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Hughes AD, Davey Smith G, Howe LD, Lawlor D, Jones S, Park CM, Chaturvedi N. Differences between brachial and aortic blood pressure in adolescence and their implications for diagnosis of hypertension. J Hypertens 2024; 42:1382-1389. [PMID: 38660719 PMCID: PMC11216383 DOI: 10.1097/hjh.0000000000003743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/06/2024] [Accepted: 04/04/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVES Blood pressure (BP) is the leading global cause of mortality, and its prevalence is increasing in children and adolescents. Aortic BP is lower than brachial BP in adults. We aimed to assess the extent of this difference and its impact on the diagnosis of hypertension among adolescents. METHODS We used data from 3850 participants from a UK cohort of births in the early 1990s in the Southwest of England, who attended their ∼17-year follow-up and had valid measures of brachial and aortic BP at that clinic [mean (SD) age 17.8 (0.4) years, 66% female individuals]. Data are presented as mean differences [95% prediction intervals] for both sexes. RESULTS Aortic systolic BP (SBP) was lower than brachial SBP [male, -22.3 (-31.2, -13.3) mmHg; female, -17.8 (-25.5, -10.0) mmHg]. Differences between aortic and brachial diastolic BP (DBP) were minimal. Based on brachial BP measurements, 101 male individuals (6%) and 22 female individuals (1%) were classified as hypertensive. In contrast, only nine male individuals (<1%) and 14 female individuals (<1%) met the criteria for hypertension based on aortic BP, and the predictive value of brachial BP for aortic hypertension was poor (positive-predictive value = 13.8%). Participants with aortic hypertension had a higher left ventricular mass index than those with brachial hypertension. CONCLUSION Brachial BP substantially overestimates aortic BP in adolescents because of marked aortic-to-brachial pulse pressure amplification. The use of brachial BP measurement may result in an overdiagnosis of hypertension during screening in adolescence.
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Affiliation(s)
- Alun D. Hughes
- MRC Unit for Lifelong Health & Ageing, Department of Population Science & Experimental Medicine, Institute of Cardiovascular Science, University College London, London
| | - George Davey Smith
- MRC Integrative Epidemiology Unit, University of Bristol, Oakfield House, Oakfield Grove, Bristol, UK
| | - Laura D. Howe
- MRC Integrative Epidemiology Unit, University of Bristol, Oakfield House, Oakfield Grove, Bristol, UK
| | - Deborah Lawlor
- MRC Integrative Epidemiology Unit, University of Bristol, Oakfield House, Oakfield Grove, Bristol, UK
| | - Siana Jones
- MRC Unit for Lifelong Health & Ageing, Department of Population Science & Experimental Medicine, Institute of Cardiovascular Science, University College London, London
| | - Chloe M. Park
- MRC Unit for Lifelong Health & Ageing, Department of Population Science & Experimental Medicine, Institute of Cardiovascular Science, University College London, London
| | - Nish Chaturvedi
- MRC Unit for Lifelong Health & Ageing, Department of Population Science & Experimental Medicine, Institute of Cardiovascular Science, University College London, London
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Girardin L, Stokes C, Thet MS, Oo AY, Balabani S, Díaz-Zuccarini V. Patient-Specific Haemodynamic Analysis of Virtual Grafting Strategies in Type-B Aortic Dissection: Impact of Compliance Mismatch. Cardiovasc Eng Technol 2024; 15:290-304. [PMID: 38438692 PMCID: PMC11239731 DOI: 10.1007/s13239-024-00713-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 01/02/2024] [Indexed: 03/06/2024]
Abstract
INTRODUCTION Compliance mismatch between the aortic wall and Dacron Grafts is a clinical problem concerning aortic haemodynamics and morphological degeneration. The aortic stiffness introduced by grafts can lead to an increased left ventricular (LV) afterload. This study quantifies the impact of compliance mismatch by virtually testing different Type-B aortic dissection (TBAD) surgical grafting strategies in patient-specific, compliant computational fluid dynamics (CFD) simulations. MATERIALS AND METHODS A post-operative case of TBAD was segmented from computed tomography angiography data. Three virtual surgeries were generated using different grafts; two additional cases with compliant grafts were assessed. Compliant CFD simulations were performed using a patient-specific inlet flow rate and three-element Windkessel outlet boundary conditions informed by 2D-Flow MRI data. The wall compliance was calibrated using Cine-MRI images. Pressure, wall shear stress (WSS) indices and energy loss (EL) were computed. RESULTS Increased aortic stiffness and longer grafts increased aortic pressure and EL. Implementing a compliant graft matching the aortic compliance of the patient reduced the pulse pressure by 11% and EL by 4%. The endothelial cell activation potential (ECAP) differed the most within the aneurysm, where the maximum percentage difference between the reference case and the mid (MDA) and complete (CDA) descending aorta replacements increased by 16% and 20%, respectively. CONCLUSION This study suggests that by minimising graft length and matching its compliance to the native aorta whilst aligning with surgical requirements, the risk of LV hypertrophy may be reduced. This provides evidence that compliance-matching grafts may enhance patient outcomes.
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Affiliation(s)
- Louis Girardin
- Department of Mechanical Engineering, University College London, Torrington Place, London, WC1E 7JE, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, 43-45 Foley Street, London, W1W 7TS, UK
| | - Catriona Stokes
- Department of Mechanical Engineering, University College London, Torrington Place, London, WC1E 7JE, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, 43-45 Foley Street, London, W1W 7TS, UK
| | - Myat Soe Thet
- Department of Cardiothoracic Surgery, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK
| | - Aung Ye Oo
- Department of Cardiothoracic Surgery, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK
| | - Stavroula Balabani
- Department of Mechanical Engineering, University College London, Torrington Place, London, WC1E 7JE, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, 43-45 Foley Street, London, W1W 7TS, UK
| | - Vanessa Díaz-Zuccarini
- Department of Mechanical Engineering, University College London, Torrington Place, London, WC1E 7JE, UK.
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, 43-45 Foley Street, London, W1W 7TS, UK.
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Rivolo S, Hadjilucas L, Sinclair M, van Horssen P, van den Wijngaard J, Wesolowski R, Chiribiri A, Siebes M, Smith NP, Lee J. Impact of coronary bifurcation morphology on wave propagation. Am J Physiol Heart Circ Physiol 2016; 311:H855-H870. [PMID: 27402665 PMCID: PMC5114464 DOI: 10.1152/ajpheart.00130.2016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 07/05/2016] [Indexed: 01/09/2023]
Abstract
The branching pattern of the coronary vasculature is a key determinant of its function and plays a crucial role in shaping the pressure and velocity wave forms measured for clinical diagnosis. However, although multiple scaling laws have been proposed to characterize the branching pattern, the implications they have on wave propagation remain unassessed to date. To bridge this gap, we have developed a new theoretical framework by combining the mathematical formulation of scaling laws with the wave propagation theory in the pulsatile flow regime. This framework was then validated in multiple species using high-resolution cryomicrotome images of porcine, canine, and human coronary networks. Results demonstrate that the forward well-matchedness (no reflection for pressure/flow waves traveling from the coronary stem toward the microcirculation) is a salient feature in the coronary vasculature, and this result remains robust under many scenarios of the underlying pulse wave speed distribution assumed in the network. This result also implies a significant damping of the backward traveling waves, especially for smaller vessels (radius, <0.3 mm). Furthermore, the theoretical prediction of increasing area ratios (ratio between the area of the mother and daughter vessels) in more symmetric bifurcations found in the distal circulation was confirmed by experimental measurements. No differences were observed by clustering the vessel segments in terms of transmurality (from epicardium to endocardium) or perfusion territories (left anterior descending, left circumflex, and right coronary artery).
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Affiliation(s)
- Simone Rivolo
- Department of Biomedical Engineering, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom, European Union
| | - Lucas Hadjilucas
- Department of Biomedical Engineering, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom, European Union
| | - Matthew Sinclair
- Department of Biomedical Engineering, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom, European Union
| | - Pepijn van Horssen
- Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Jeroen van den Wijngaard
- Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Roman Wesolowski
- Department of Cardiovascular Imaging, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom, European Union; and
| | - Amedeo Chiribiri
- Department of Cardiovascular Imaging, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom, European Union; and
| | - Maria Siebes
- Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Nicolas P Smith
- Faculty of Engineering, The University of Auckland, Auckland, New Zealand
| | - Jack Lee
- Department of Biomedical Engineering, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom, European Union;
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Manisty CH, Hughes AD. Meta-analysis of the comparative effects of different classes of antihypertensive agents on brachial and central systolic blood pressure, and augmentation index. Br J Clin Pharmacol 2013; 75:79-92. [PMID: 22625662 DOI: 10.1111/j.1365-2125.2012.04342.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
AIMS Brachial systolic blood pressure (bSBP) exceeds aortic pressure by a variable amount, and estimated central systolic blood pressure (cSBP) may be a better indicator of cardiovascular risk than bSBP. We undertook a systematic review and meta-analysis to compare the effect of single and multiple antihypertensive agents on bSBP, cSBP and augmentation index (AIx). METHODS A random effects meta-analysis was performed on 24 randomized controlled trials of antihypertensives with measurements of bSBP, cSBP and/or AIx. Separate analyses were performed for drug comparisons with or without placebo, and drug combinations. RESULTS In the placebo vs. drug meta-analysis, antihypertensive therapy reduced bSBP more than cSBP and there was no statistically significant evidence of heterogeneity by drug class, although the number of individual studies was small. In placebo-adjusted drug vs. drug comparison, treatment with β-blockers, omapatrilat and thiazide diuretics lowered cSBP significantly less than bSBP (i.e. central to brachial amplification decreased), whereas other monotherapies lowered cSBP and bSBP to similar extents. Sample sizes were too small and effect estimates insufficiently precise to allow firm conclusions to be made regarding comparisons between individual drug classes. Antihypertensive combinations that included β-blockers decreased central to brachial amplification. β-Blockers increased AIx, whereas all other antihypertensive agents reduced AIx to similar extents. CONCLUSIONS A reduction in central to brachial amplification by some classes of antihypertensive drug will result in lesser reductions in cSBP despite achievement of target bSBP. This effect could contribute to differences in outcomes in randomized clinical trials when β-blocker- and/or diuretic-based antihypertensive therapy are compared with other regimens.
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Affiliation(s)
- Charlotte H Manisty
- International Centre for Circulatory Health, National Heart & Lung Institute, Faculty of Medicine, Imperial College London, and Imperial College Healthcare NHS Trust, London, UK
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Apol MEF, Etienne RS, Olff H. Revisiting the evolutionary origin of allometric metabolic scaling in biology. Funct Ecol 2008. [DOI: 10.1111/j.1365-2435.2008.01458.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Kizilova NN. Modeling of intraorgan arterial vasculature. II. Propagation of pressure waves. Biophysics (Nagoya-shi) 2007. [DOI: 10.1134/s0006350907010125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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