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Woodiwiss AJ, Norton GR, Ben-Dov IZ, Gavish B, Bursztyn M. Association of Blood Pressure Variability Ratio With Glomerular Filtration Rate Independent of Blood Pressure and Pulse Wave Velocity. Am J Hypertens 2017; 30:1177-1188. [PMID: 28992192 DOI: 10.1093/ajh/hpx122] [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: 03/29/2017] [Accepted: 07/13/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Blood pressure variability ratio (BPVR)(derived from within-subject SD of 24-hour ambulatory blood pressure [BP]) predicts all-cause mortality independent of BP and has a similar prognostic ability to ambulatory arterial stiffness (AASI). Whether BPVR, and AASI, offer prognostic information beyond measurements of arterial stiffness at a given pressure, as indexed by pulse wave velocity (PWV), is not known. METHODS We assessed whether BPVR and AASI were associated with indices of subclinical organ damage (TOD) [estimated glomerular filtration rate (eGFR), left ventricular mass index, early-to-late transmitral velocity (E/A), carotid intima-media thickness (IMT)] independent of BP, and whether BPVR-TOD and AASI-TOD relations were independent of PWV (applanation tonometry) in 772 randomly selected participants from an urban, developing community. AASI was derived from 24-hour diastolic BP vs. systolic BP standard linear regression. RESULTS On bivariate analyses, BPVR, AASI, and PWV were correlated with all indices of TOD (P < 0.0005). However, after adjustments for potential confounders including age and 24-hour mean BP, BPVR, and PWV (P < 0.005 to P < 0.0001), but not AASI (P > 0.25), were independently associated with eGFR, but not other indices of TOD. Importantly, the BPVR-eGFR relation was independent of BP variability (P < 0.005) and PWV (P < 0.001). CONCLUSIONS BPVR was negatively associated with eGFR independent of mean BP, BP variability, and PWV. Therefore, in the prediction of cardiovascular risk, measurements of arterial stiffening (BPVR) may provide information beyond the impact of arterial stiffness.
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Affiliation(s)
- Angela J Woodiwiss
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, University of the Witwatersrand, Johannesburg, South Africa
| | - Gavin R Norton
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, University of the Witwatersrand, Johannesburg, South Africa
| | - Iddo Z Ben-Dov
- The Nephrology and Hypertension Services, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | - Michael Bursztyn
- Department of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Eriksen BO, Stefansson VTN, Jenssen TG, Mathisen UD, Schei J, Solbu MD, Wilsgaard T, Melsom T. High Ambulatory Arterial Stiffness Index Is an Independent Risk Factor for Rapid Age-Related Glomerular Filtration Rate Decline in the General Middle-Aged Population. Hypertension 2017; 69:651-659. [PMID: 28223468 DOI: 10.1161/hypertensionaha.117.09020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 01/15/2017] [Accepted: 01/27/2017] [Indexed: 11/16/2022]
Abstract
Arterial stiffness is a risk factor for cardiovascular and chronic kidney disease. However, the role of arterial stiffness as a predictor of the age-related glomerular filtration rate (GFR) decline in the general population remains unresolved because of difficulty in measuring GFR with sufficient precision in epidemiological studies. The ambulatory arterial stiffness index (AASI) is a proposed indicator of arterial stiffness easily calculated from ambulatory blood pressure. We investigated whether AASI could predict GFR decline measured as iohexol clearance in the general population. We calculated AASI from baseline ambulatory blood pressure and measured the iohexol clearance at baseline and follow-up in the RENIS-FU study (Renal Iohexol Clearance Survey Follow-Up). AASI was defined as 1 minus the regression slope of the diastolic blood pressure measurement over the systolic blood pressure measurement for each patient. The RENIS cohort included a representative sample of the general middle-aged population without baseline diabetes mellitus, cardiovascular disease, or kidney disease (n=1608). The participant age was 50 to 62 years old at baseline, and the median observation time was 5.6 years. The mean (SD) of the GFR decline rate was 0.95 mL/min per year (2.23) and that of the AASI was 0.38 mL/min per year (0.13). Baseline ambulatory blood pressure or the night/day systolic or diastolic ambulatory blood pressure ratios were not associated with GFR decline. In multivariable-adjusted linear mixed regression analysis, 1 SD of increase in the baseline AASI was associated with a 0.14 mL/min per year (95% confidence interval, -0.26 to -0.02) steeper GFR decline. We conclude that the AASI is an independent risk factor for accelerated age-related GFR decline in the general middle-aged population.
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Affiliation(s)
- Bjørn Odvar Eriksen
- From the Metabolic and Renal Research Group (B.O.E., V.T.N.S., T.G.J., U.D.M., J.S., M.D.S., T.M.), Department of Community Medicine, Faculty of Health Sciences (T.W.), UiT The Arctic University of Norway; Section of Nephrology, University Hospital of North Norway (B.O.E., U.D.M., M.D.S., T.M.); and Department of Transplant Medicine, Oslo University Hospital, Norway (T.G.J.).
| | - Vidar Tor Nyborg Stefansson
- From the Metabolic and Renal Research Group (B.O.E., V.T.N.S., T.G.J., U.D.M., J.S., M.D.S., T.M.), Department of Community Medicine, Faculty of Health Sciences (T.W.), UiT The Arctic University of Norway; Section of Nephrology, University Hospital of North Norway (B.O.E., U.D.M., M.D.S., T.M.); and Department of Transplant Medicine, Oslo University Hospital, Norway (T.G.J.)
| | - Trond Geir Jenssen
- From the Metabolic and Renal Research Group (B.O.E., V.T.N.S., T.G.J., U.D.M., J.S., M.D.S., T.M.), Department of Community Medicine, Faculty of Health Sciences (T.W.), UiT The Arctic University of Norway; Section of Nephrology, University Hospital of North Norway (B.O.E., U.D.M., M.D.S., T.M.); and Department of Transplant Medicine, Oslo University Hospital, Norway (T.G.J.)
| | - Ulla Dorte Mathisen
- From the Metabolic and Renal Research Group (B.O.E., V.T.N.S., T.G.J., U.D.M., J.S., M.D.S., T.M.), Department of Community Medicine, Faculty of Health Sciences (T.W.), UiT The Arctic University of Norway; Section of Nephrology, University Hospital of North Norway (B.O.E., U.D.M., M.D.S., T.M.); and Department of Transplant Medicine, Oslo University Hospital, Norway (T.G.J.)
| | - Jørgen Schei
- From the Metabolic and Renal Research Group (B.O.E., V.T.N.S., T.G.J., U.D.M., J.S., M.D.S., T.M.), Department of Community Medicine, Faculty of Health Sciences (T.W.), UiT The Arctic University of Norway; Section of Nephrology, University Hospital of North Norway (B.O.E., U.D.M., M.D.S., T.M.); and Department of Transplant Medicine, Oslo University Hospital, Norway (T.G.J.)
| | - Marit Dahl Solbu
- From the Metabolic and Renal Research Group (B.O.E., V.T.N.S., T.G.J., U.D.M., J.S., M.D.S., T.M.), Department of Community Medicine, Faculty of Health Sciences (T.W.), UiT The Arctic University of Norway; Section of Nephrology, University Hospital of North Norway (B.O.E., U.D.M., M.D.S., T.M.); and Department of Transplant Medicine, Oslo University Hospital, Norway (T.G.J.)
| | - Tom Wilsgaard
- From the Metabolic and Renal Research Group (B.O.E., V.T.N.S., T.G.J., U.D.M., J.S., M.D.S., T.M.), Department of Community Medicine, Faculty of Health Sciences (T.W.), UiT The Arctic University of Norway; Section of Nephrology, University Hospital of North Norway (B.O.E., U.D.M., M.D.S., T.M.); and Department of Transplant Medicine, Oslo University Hospital, Norway (T.G.J.)
| | - Toralf Melsom
- From the Metabolic and Renal Research Group (B.O.E., V.T.N.S., T.G.J., U.D.M., J.S., M.D.S., T.M.), Department of Community Medicine, Faculty of Health Sciences (T.W.), UiT The Arctic University of Norway; Section of Nephrology, University Hospital of North Norway (B.O.E., U.D.M., M.D.S., T.M.); and Department of Transplant Medicine, Oslo University Hospital, Norway (T.G.J.)
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Gavish B, Izzo JL. Arterial Stiffness: Going a Step Beyond. Am J Hypertens 2016; 29:1223-1233. [PMID: 27405964 DOI: 10.1093/ajh/hpw061] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 05/23/2016] [Indexed: 01/09/2023] Open
Abstract
Interest in arterial stiffness has been fueled by the scientific and clinical implications of its "vicious cycle" relationship with aging and systolic blood pressure. In physical terms, stiffness is the slope of the relationship between an artery's distending pressure and its cross-sectional area or volume. Pulse wave velocity (PWV, in m/s), the most common arterial stiffness indicator, is usually measured by the foot-to-foot time and distance method and is proportional to [stiffness × area (or volume)]1/2 at a given pressure. Its intrinsic pressure dependency and other flaws in current PWV methods limit its utility. In contrast, the arterial stiffness-arterial pressure relationship is near-linear, with a slope β, the exponent of the curvilinear arterial pressure-arterial volume relationship. The concept of arterial stiffening is related to β and describes a more functionally relevant aspect of arterial behavior: the change in stiffness for a given change in pressure. Arterial stiffening can be estimated from the variability of within-individual BP measurements (24-h ambulatory, home BP, or BP measured at different arm heights) and can be expressed as the pulse stiffening ratio (PSR) = [systolic stiffness]/[diastolic stiffness] or the ambulatory arterial stiffness index (AASI or its symmetric form, sAASI). High arterial stiffness (PWV) and stiffening (β, stiffness index, cardio-ankle vascular index, AASI, and PSR) are associated with increased cardiovascular disease risk, but it remains unclear whether these indicators are useful in improving medical care quality; the standard of care remains stringent BP control.
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Affiliation(s)
- Benjamin Gavish
- Department of Medicine, University at Buffalo, Buffalo, New York, USA
| | - Joseph L Izzo
- Department of Medicine, University at Buffalo, Buffalo, New York, USA
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Wang C, Zhang J, Li CC, Gong WY, Liu X, Ye ZC, Peng H, Lou TQ. The ambulatory arterial stiffness index and target-organ damage in Chinese patients with chronic kidney disease. BMC Nephrol 2013; 14:257. [PMID: 24245955 PMCID: PMC3840650 DOI: 10.1186/1471-2369-14-257] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 11/07/2013] [Indexed: 01/23/2023] Open
Abstract
Background The ambulatory arterial stiffness index (AASI) can be used to predict cardiovascular morbidity and mortality in hypertensive patients. However, data on AASI in Chinese patients with chronic kidney disease (CKD) is not available. Methods This cross-sectional study enrolled 583 CKD patients. Univariate and multivariate analyses were used to evaluate the relationship between AASI and renal function and parameters of cardiovascular injury. Results Patients with a higher AASI had a higher systolic blood pressure, a lower estimated glomerular filtration rate (eGFR), a higher serum cystatin C, a higher left ventricular mass index (LVMI) and carotid intima-media thickness (cIMT). Univariate analyses showed that AASI was positively correlated with serum cystatin C (r=0.296, P < 0.001), serum creatinine (r=0.182, P < 0.001), and LVMI (r = 0.205, P < 0.001) and negatively correlated with the eGFR (r = –0.200, P < 0.001). Multivariate analyses revealed that serum cystatin C, eGFR, serum creatinine and LVMI were independently correlated with AASI. Conclusions These data suggest that AASI was closely correlated with renal function and parameters of cardiovascular injury in Chinese CKD patients. Good quality, long-term, large longitudinal trials to validate the role of AASI in clinical practice for Chinese CKD patients.
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Affiliation(s)
| | | | | | | | | | | | | | - Tan-Qi Lou
- Division of Nephrology, Department of medicine, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510630, China.
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Liu Z, Peng J, Lu F, Zhao Y, Wang S, Sun S, Zhang H, Diao Y. Salt loading and potassium supplementation: effects on ambulatory arterial stiffness index and endothelin-1 levels in normotensive and mild hypertensive patients. J Clin Hypertens (Greenwich) 2013; 15:485-96. [PMID: 23815537 PMCID: PMC8033958 DOI: 10.1111/jch.12109] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 02/27/2013] [Accepted: 03/06/2013] [Indexed: 12/25/2022]
Abstract
The authors investigated effects of excessive salt intake and potassium supplementation on ambulatory arterial stiffness index (AASI) and endothelin-1 (ET-1) in salt-sensitive and non-salt-sensitive individuals. AASI and symmetric AASI (s-AASI) were used as indicators of arterial stiffness. Plasma ET-1 levels were used as an index of endothelial function. Chronic salt-loading and potassium supplementation were studied in 155 normotensive to mild hypertensive patients from rural northern China. After 3 days of baseline investigation, participants were maintained sequentially for 7 days each on diets of low salt (51.3 mmol/d), high salt (307.7 mmol/d), and high salt+potassium (60 mmol/d). Ambulatory 24-hour blood pressure (BP) and plasma ET-1 were measured at baseline and on the last 2 days of each intervention. High-salt intervention significantly increased BP, AASI, s-AASI (all P<.001); potassium supplementation reversed increased plasma ET-1 levels. High-salt-induced changes in BP, s-AASI, and plasma ET-1 were greater in salt-sensitive individuals. Potassium supplementation decreased systolic BP and ET-1 to a significantly greater extent in salt-sensitive vs non-salt-sensitive individuals (P<.001). Significant correlations were identified between s-AASI and ET-1 change ratios in response to both high-salt intervention and potassium supplementation (P<.001). Reducing dietary salt and increasing daily potassium improves arterial compliance and ameliorates endothelial dysfunction.
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Affiliation(s)
- Zhendong Liu
- Cardio‐Cerebrovascular Control and Research CenterInstitute of Basic MedicineShandong Academy of Medical SciencesJinanShandongChina
| | - Jie Peng
- The Key Laboratory of Cardiovascular Remodeling and Function ResearchChinese Ministry of Education and Chinese Ministry of Public HealthShandong University Qilu HospitalJinanShandongChina
| | - Fanghong Lu
- Cardio‐Cerebrovascular Control and Research CenterInstitute of Basic MedicineShandong Academy of Medical SciencesJinanShandongChina
| | - Yingxin Zhao
- Cardio‐Cerebrovascular Control and Research CenterInstitute of Basic MedicineShandong Academy of Medical SciencesJinanShandongChina
| | - Shujian Wang
- Cardio‐Cerebrovascular Control and Research CenterInstitute of Basic MedicineShandong Academy of Medical SciencesJinanShandongChina
| | - Shangwen Sun
- Cardio‐Cerebrovascular Control and Research CenterInstitute of Basic MedicineShandong Academy of Medical SciencesJinanShandongChina
| | - Hua Zhang
- Cardio‐Cerebrovascular Control and Research CenterInstitute of Basic MedicineShandong Academy of Medical SciencesJinanShandongChina
| | - Yutao Diao
- Cardio‐Cerebrovascular Control and Research CenterInstitute of Basic MedicineShandong Academy of Medical SciencesJinanShandongChina
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Guasch B, Torguet P, Garcia I, Calabia J, Martín N, Maté G, Faur D, Barreiro Y, Molina C, Noboa C, Vallès M. Utilidad de la monitorización ambulatoria de la presión arterial en la evaluación de la rigidez arterial. Correlaciones con la velocidad de onda de pulso y las tensiones arteriales centrales. HIPERTENSION Y RIESGO VASCULAR 2013. [DOI: 10.1016/j.hipert.2012.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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