is found in coronary or lower extremity arteries, it is an independent predictor of cardiovascular events and lower extremity amputation. Recent evidence suggests a role for several endogenous stimulators and inhibitors in the pathogenesis of arterial calcification. Inflammatory mediators and matrix-degrading enzymes are also thought to control the progression of calcification in humans. Current research involves efforts to define the complex interactions between cellular and molecular mediators of arterial calcification.
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Affiliation(s)
- Raul J Guzman
- Department of Surgery, Division of Vascular Surgery, Vanderbilt University Medical Center, Nashville, TN 37235, USA.
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106
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Leoncini G, Ratto E, Viazzi F, Vaccaro V, Parodi A, Falqui V, Conti N, Tomolillo C, Deferrari G, Pontremoli R. Metabolic syndrome and ambulatory arterial stiffness index in non-diabetic patients with primary hypertension. J Hum Hypertens 2007; 21:802-7. [PMID: 17541383 DOI: 10.1038/sj.jhh.1002240] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Increased arterial stiffness and the presence of metabolic syndrome (MS) have been shown to predict cardiovascular events in patients with primary hypertension. We investigated the relationship between a recently proposed index of arterial stiffness derived from ambulatory blood pressure (BP) monitoring and MS in 156 untreated, non-diabetic patients with primary hypertension. Ambulatory arterial stiffness index (AASI) was defined as 1 minus the regression slope of diastolic over systolic BP readings obtained from 24-h recordings. A modified National Cholesterol Education Program definition for MS was used, with body mass index replacing waist circumference. The prevalence of MS was 23%. Patients with MS were more frequently male (0.0291) and had increased serum uric acid (P=0.0005), high-sensitivity C-reactive protein (P=0.0259), as well as total and low-density lipoprotein (LDL)-cholesterol (P=0.0374 and P=0.0350, respectively) as compared to those without MS. After adjusting for these confounders, the association between AASI and the presence of MS was statistically significant (P=0.0257). Moreover, the prevalence of increased AASI (upper tertile, that is >or=0.550) was greater in patients with MS (P=0.0156). After adjusting for age and 24-h mean BP, the presence of MS entailed a more than twofold greater risk for increased AASI (0.0280). MS is associated with increased AASI in non-diabetic patients with primary hypertension. These data support the role of this new index of arterial stiffness as a marker of risk and help to explain the high cardiovascular morbidity and mortality that is observed in hypertensive patients with MS.
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Affiliation(s)
- G Leoncini
- Department of Cardio-Nephrology, Azienda Ospedaliera Universitaria San Martino, Genoa, Italy
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107
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Schillaci G, Parati G, Pirro M, Pucci G, Mannarino MR, Sperandini L, Mannarino E. Ambulatory arterial stiffness index is not a specific marker of reduced arterial compliance. Hypertension 2007; 49:986-91. [PMID: 17372039 DOI: 10.1161/hypertensionaha.106.082248] [Citation(s) in RCA: 121] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Ambulatory arterial stiffness index (AASI), a measure based on the relative behavior of 24-hour systolic and diastolic blood pressure (BP), has been suggested as a marker of arterial stiffness and a predictor of cardiovascular mortality. However, a narrow range of diastolic BP values over the 24 hours tends to flatten the regression slope and to artificially increase AASI. We explored the possible influence of different ranges of 24-hour diastolic BP fluctuations, such as those related to nocturnal BP fall, on AASI, and on its relationship with target organ damage. In 515 untreated hypertensive patients, AASI was directly related to age (r=0.30) and 24-hour systolic BP (r=0.20), whereas it was inversely related with nocturnal systolic and diastolic BP reduction (r=-0.28 and -0.46, respectively; all P<0.001). A direct relationship was found between AASI and left ventricular mass index (r=0.17; P<0.001), but this relation was no longer significant after adjustment for age, sex, body mass index, daytime systolic BP, and day-night systolic BP reduction (all P<0.05). AASI was directly related to carotid-femoral pulse wave velocity, an intrinsic measure of aortic stiffness (r=0.28; P<0.001), but no independent relation was found in a multiple linear regression. Our conclusions are as follows: (1) AASI is strongly dependent on the degree of nocturnal BP fall in hypertensive patients; (2) there is no significant relation between AASI and left ventricular mass after proper adjustment for confounders; and (3) the relation between AASI and a widely accepted measure of aortic stiffness, such as pulse wave velocity, is weak and importantly affected by other factors.
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Affiliation(s)
- Giuseppe Schillaci
- Unit of Internal Medicine, Angiology and Arteriosclerosis, University of Perugia, Perugia, Italy.
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108
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Li Y, Wang JG, Dolan E, O’Brien E, Hansen TW, Ibsen H, Kikuya M, Imai Y, Richart T, Thijs L, Staessen JA. Letter to the Editor. Hypertension 2007. [DOI: 10.1161/01.hyp.0000254948.10037.4a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Yan Li
- Shanghai Institute of Hypertension, Shanghai Jiaotong University Medical School, Shanghai, China
| | - Ji-Guang Wang
- Shanghai Institute of Hypertension, Shanghai Jiaotong University Medical School, Shanghai, China
| | - Eamon Dolan
- Cambridge University Hospital, Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - Eoin O’Brien
- Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland
| | | | - Hans Ibsen
- Copenhagen University Hospital, Copenhagen, Denmark
| | - Masahiro Kikuya
- Tohoku University Graduate School of Pharmaceutical Science and Medicine, Sendai, Japan
| | - Yutuka Imai
- Tohoku University Graduate School of Pharmaceutical Science and Medicine, Sendai, Japan
| | - Tom Richart
- Division of Hypertension and Cardiovascular Rehabilitation, Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium
| | - Lutgarde Thijs
- Division of Hypertension and Cardiovascular Rehabilitation, Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium
| | - Jan A. Staessen
- Division of Hypertension and Cardiovascular Rehabilitation, Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium
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109
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Li Y, Wang JG, Dolan E, O’Brien E, Thijs L, Nawrot T, Staessen JA. Response to Correlating Ambulatory Blood Pressure Measurements With Arterial Stiffness: A Conceptual Inconsistency. Hypertension 2006. [DOI: 10.1161/01.hyp.0000248121.29383.6e] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Yan Li
- Shanghai Institute of Hypertension, Shanghai Jiaotong University Medical School, Shanghai, China
| | - Ji-Guang Wang
- Shanghai Institute of Hypertension, Shanghai Jiaotong University Medical School, Shanghai, China
| | - Eamon Dolan
- Cambridge University Hospitals, Addenbrook’s Hospital, Cambridge, United Kingdom
| | - Eoin O’Brien
- Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland
| | - Lutgarde Thijs
- Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium
| | - Tim Nawrot
- Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium
| | - Jan A. Staessen
- Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium
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