Non-invasive 24hour ambulatory monitoring of aortic wave reflection and arterial stiffness by a novel oscillometric device: The first feasibility and reproducibility study

Effect of Prior Moderate Aerobic Exercise to Prolonged Sitting on Peripheral and Central Cardiovascular Measures in Young Women

BACKGROUND

Prolonged sitting is a risk factor for cardiovascular disease (CVD). We examined whether moderate aerobic exercise prior to prolonged sitting (EX + SIT) has protective effects on peripheral and central cardiovascular and autonomic measures.

METHODS

Young women (n = 26; 23.4 ± 4.3 years old; BMI = 23.1 ± 4.3) completed two sessions in random order: (1) EX + SIT, which consisted of 25 min of moderate aerobic exercise followed by a 3 h prolonged sitting bout, and (2) a 3 h prolonged sitting bout only (SIT-only). Seated peripheral and central blood pressure (BP), pulse wave velocity (PWV), and heart rate variability (HRV) were measured at baseline and after 1 h, 2 h, and 3 h of sitting. Generalized linear mixed models with random effects examined the effects of conditions (i.e., EX + SIT vs. SIT) on BP, PWV, and HRV while adjusting for baseline values.

RESULTS

Only peripheral and central diastolic BP (β = 2.18; p = 0.016 and β = 1.99; p = 0.034, respectively) were significantly lower in the EX + SIT condition compared to the SIT-only condition. No differences were detected in other BP, PWV, or HRV variables between the two conditions (p > 0.05 for all).

CONCLUSIONS

Performing moderate aerobic exercise in the morning before engaging in prolonged sitting bouts may reduce some of the prolonged-sitting-induced cardiovascular impairments in young women. Further research is needed to confirm these findings in males and middle-aged/older adults.

The role of non-invasive oscillometric method to detect aortic stiffness in patients with subclinical hypothyroidism

INTRODUCTION

Subclinical hypothyroidism (SCH) is a biochemical condition that is diagnosed when peripheral free thyroid hormone levels are within normal reference laboratory range but serum thyroid-stimulating hormone (TSH) levels are mildly elevated. The aim of this study was to investigate the relationship between SCH and arterial stiffness using two different non-invasive methods, including echocardiography and oscillometric arteriography.

MATERIAL AND METHODS

The study included 33 newly diagnosed SCH patients and 34 age- and gender-matched healthy controls. Systolic and diastolic diameters and elastic parameters of the aorta were calculated by 2D Transthoracic echocardiography (TTE). Central blood pressure and aortic stiffness values of patient groups were measured noninvasively from the brachial artery using Mobil-O-Graph arteriography. Pulse wave velocity (PWV) and augmentation index (AIx) were used as arterial stiffness indicators.

RESULTS

There was no significant difference between SCH and control groups with regard to age, gender, and body mass index (BMI). Aortic strain and aortic distensibility, were significantly lower in the SCH group than in the control group (p < 0.001). PWV and AIx which measured by Mobil-O-Graph arteriography were found to be significantly higher in the subclinical hypothyroid group compared to the control group (p < 0.05).

CONCLUSION

Aortic stiffness assessed by TTE and Mobil-O-Graph arteriography deteriorated in patients with SCH after excluding other cardiovascular risk factors. The assessment of aortic stiffness by the oscillometric method was easy and useful for widespread clinical use.

Aortic pulse wave analysis and functional capacity of heart transplantation candidates: a pilot study

We compared cardiovascular parameters obtained with the Mobil-O-Graph and functional capacity assessed by the Duke Activity Status Index (DASI) before and after Heart Transplantation (HT) and also compared the cardiovascular parameters and the functional capacity of candidates for HT with a control group. Peripheral and central vascular pressures increased after surgery. Similar results were observed in cardiac output and pulse wave velocity. The significant increase in left ventricular ejection fraction (LVEF) postoperatively was not followed by an increase in the functional capacity. 24 candidates for HT and 24 controls were also compared. Functional capacity was significantly lower in the HT candidates compared to controls. Stroke volume, systolic, diastolic, and pulse pressure measured peripherally and centrally were lower in the HT candidates when compared to controls. Despite the significant increase in peripheral and central blood pressures after surgery, the patients were normotensive. The 143.85% increase in LVEF in the postoperative period was not able to positively affect functional capacity. Furthermore, the lower values of LVEF, systolic volume, central and peripheral arterial pressures in the candidates for HT are consistent with the characteristics signs of advanced heart failure, negatively impacting functional capacity, as observed by the lower DASI score.

Pulse Wave Velocity of 8.2 m/s as a Threshold Associated with Cardiovascular Target Organ Damage Presence

BACKGROUND

Previous studies have established normal and reference values for Pulse Wave Velocity (PWV). However, the PWV value that has the strongest association with cardiovascular biomarkers remains poorly understood.

OBJECTIVE

This study aimed to determine the PWV value more likely to be associated with left ventricular hypertrophy (LVH), increased intima-media thickness (IMT), and presence of carotid plaques in patients with hypertension.

METHODS

This cross-sectional study included 119 patients. Analysis of receiver operating characteristic (ROC) curves was performed for each cardiovascular biomarker. Statistical significance was set at p < 0.05.

RESULTS

According to the ROC curve analysis, the PWV values were 8.1 m/s, 8.2 m/s, and 8.7 for the LVH, IMT, and presence of carotid plaques, respectively. A PWV value of 8.2 m/s was identified as the best parameter to determine the three TOD biomarkers. PWV above 8.2 m/s was associated with increased CIMT (p = 0.004) and the presence of carotid plaques (p = 0.003) and LVH (p<0.001). PWV above 8.2 showed greater sensitivity for increased CIMT (AUC = 0.678, sensitivity = 62.2), LVH (AUC = 0.717, sensitivity = 87.2), and the presence of plaques (AUC = 0.649, sensitivity = 74.51) in the ROC curve analysis.

CONCLUSION

The PWV value 8.2 m/s was more sensitive in early identifying the existence of cardiovascular biomarkers of TOD.

Handgrip Strength Is Associated with Specific Aspects of Vascular Function in Individuals with Metabolic Syndrome

BACKGROUND

Metabolic syndrome (MetS) is a disorder associated with an increased risk for the development of diabetes mellitus and its complications. Lower isometric handgrip strength (HGS) is associated with an increased risk of cardiometabolic diseases. However, the association between HGS and arterial stiffness parameters, which are considered the predictors of morbidity and mortality in individuals with MetS, is not well defined.

OBJECTIVE

To determine the association between HGS and HGS asymmetry on components of vascular function in adults with MetS.

METHODS

We measured handgrip strength normalized to bodyweight (HGS/kg), HGS asymmetry, body composition, blood glucose, lipid profile, blood pressure, pulse wave velocity (PWV), reflection coefficient (RC), augmentation index @75 bpm (AIx@75) and peripheral vascular resistance (PVR) in 55 adults with a diagnosis of MetS between 25 and 54 years old.

RESULTS

Mean age was 43.1 ± 7.0 years, 56.3% were females. HGS/kg was negatively correlated with AIx@75 (r = -0.440), p < 0.05, but these associations were not significant after adjusting for age and sex. However, when interaction effects between sex, HGS/kg and age were examined, we observed an inverse relationship between HGS/kg and AIx@75 in the older adults in the sample, whereas in the younger adults, a weak direct association was found. We also found a significant association between HGS asymmetry and PVR (beta = 30, 95% CI = 7.02; 54.2; p <0.012).

CONCLUSIONS

Our findings suggest that in people with MetS, maintaining muscle strength may have an increasingly important role in older age in the attenuation of age-related increases in AIx@75-a marker of vascular stiffness-and that a higher HGS asymmetry could be associated with a greater vascular resistance.

Low length-for-age Z-score within 1 month after birth predicts hyperdynamic circulation at the age of 21 years in rural Malawi

Low birth weight predisposes to the development of hypertension in middle- and high-income countries. We examined the relation of early life length-for-age score (Z-score) on cardiovascular function in young adults in Malawi, a low-income country. Capture of supine, seated, and standing brachial pulse waveforms (Mobil-O-Graph) were performed in 223 females and 152 males (mean age 21 years), and analyzed according to the length-for-age Z-score tertiles during the first month of life. Plasma LDL cholesterol in young adulthood was slightly lower in the lowest versus highest tertile. Otherwise, blood hemoglobin and plasma chemistry were similar in all tertiles. Irrespective of posture, blood pressure, forward and backward wave amplitudes, and pulse wave velocity were corresponding in all tertiles. In the three postures, the lowest tertile presented with 4.5% lower systemic vascular resistance than the highest tertile (p = 0.005), and 4.4% and 5.5% higher cardiac output than the middle and highest tertiles, respectively (p < 0.01). Left cardiac work was 6.8% and 6.9% higher in the lowest tertile than in the middle and highest tertiles, respectively (p < 0.01). To conclude, in a low-income environment, low length-for-age Z-score after birth predicted hyperdynamic circulation at 21 years of age without changes in blood pressure and metabolic variables.

Twenty-Four-Hour Central Hemodynamic Load in Adults With and Without a History of COVID-19

BACKGROUND

Although hypertension is a risk factor for severe Coronavirus Disease 2019 (COVID-19) illness, little is known about the effects of COVID-19 on blood pressure (BP). Central BP measures taken over a 24-hour period using ambulatory blood pressure monitoring (ABPM) adds prognostic value in assessing cardiovascular disease (CVD) risk compared with brachial BP measures from a single time point. We assessed CVD risk between adults with and without a history of COVID-19 via appraisal of 24-hour brachial and central hemodynamic load from ABPM.

METHODS

Cross-sectional analysis was performed on 32 adults who tested positive for COVID-19 (29 ± 13 years, 22 females) and 43 controls (28 ± 12 years, 26 females). Measures of 24-hour hemodynamic load included brachial and central systolic and diastolic BP, pulse pressure, augmentation index (AIx), pulse wave velocity (PWV), nocturnal BP dipping, the ambulatory arterial stiffness index (AASI), and the blood pressure variability ratio (BPVR).

RESULTS

Participants who tested positive for COVID-19 experienced 6 ± 4 COVID-19 symptoms, were studied 122 ± 123 days after testing positive, and had mild-to-moderate COVID-19 illness. The results from independent samples t-tests showed no significant differences in 24-hour, daytime, or nighttime measures of central or peripheral hemodynamic load across those with and without a history of COVID-19 (P > 0.05 for all).

CONCLUSIONS

No differences in 24-hour brachial or central ABPM measures were detected between adults recovering from mild-to-moderate COVID-19 and controls without a history of COVID-19. Adults recovering from mild-to-moderate COVID-19 do not have increased 24-hour central hemodynamic load.

Pulse Wave Velocity for Risk Stratification of Patients with Aortic Aneurysm

Background: Patients with an aortic aneurysm are at high cardiovascular risk. Pulse wave velocity (PWV) is used as a parameter for risk stratification but may be affected by aortic disease (AoD). This study aimed to investigate the dependence of PWV on treated or untreated AoD and to identify modifiable factors of PWV. Methods: The measurement of PWV with the Mobil-O-Graph was performed fully automatically in a collective of 381 patients (75.6% male and 24.4% female). Of all patients, 53.8% had nonaortic atherosclerotic vascular disease (AVD), 28.9% had treated AoD, and 17.3% had untreated AoD. Results: There was a statistically significant effect of age (R2 = 0.838) and current systolic blood pressure (SBP) on PWV (page corrected < 0.05). After correction for age, no statistically significant difference was found between the PWV of men and women, patients with different body weights or degrees of chronic kidney disease, diabetics and nondiabetics, and smokers and nonsmokers. Comparison between patients with nonaortic AVD and treated or untreated AoD revealed no statistically significant differences (PWVnonaortic AVD 10.0 ± 1.8 m/s, PWVtreated AoD 10.0 ± 1.5 m/s, PWVuntreated AoD 9.8 ± 1.6 m/s; page corrected > 0.05). Conclusions: PWV determined with the Mobil-O-Graph correlated with age and current SBP. Neither aortic disease versus nonaortic AVD, its treatment, nor other cardiovascular risk factors had a significant effect on PWV. Successful blood pressure control is crucial to avoid high PWV and thus an increase in cardiovascular events.

Evaluation of pulse wave velocity and central systolic blood pressure in children and adolescents with chronic kidney disease

OBJECTIVE

Investigate pulse wave velocity and central systolic blood pressure among pediatric population with chronic kidney disease.

METHODS

In this cross-sectional study, 57 patients (61.4% male) aged 6.2 to 17.5 years old, 44 with nondialysis chronic kidney disease and 13 on chronic dialysis, were included in the analysis. The pulse wave velocity and the central systolic blood pressure were measured with an oscillometric device with an inbuilt ARC SolverⓇ algorithm and were compared with previously established percentiles.

RESULTS

The prevalence of elevated pulse wave velocity was 21.1% (95%Cl: 11.4-33.9) and elevated central systolic blood pressure was 28.1% (95%CI: 17.0-41.5). According to the generalized linear model, there was a higher risk of elevated pulse wave velocity in patients undergoing chronic dialysis treatment than nondialysis chronic kidney disease patients (adjPR=4.24, 95%CI: 1.97-9.13, p=<0.001). Hypertensive patients (stage 2) had a higher risk of elevated pulse wave velocity than normotensive ones (adjPR=2.70, 95%CI: 1.05-6.95, p=0.040), as did patients younger than 12 years than the older patients (adjPR=2.95, 95%CI: 1.05-8.40, p=0.041). Hypertensive patients had a higher risk of elevated central systolic blood pressure than normotensives (adjPR=3.29, 95%Cl: 1.36-7.94), as did patients undergoing chronic dialysis treatment when comparing to nondialysis chronic kidney disease patients (adjPR=2.08, 95%Cl: 1.07-4.02).

CONCLUSION

Younger age, dialysis, and hypertension in children are independently associated with higher pulse wave velocity. Hypertension and dialysis are independently associated with higher central systolic blood pressure.

Arterial stiffness and functional capacity in individuals with chronic stroke: a cross-sectional study

OBJECTIVE

To investigate the association between arterial stiffness and functional capacity in individuals with chronic stroke and compare the arterial stiffness between individuals with better and poor functional capacity.

DESIGN

Cross-sectional study.

PARTICIPANTS

Individuals after chronic stroke have their arterial stiffness index evaluated by augmentation index heart rate adjusted for 75 bpm (AIx@75), assessed by Mobil-O-Graph® device (IEM, Stolberg, Germany), in percent, on the paretic upper limb. Functional capacity was assessed with the Duke Activity Status Index (DASI) in metabolic equivalent (METS). The individuals were assigned into two groups: better (DASI ≥ 31.95) and poor (DASI < 31.95) functional capacity. Pearson's correlation and t test were used for analysis.

RESULTS

Twenty-eight individuals (arterial stiffness 23.8 ± 10% and functional capacity 29 ± 19 METS) were included. The association between arterial stiffness and functional capacity was negative and statistically significant, with moderate magnitude (r = -0.53, p < .001). Individuals who had better functional capacity have lower arterial stiffness indices (AIx@75 = 17.4% versus 27.4% in better and lower functional capacity, respectively) (p = .01).

CONCLUSION

Arterial stiffness of the paretic upper limb has a negative association with functional capacity.

Superiority of 24-Hour Aortic Over 24-Hour Brachial Pressure to Associate With Carotid Arterial Damage on the Basis of Pressure Amplification Variability: the SAFAR Study

BACKGROUND

Evidence suggests marginal superiority of static aortic systolic blood pressure (aSBP) compared with brachial SBP regarding the association with organ damage and prognosis of cardiovascular disease. The noninvasive 24-hour aSBP assessment is feasible and associates better with presence of left ventricular hypertrophy compared with 24-hour brachial systolic blood pressure. We aimed at comparing the association of 24-hour aSBP and 24-hour brachial systolic blood pressure with indices of arterial damage and examining the role of 24-hour SBP amplification variability (within-subjects' SD) in this association.

METHODS

Consecutive subjects referred for cardiovascular disease risk assessment underwent 24-hour aortic and brachial ambulatory BP monitoring using a validated oscillometric device (Mobil-O-Graph). Arterial damage was assessed by carotid intima-media thickness and detection of carotid and femoral atheromatosis (plaque presence).

RESULTS

Cross-sectionally 501 individuals (aged 54±13 years, 57% men, 80% hypertensives) were examined. Multivariable analysis revealed superiority of 24-hour aSBP regarding the association with intimal-medial thickness, carotid hypertrophy and carotid-but not femoral-atheromatosis. In receiver operator characteristics analysis, 24-hour aBP displayed a higher discriminatory ability-compared to 24-hour brachial systolic blood pressure-for the detection of both carotid hypertrophy (area under the curve, 0.662 versus 0.624, P<0.05) and carotid atheromatosis (area under the curve, 0.573 versus 0.547, P<0.05). This effect was more prominent in individuals with above-median 24-hour SD of SBP amplification.

CONCLUSIONS

Our results suggest that 24-hour aSBP assessment may be of significant value in clinical practice to detect site-specific arterial damage on the basis of pressure amplification variability and should be prospectively examined in clinical trials.

Endothelial Dysfunction in Fabry Disease Is Related to Glycocalyx Degradation

Fabry disease (FD) is an X-linked multisystemic lysosomal storage disease due to a deficiency of α-galactosidase A (GLA/AGAL). Progressive cellular accumulation of the AGAL substrate globotriaosylceramide (Gb3) leads to endothelial dysfunction. Here, we analyzed endothelial function in vivo and in vitro in an AGAL-deficient genetic background to identify the processes underlying this small vessel disease. Arterial stiffness and endothelial function was prospectively measured in five males carrying GLA variants (control) and 22 FD patients under therapy. AGAL-deficient endothelial cells (EA.hy926) and monocytes (THP1) were used to analyze endothelial glycocalyx structure, function, and underlying inflammatory signals. Glycocalyx thickness and small vessel function improved significantly over time (p<0.05) in patients treated with enzyme replacement therapy (ERT, n=16) and chaperones (n=6). AGAL-deficient endothelial cells showed reduced glycocalyx and increased monocyte adhesion (p<0.05). In addition, increased expression of angiopoietin-2, heparanase and NF-κB was detected (all p<0.05). Incubation of wild-type endothelial cells with pathological globotriaosylsphingosine concentrations resulted in comparable findings. Treatment of AGAL-deficient cells with recombinant AGAL (p<0.01), heparin (p<0.01), anti-inflammatory (p<0.001) and antioxidant drugs (p<0.05), and a specific inhibitor (razuprotafib) of angiopoietin-1 receptor (Tie2) (p<0.05) improved glycocalyx structure and endothelial function in vitro. We conclude that chronic inflammation, including the release of heparanases, appears to be responsible for the degradation of the endothelial glycocalyx and may explain the endothelial dysfunction in FD. This process is partially reversible by FD-specific and anti-inflammatory treatment, such as targeted protective Tie2 treatment.

Accuracy of a new instrument for noninvasive evaluation of pulse wave velocity: the Arterial sTiffness faitHful tOol aSsessment project

BACKGROUND

Large artery stiffness, assessed by carotid--femoral pulse wave velocity (cfPWV), is a major risk factor for cardiovascular events, commonly used for risk stratification. Currently, the reference device for noninvasive cfPWV is SphygmoCor but its cost and technically challenging use limit its diffusion in clinical practice.

AIM

To validate a new device for noninvasive assessment of cfPWV, ATHOS (Arterial sTiffness faitHful tOol aSsessment), designed in collaboration with the Politecnico di Torino, against the reference noninvasive method represented by SphygmoCor.

METHODS

Ninety healthy volunteers were recruited. In each volunteer, we assessed cfPWV, using SphygmoCor (PWVSphygmoCor) and ATHOS (PWVATHOS) devices in an alternate fashion, following the ARTERY Society guidelines. The accuracy was assessed by Bland--Altman plot, and reproducibility was assessed by interoperator correlation coefficient (ICC).

RESULTS

Mean PWVATHOS and mean PWVSphygmoCor were 7.88 ± 1.96 and 7.72 ± 1.95 m/s, respectively. Mean difference between devices was 0.15 ± 0.56 m/s, with a high correlation between measurements (r = 0.959, P < 0.001). Considering only PWV values at least 8 m/s (n = 30), mean difference was 0.1 ± 0.63 m/s. The ICC was 97.7% with ATHOS.

CONCLUSION

ATHOS showed an excellent level of agreement with SphygmoCor, even at high PWV values, with a good reproducibility. Its simplicity of use could help increase clinical application of PWV assessment, improving patients' cardiovascular risk stratification.

Estimated Arterial Stiffness and Prediction of Vascular Aging: The Rising of a New Era

Arterial stiffness has been associated with cardiovascular events and correlated with cardiovascular risk factors. In the new guidelines of the European Society of Hypertension, the evaluation of arterial stiffness, and specifically carotid-femoral pulse wave velocity (c-f PWV), was taken into account for the detailed screening of the hypertensive population. Despite the importance of arterial stiffness as a target organ damage, the measurement is time-consuming, not practical, needs expensive equipment and experienced staff. For all these reasons, c-f PWV is not recommended for the everyday clinical practice and its current use is restricted for research purposes. The importance of arterial properties in clinical practice and cardiovascular prevention is well known. Hence, the estimation of arterial stiffness and vascular health based on parameters that affect arterial stiffness, but without the use of a machine, is a new promising field. Furthermore, the relationship between age-related MRI abnormalities as well as ultrafast ultrasound with vascular effect gives a new promise for future vascular aging assessment.

Supervised Exercise Immediately After Bariatric Surgery: the Study Protocol of the EFIBAR Randomized Controlled Trial

Background

Previous studies have investigated weight loss caused by exercise following bariatric surgery. However, in most cases, the training program is poorly reported; the exercise type, volume, and intensity are briefly mentioned; and the sample size, selection criteria, and follow-up time vary greatly across studies.

Purpose

The EFIBAR study aims to investigate over 1 year the effects of a 16-week supervised exercise program, initiated immediately after bariatric surgery, on weight loss (primary outcome), body composition, cardiometabolic risk, physical fitness, and quality of life in patients with severe/extreme obesity.

Material and Methods

The EFIBAR study is a parallel-group, superiority, randomized controlled trial (RCT), comprising 80 surgery patients. Half of the participants, randomly selected, perform a 16-week supervised exercise program, including both strength and aerobic training, starting immediately after the surgery (7–14 days). For each participant, all primary and secondary outcomes are measured at three different time points: (i) before the surgery, (ii) after the intervention (≈4 months), and (iii) 1 year after the surgery.

Conclusion

The EFIBAR study will provide new insights into the multidimensional benefits of exercise in adults with severe/extreme obesity following bariatric surgery.

Trial Registration

EFIBAR randomized controlled trial was prospectively registered at Clinicaltrials.gov (NCT03497546) on April 13, 2018.

Non-Invasive Methods for PWV Measurement in Blood Vessel Stiffness Assessment

In recent years, statistical studies highlighted an increasing incidence of cardiovascular diseases (CVD) which reflected on additional costs on the healthcare systems worldwide. Pulse wave velocity (PWV) measurement is commonly considered a CVD predictor factor as well as a marker of Arterial Stiffness (AS), since it is closely related to the mechanical characteristics of the arterial wall. An increase in PWV is due to a more rigid arterial system. Because of the prevalence of the elastic component, in young people the PWV is lower than in the elderly. Nowadays, invasive and non-invasive methods for PWV assessment are employed: there is an increasing attention in the development of non-invasive devices which mostly perform a regional PWV measurement (over a long arterial portion) rather than local (over a short arterial portion). The accepted gold-standard for non-invasive AS measurement is the carotid-femoral PWV used to evaluate the arterial damage, the corresponding cardiovascular risk and to adapt the proper therapy. This review article considers the main commercially available devices underlining their operating principles in terms of sensors, execution mode, pulse waveform acquired, site of measurement, distance and time estimation methods, as well as their main limitations in clinical practice.

Associations Between Arterial Stiffness Indices and Chronic Kidney Disease Categories in Essential Hypertensive Patients

BACKGROUND

This study investigated the association between arterial stiffness indices and asymptomatic chronic kidney disease (CKD) risk categories in hypertensive patients.

METHODS

Arterial stiffness indices, including 24-hour brachial and aortic systolic blood pressure (SBP) and pulse wave velocity (PWV), were measured by an oscillometric Mobil-O-Graph device, brachial-ankle PWV (baPWV) by a volume-plethysmographic method, and renal resistive index (RI) by ultrasonography, in 184 essential hypertensive patients (66.0 ± 17.1 years, 47.3% male). CKD was categorized into 3 stages based on the Kidney Disease Improving Global Outcomes (KDIGO) criteria, using a combination of estimated glomerular filtration and albuminuria.

RESULTS

The 24-hour aortic PWV (aPWV), baPWV, and RI increased with worsening severity of CKD risk category (all P < 0.01 for trend). Multivariate logistic regression analysis found that a 1 SD increase of nighttime aortic SBP (odds ratio [OR] 1.52), PWV (OR 4.80), or RI (OR 1.75) was an independent predictor of high or very-high CKD stage (all P < 0.05). After adjustment for potential confounders, day-to-night change in brachial SBP as well as in aPWV differed among groups (P < 0.05, respectively). In a multivariate regression model, day-to-night changes in aortic SBP and PWV, and RI were independently associated with day-to-night brachial SBP change.

CONCLUSIONS

In hypertension, circadian hemodynamics in high CKD stage are characterized by higher nighttime values of aortic SBP and PWV and disturbed intrarenal hemodynamics. Further, the blunted nocturnal BP reduction in these patients might be mediated via disturbed intrarenal hemodynamics and circadian hemodynamic variation in aortic SBP and arterial stiffness.

Age dependence of brachial cuff-based ambulatory PWV in end-stage kidney disease patients undergoing long-term peritoneal dialysis

BACKGROUND

The newly introduced device Mobil-O-Graph (IEM, Stolberg, Germany) combines brachial cuff oscillometry and pulse wave analysis, enabling the determination of pulse wave velocity (PWV) via complex mathematic algorithms during 24-h ambulatory blood pressure monitoring (ABPM). However, the determinants of oscillometric PWV in the end-stage kidney disease (ESKD) population remain poorly understood.

METHODS

In this study, 81 ESKD patients undergoing long-term peritoneal dialysis underwent 24-h ABPM with the Mobil-O-Graph device. The association of 24-h oscillometric PWV with several demographic, clinical and haemodynamic parameters was explored using linear regression analysis.

RESULTS

In univariate analysis, among 21 risk factors, 24-h PWV exhibited a positive relationship with age, body mass index, overhydration assessed via bioimpedance spectroscopy, diabetic status, history of dyslipidaemia and coronary heart disease, and it had a negative relationship with female sex and 24-h heart rate. In stepwise multivariate analysis, age (β: 0.883), 24-h systolic blood pressure (BP) (β: 0.217) and 24-h heart rate (β: -0.083) were the only three factors that remained as independent determinants of 24-h PWV (adjusted R ² = 0.929). These associations were not modified when all 21 risk factors were analysed conjointly or when the model included only variables shown to be significant in univariate comparisons.

CONCLUSION

The present study shows that age together with simultaneously assessed oscillometric BP and heart rate are the major determinants of Mobil-O-Graph-derived PWV, explaining >90% of the total variation of this marker. This age dependence of oscillometric PWV limits the validity of this marker to detect the premature vascular ageing, a unique characteristic of vascular remodelling in ESKD.

Improvement of Arterial Stiffness One Month after Bariatric Surgery and Potential Mechanisms

Arterial stiffness (AS) is an independent predictor of cardiovascular risk. We aimed to analyze changes (Δ) in AS 1-month post-bariatric surgery (BS) and search for possible pathophysiological mechanisms. Patients with severe obesity (43% hypertensives) were prospectively evaluated before and 1-month post-BS, with AS assessed by pulse-wave velocity (PWV), augmentation index (AIx@75) and pulse pressure (PP). Ambulatory 24 h blood pressure (BP), anthropometric data, renin-angiotensin-aldosterone system (RAAS) components and several adipokines and inflammatory markers were also analyzed. Overall reduction in body weight was mean (interquartile range (IQR)) = 11.0% (9.6–13.1). A decrease in PWV, AIx@75 and PP was observed 1-month post-BS (all, p < 0.01). There were also significant Δ in BP, RAAS components, adipokines and inflammatory biomarkers. Multiple linear regression adjusted models showed that Δaldosterone was an independent variable (B coeff.95%CI) for final PWV (B = −0.003, −0.005 to 0.000; p = 0.022). Angiotensin-converting enzyme (ACE)/ACE2 and ACE were independent variables for final AIx@75 (B = 0.036, 0.005 to 0.066; p = 0.024) and PP (B = 0.010, 0.003 to 0.017; p = 0.01), respectively. There was no correlation between ΔAS and anthropometric changes nor with Δ of adipokines or inflammatory markers except high-sensitivity C-reactive protein (hs-CRP). Patients with PWV below median decreased PWV (mean, 95%CI = −0.18, −0.25 to −0.10; p < 0.001) and both AIx@75 and PP at 1-month, but not those with PWV above median. In conclusion, there is an improvement in AS 1-month post-BS that correlates with ΔBP and Δrenin-angiotensin-aldosterone components. The benefit is reduced in those with higher PWV.

Cardiovascular risk assessment in children and adolescents with congenital solitary kidneys

Patients with solitary kidneys (SKs) are at risk of hypertension (HT) and associated end-organ damage. The authors aimed to evaluate whether children with congenital SKs (CSKs) have higher office, ambulatory, or central blood pressure (BP), increased arterial stiffness or left ventricular mass index, or any risk for arrhythmia. With this purpose, patients with CSK and healthy controls being followed up between January 2018 and June 2019 were enrolled in the study. Demographic, biochemical, and office blood pressure (BP) data were recorded. Then, ambulatory blood pressure monitoring (ABPM) and measurements of central BP (cBP), pulse wave velocity (PWV), and augmentation index (AIx@75) were obtained. Ventricular repolarization parameters were acquired by 12-lead electrocardiography. Left ventricular mass index (LVMI) and abdominal aortic stiffness parameters including strain, pressure strain elastic modulus (Ep), and normalized Ep (Ep*) were calculated with echocardiographic measurements. Finally, 36 children with CSK and 36 healthy controls were included. Serum creatinine, uric acid, total cholesterol levels, ABPM parameters, cBP levels, and PWV values were significantly higher, and eGFR levels were significantly lower in the CSK group. VR parameters, abdominal aortic stiffness indices, and LVMI were similar between the groups. CSK increased the risk of HT in ABPM (HT_ABPM ) by 6 times. PWV was significantly correlated with Ep and Ep* in cases with CSK. Determination of cBP and PWV along with 24-hour ABPM would be a useful tool in children with CSK.

Sex difference in cerebral blood flow velocity during exercise hyperthermia

INTRODUCTION

Cerebral blood flow and thermal perception during physical exercise under hyperthermia conditions in females are poorly understood. Because sex differences exist for blood pressure control, resting middle cerebral artery velocity (MCA_Vmean), and pain, we tested the hypothesis that females would have greater reductions in MCAv_mean and increased thermal perceptual strain during exercise hyperthermia compared to males.

METHODS

Twenty-two healthy active males and females completed 60 min of matched exercise metabolic heat production in a 1) control cool (24.0 ± 0.0 °C; 14.4 ± 3.4% Rh) and 2) hot (42.3 ± 0.3 °C; 28.4 ± 5.2% Rh) conditions in random order, separated by at least 3 days while MCAv_mean, thermal comfort, and preference was obtained during the exercise.

RESULTS

Compared to 36 °C mean body temperature (M^bt), as hyperthermia increased to 39 °C Mbt, females had a greater reduction in absolute (MCAv_mean), and relative change (%Δ MCAv_mean) and conductance (%Δ MCAv_mean conductance) in MCA_Vmean compared to males (Interaction: Temperature x Sex, P ≤ 0.002). During exercise in cool conditions, absolute and conductance MCAv_mean was maintained from rest through exercise; however, females had greater MCA_Vmean compared to males (Main effect: Sex, P < 0.0008). We also found disparities in females' perceptual thermal comfort and thermal preference. These differences may be associated with a greater reduction in partial pressure of end-tidal CO₂, and different cardiovascular and blood pressure control to exercise under hyperthermia.

CONCLUSIONS

In summary, females exercise cerebral blood flow velocity is reduced to a greater extent (25% vs 15%) and the initial reduction occurs at lower hyperthermia mean body temperatures (~38 °C vs ~39 °C) and are under greater thermal perceptual strain compared to males.

Association Between Physical Activity Intensity Levels and Arterial Stiffness in Healthy Children

BACKGROUND

Physical activity (PA) has a substantial impact on arterial stiffness in adults; however, evidence regarding children is scarce. The aim of this study was to examine the association between objectively measured PA with different intensities and surrogate measures of arterial stiffness in healthy children.

METHODS

Altogether, 80 children (41 girls and 39 boys, ranging from 8-11 y) participated in this prospective, cross-sectional study. Sedentary time and PA of light, moderate, and vigorous intensity levels were measured over a period of 7 days by accelerometry. Arterial stiffness parameters, including pulse wave velocity and central systolic blood pressure (cSBP), were noninvasively assessed by the oscillometric Mobil-O-Graph. Associations were tested using multiple linear regressions with adjustments for potential confounders (α ≤ .05).

RESULTS

PA of moderate intensity was negatively associated with cSBP (β = -0.266, P = .017). PA of vigorous intensity was inversely related to pulse wave velocity (β = -0.225, P = .045) and cSBP (β = -0.286, P = .010), respectively.

CONCLUSION

Higher time spent in PA of moderate and vigorous intensity is associated with reduced pulse wave velocity and lower cSBP values in children. It suggests that PA is a favorable determinant of arterial health.

Current assessment of pulse wave velocity: comprehensive review of validation studies

OBJECTIVE

Carotid-femoral pulse wave velocity (PWV) is considered the gold standard for arterial stiffness assessment in clinical practice. A large number of devices to measure PWV have been developed and validated. We reviewed different validation studies of PWV estimation techniques and assessed their conformity to the Artery Society Guidelines and the American Heart Association recommendations.

METHODS

Pubmed and Medline (1995-2017) were searched to identify PWV validation studies. Of the 96 article retrieved, 26 met the inclusion criteria.

RESULTS

Several devices had been developed and validated to noninvasively measure arterial stiffness, using applanation tonometry (SphygmoCor, PulsePen), piezoelectric mechanotransducers (Complior), cuff-based oscillometry (Arteriograph, Vicorder and Mobil-O-Graph), photodiode sensors (pOpmètre) and devices assessing brachial-ankle pulse wave velocity and cardiac-ankle PWV. Ultrasound technique and MRI remain confined to clinical research. Good agreement was found with the Artery Society Guidelines. Two studies (Complior, SphygmoCor Xcel) showed best adherence with the guidelines. In Arteriograph, MRI, ultrasound and SphygmoCor Xcel validation studies sample size was smaller than the minimum suggested by the guidelines. High discrepancies between devices were shown in distance estimation: in two studies (Arteriograph, Complior) path length was estimated in conformity to the guidelines. Transit time was calculated using the intersecting tangent method, but in two studies (Vicorder, pOpmètre) best agreement was found using the maximum of the second derivative. Six studies reached the accuracy level 'excellent' defined in the Artery guidelines.

CONCLUSION

Method to assess transit time and path length need validation in larger populations. Further studies are required in different risk population to implement clinical applicability of every device.

Assessment of subclinical atherosclerotic cardiovascular disease in patients with ankylosing spondylitis

Objective:

The aim of the present study was to compare patients with ankylosing spondylitis (AS) with healthy controls with respect to subclinical atherosclerotic cardiovascular disease (CVD).

Methods:

A total of 44 patients with AS with no history of CVD, diabetes mellitus, hypertension, chronic kidney disease, and lipid-lowering drug use were compared with 40 age- and sex-matched healthy controls with respect to carotid intima-media thickness (CIMT) and pulse wave velocity (PWV), which are surrogate markers of subclinical atherosclerosis. Correlation analysis was also performed to examine the association between surrogate markers and disease activity with inflammation [Ankylosing spondylitis disease activity score with C-reactive protein (ASDAS-CRP)].

Results:

In addition to age and sex, both groups were comparable with respect to cigarette smoking, body mass index, and high-density lipoprotein cholesterol (p=0.425, p=0.325, and p=0.103, respectively). The level of total cholesterol was significantly lower in patients with AS (p=0.002). Nonsteroidal anti-inflammatory drug and tumor necrosis factor alpha inhibitor use ratios in patients with AS were 79.5% and 65.9%, respectively. There was no significant difference between both groups regarding PWV and CIMT (p=0.788 and p=0.253, respectively). In patients with AS, there was a significant correlation between ASDAS-CRP and CIMT (r=0.315, p=0.038), but the correlation between ASDAS-CRP and PWV was not significant (r=−0.183, p=0.234).

Conclusion:

The results of the present study could not provide sufficient evidence whether disease activity with inflammation caused subclinical atherosclerotic CVD in patients with AS without overt CVD. The increased atherosclerotic CVD risk is most probably multifactorial in patients with AS, but the extent of the contribution of disease activity with inflammation to increased atherosclerosis is controversial.

Accuracy and precision of cardiac output estimation by an automated, brachial cuff-based oscillometric device in patients with shock

Non-invasive monitoring of cardiac output is a technological and clinical challenge, especially for critically ill, surgically operated, or intensive care unit patients. A brachial cuff-based, automated, oscillometric device used for blood pressure and arterial stiffness ambulatory monitoring (Mobil-O-Graph) provides a non-invasive estimation of cardiac output values simultaneously with regular blood pressure measurement. The aim of the study was to evaluate the feasibility of this apparatus to estimate cardiac output in intensive care unit patients and to compare the non-invasive estimated cardiac output values with the respective gold standard method of thermodilution during pulmonary artery catheterization. Repeated sequential measurements of cardiac output were performed, in random order, by thermodilution (reference) and Mobil-O-Graph (test), in 24 patients hospitalized at intensive care unit. Reproducibility and accuracy of the test device were evaluated by Bland–Altman analysis, intraclass correlation coefficient, and percentage error. Mobil-O-Graph underestimated significantly the cardiac output by −1.12 ± 1.38 L/min ( p < 0.01) compared to thermodilution. However, intraclass correlation coefficient was >0.7 indicating a fair agreement between the test and the reference methods, while percentage error was approximately 39% which is considered to be within the acceptable limits. Cardiac output measurements were reproducible by both Mobil-O-Graph (intraclass correlation coefficient = 0.73 and percentage error = 27.9%) and thermodilution (intraclass correlation coefficient = 0.91 and percentage error = 26.7%). We showed for the first time that cardiac output estimation in intensive care unit patients using a non-invasive, automated, oscillometric, cuff-based apparatus is reproducible (by analyzing two repeated cardiac output measurements), exhibiting similar precision to thermodilution. However, the accuracy of Mobil-O-Graph (error compared to thermodilution) could be considered fairly acceptable. Future studies remain to further examine the reliability of this technology in monitoring cardiac output or stroke volume acute changes which is a more clinically relevant objective.

Comparison of 24-Hour Ambulatory Central Blood Pressure Reduction Efficacy Between Fixed Amlodipine or Up-Titrated Hydrochlorothiazide Plus Losartan: The K-Central Study

OBJECTIVE

The main objective of this study was to evaluate non-inferiority of office mean systolic blood pressure (BP) reduction efficacy and superiority of 24-hour ambulatory central BP reduction efficacy between losartan combined with fixed dose amlodipine (L/A group) and dose up-titrated hydrochlorothiazide (L/H group) according to office BP.

METHODS

We conducted a prospective, randomized, double-blind multicenter trial in 231 patients with hypertensive (mean age = 59.2 ± 12.2 years). Patients received losartan 50 mg monotherapy for 4 weeks, followed by additional use of amlodipine 5 mg or hydrochlorothiazide 12.5 mg for 20 weeks after randomization. The patients who did not achieve the BP goal after 4 weeks' randomization received an increased dose of 100 mg/5 mg for the L/A group and 100 mg/25 mg for L/H group, respectively. The 24-hour ambulatory central BP was measured at baseline and after 20 weeks' treatment.

RESULTS

Office mean systolic BP reduction of L/A group was not inferior to L/H group after 4 weeks' treatment (-17.6 ± 13.3 vs. -14.4 ± 12.6 mm Hg, P = 0.0863) and was not significantly different after 20 weeks' treatment. (-15.7 ± 14.0 vs. -14.7 ± 15.1 mm Hg, P = 0.6130) The 24-hour ambulatory central systolic BP was significantly more reduced in the L/A group compared with that in the L/H group after 20 weeks' treatment (-9.37 ± 10.67 vs. -6.28 ± 10.50 mm Hg, P = 0.0407). The 24-hour ambulatory central systolic BP at the completion of the study and its reduction magnitude were independently associated with reductions in aortic pulse wave velocity, pulse pressure, and wave reflection magnitude.

CONCLUSION

Office systolic BP reduction with L/A was not inferior to L/H after 4 week's treatment. The combination of losartan and amlodipine was more favorable in 24-hour ambulatory central hemodynamics beyond BP-lowering efficacy than the combination of losartan and hydrochlorothiazide, regardless of office BP.

CLINICAL TRIALS REGISTRATION

NCT02294539.

Circadian hemodynamic characteristics in hypertensive patients with primary aldosteronism

OBJECTIVE

The present study aimed to compare circadian hemodynamic characteristics in hypertensive patients with and without primary aldosteronism.

METHODS

Circadian hemodynamics, including 24-h brachial and central blood pressure (BP), SBP variability indices, central pulse wave velocity (PWV), augmentation index (AIx@75), cardiac index, and total vascular resistance (TVR), were evaluated using an oscillometric device, Mobil-O-Graph, in 60 patients with primary aldosteronism (63.4±13.3 years, 47% women) and 120 age-matched and sex-matched patients with essential hypertension.

RESULTS

Office SBP, PWV, AIx@75, and BP variability indices were similar between groups; however, 24-h brachial (124 ± 14 vs 130 ± 11 mmHg) as well as central (112 ± 12 vs 120 ± 10 mmHg) SBP was higher (both P < 0.01), and the difference between 24-h brachial and central SBP (11 ± 5 vs 9 ± 3 mmHg, P < 0.05), an index of pressure amplification, was smaller in primary aldosteronism than in essential hypertension. In both groups, cardiac index decreased from daytime to night-time (both P < 0.01), but this decrease was smaller in primary aldosteronism (P < 0.05). During daytime, TVR in primary aldosteronism was higher than that in essential hypertension (P < 0.05), and the significant increase of TVR from daytime to night-time was lost in primary aldosteronism. In a multivariate stepwise regression model, primary aldosteronism emerged as an independent predictor of 24-h central SBP as well as the difference between 24-h brachial and central SBP.

CONCLUSION

Our results demonstrated that circadian hemodynamics in primary aldosteronism patients are characterized by increased central SBP, smaller disparity between brachial and central SBP, and disturbed circadian hemodynamic variation.

Progressive dry to humid hyperthermia alters exercise cerebral blood flow

INTRODUCTION

Exercising in hot conditions may increase the risk for exertional heat-related illness due to reduction in cerebral blood flow (CBF); however, the acute effect of exercise-induced changes on CBF during compensable and uncompensable heat stress remain unclear. We tested the hypothesis that exercising in hot dry and humid conditions would have different CBF responses.

METHODS

Nine healthy active males completed a 30 min baseline rest then 60 min of low intensity self-paced exercise (12 rating of perceived exertion) in a 1) control compensable neutral dry (CN; 23.7 ± 0.7 °C; 10.7 ± 0.8%Rh) and 2) compensable hot dry (CH; 42.3 ± 0.3 °C; 10.7 ± 1.8%Rh) that progressively increased to an uncompensable hot humid (UCH; 42.3 ± 0.3 °C; 55.2 ± 7.7%Rh) environment in random order separated by at least 4 days.

RESULTS

We observed that during CN environments from rest through 60 min of exercise, middle cerebral velocity (MCAv_mean) and conductance (MCAv_mean CVC) remained unchanged. In contrast, during CH, MCAv_mean, MCAv_mean CVC, and cardiac output (Q) increased and systemic vascular resistance (SVR) decreased. However, under UCH, MCAv_mean, MCAv_mean CVC, and Q was reduced. No difference in mean arterial pressure or ventilation was observed during any condition. Only during UCH, end-tidal PO₂ increased and PCO₂ decreased. The redistribution of blood to the skin for thermoregulation (heart rate, skin blood flow and sweat rate) remained higher during exercise in UCH environments.

CONCLUSIONS

Collectively, exercise cerebral blood flow is altered by an integrative physiological manner that differs in CN, CH, and UCH environments. The control of CBF may be secondary to thermoregulatory control which may provide an explanation for the cause of exertional heat illness.

Association Between Circadian Hemodynamic Characteristics and Target Organ Damage in Patients With Essential Hypertension

BACKGROUND

This study investigated the association between circadian hemodynamic characteristics and asymptomatic hypertensive organ damage.

METHODS

Circadian hemodynamics, including 24-hour brachial and aortic systolic blood pressure (SBP), pulse wave velocity (PWV), augmentation index (AIx@75), cardiac index, and total vascular resistance (TVR), were evaluated using an oscillometric device, Mobil-O-Graph, in 284 essential hypertensive patients (67.8 ± 16.0 years, 54% female). Hypertensive target organ damage (TOD), namely carotid wall thickening, left ventricular hypertrophy, and albuminuria, was assessed in all patients.

RESULTS

Office SBP and 24-hour brachial and aortic SBP all increased with increasing number of organs involved (all P < 0.01 for trend). After multivariate logistic regression analysis, 24-hour brachial SBP (odds ratio [OR] = 1.04 for 1 mm Hg increase, P < 0.001) as well as aortic SBP (OR = 1.03 for 1 mm Hg increase, P < 0.05) maintained significance. Percent decrease during nighttime in brachial SBP, PWV, and TVR, but not cardiac index, showed a significant graded relationship with the number of organs involved. In a multivariate stepwise regression model, the nighttime values of brachial SBP, PWV, and TVR emerged as independent predictors of the presence of TOD.

CONCLUSION

In essential hypertension, 24-hour aortic SBP could be a marker of subclinical TOD, and further, the blunted nocturnal BP reduction in TOD patients might be mediated by disturbed circadian hemodynamic variations in aortic SBP, vascular resistance, and arterial stiffness.

Influence of Body Composition on Arterial Stiffness in Middle-Aged Adults: Healthy UAL Cross-Sectional Study

Background and objectives: Several anthropometric and body composition parameters have been linked to arterial stiffness (AS) as a biomarker of cardiovascular disease. However, little is known about which of these closely related factors is more strongly associated with AS. The aim of the present study was to analyze the relationship of different anthropometric and body composition parameters with AS in middle-aged adults. Materials and Methods: This cross-sectional study included 186 middle-aged participants (85 women, 101 men; age = 42.8 ± 12.6 years) evaluated as part of the Healthy UAL study, a population study conducted at the University of Almería with the main purpose of analyzing the etiology and risk factors associated with cardio-metabolic diseases. Anthropometric measures included neck, waist, and hip circumferences, as well as the waist-to-height ratio (WHtr). Bioimpedance-derived parameters included fat-free mass index (FFMI), fat mass index (FMI), and percent of body fat (%BF). AS was measured by pulse wave velocity (PWV). The relationships of interest were examined through stepwise regression analyses in which age and sex were also introduced as potential confounders. Results: Neck circumference (in the anthropometric model; R²: 0.889; β: age = 0.855, neck = 0.204) and FFMI (in the bio-impedance model; R²: 0.891; β: age = 0.906, FFMI = 0.199) emerged as significant cross-sectional predictors of AS. When all parameters were included together (both anthropometry and bio-impedance), both neck circumference and FFMI appeared again as being significantly associated with AS (R²: 0.894; β: age = 0.882, FFMI = 0.126, neck = 0.093). Conclusion: It was concluded that FFMI and neck circumference are correlated with AS regardless of potential confounders and other anthropometric and bioimpedance-derived parameters in middle-aged adults.

Pulse Wave Velocities Derived From Cuff Ambulatory Pulse Wave Analysis

Pulse wave velocity (PWV), a measure of arterial stiffness, is an independent risk factor for cardiovascular morbidity and mortality. We investigated the relationship of ambulatory brachial cuff-based oscillometric PWV (oPWV) to 2 known correlates: age and brachial systolic blood pressure (SBP). In 234 participants in the Masked Hypertension Study, we analyzed 7284 validated hourly ambulatory SBP and oPWV readings using the Mobil-O-Graph monitor, which uses a proprietary pulse wave analysis algorithm to determine oPWV. Carotid-femoral PWV (cfPWV) was also measured. Mixed linear models were developed to estimate oPWV from age and ambulatory SBP. Participants were 34% male, with mean (SD) age 52.8 (9.9) years, SBP 123.8 (18.4) mm Hg, and oPWV 7.6 (1.3) m/s and cfPWV of 7.7 (1.7) m/s. The relationship of oPWV to age and SBP is given below: [Formula: see text] Age uniquely accounted for an estimated 75% of the total variation of oPWV, whereas SBP uniquely accounted for 20%; these findings were confirmed in an external validation dataset. Together, age and SBP accounted for 99.1% of the total variance of oPWV but (only) 40.2% of the variance of cfPWV. The correlation between oPWV and cfPWV was 0.58 but was only 0.11 after controlling for age and SBP. We conclude that the Mobil-O-Graph's oPWV is nearly completely explained by age and SBP and its relationship to cfPWV is because of their shared associations with age and SBP. Other hemodynamic variables derived from oscillometric pulse wave analysis may be useful and deserve additional scrutiny.

Measurement of arterial stiffness and vascular aging in community pharmacies-The ASINPHAR@2action project

The ASINPHAR@2action project aims at raising awareness to arterial stiffness (AS) and early vascular aging (EVA) through a community pharmacy-based intervention. This preliminary analysis is focused on the analysis of the proportion of participants with increased AS and the identification of its main determinants. We performed an observational cross-sectional study of participants enrolled in 11 community pharmacies in Portugal, between April and November 2017. Blood pressure (BP) and arterial function parameters were measured with a validated device. Clinical and demographic information was gathered, as well as the estimation of global cardiovascular risk, health-related quality of life, and dietary profile. Cholesterol and glycaemia were taken from a recent laboratory bulletin. The cohort includes 658 participants with a mean age of 57.3 ± 16.3 years, 66% women. Brachial BP was 126.6 ± 16.4 mm Hg and 79.9 ± 11.5 mm Hg, and central BP was 115.8 ± 15.4 mm Hg and 81.2 ± 11.6 mm Hg, respectively, for systolic and diastolic BP. Mean pulse wave velocity (PWV) was 8.5 ± 2.3 m/s, and the augmentation index was 23.6 ± 15.6%. The proportion of participants with increased AS was 19.8%. The overall best-fitting model for AS included age, gender, aortic PP, visceral fat, HDL cholesterol, AIx@75, total vascular resistance, hypertension, and diabetes, corresponding to an AUC of 0.910 (CI: 0.883, 0.937; P < 0.001) in the ROC curve analysis. The preliminary results of this pioneering large-scale study measuring arterial function in community pharmacies provide the grounds for the operationalization of subclinical target organ damage screening in pharmacies, as a strategy to improve cardiovascular risk monitoring and to promote adherence to treatment.

Short-term reproducibility of the 24-h ambulatory monitoring of brachial and central hemodynamics in untreated Chinese

Objective: Advanced technology allows non-invasive monitoring of the 24-h brachial and central hemodynamics simultaneously. However, related reproducibility data was limited in White patients. We therefore explored if the novel measurements would be reproducible in Chinese. Methods: From February 2017 to January 2018, 152 untreated patients who were suspected of hypertension and referred for ambulatory blood pressure (BP) monitoring were recruited. Ambulatory BP monitoring was repeated within one month (median, 12.5 days) using the Mobil-O-Graph monitors (IEM, Germany). Reproducibility was assessed as the intra-class correlation coefficient (ICC), coefficient of variation (CV), and repeatability coefficient (RC). Results: The 152 participants (average age, 58.6 years) included 54 men and 98 women. The first and second means of the ambulatory brachial and central BPs, pulse wave velocity (PWV), augmentation pressure, augmentation index (AIx) and AIx at a heart rate of 75 beats per minute (AIx@75) were all similar (p ≥ 0.065), except that the repeated daytime and 24-h brachial and central systolic BPs and pulse pressure slightly differed by approximately 1-2 mmHg (p ≤ 0.011). ICC ranged from 0.70 to 0.94 for all ambulatory BPs and ≥0.91 for the arterial measurements. CV was in the range from 5.0% to 10.3% for all BPs and PWV measurements, and from 15.5% to 22.3% for AIx and AIx@75. RC expressed as percentages of maximal variation was <15% for the PWVs and ranged from 25.5% to 54.7% for BPs, AIx and AIx@75. Conclusions: The 24-h ambulatory brachial and central BPs and arterial measurements were reproducible within a short time period in Chinese, and could therefore be used in clinical practice and research settings.

Parameters of arterial stiffness in patients with Behçet's disease and their relationship with disease duration

The results of investigations of arterial stiffness in Behçet's disease (BD) are contradictory and the reason for this contradictory situation is not clear. The lack of studies in homogenous groups according to the duration of the disease may be the cause of conflicting results. To compare arterial stiffness by assessing pulse wave velocity (PWV) and augmentation index (AIx) measurements in healthy controls (HC) and patients diagnosed with BD with short and long disease duration. This cross-sectional study was conducted between August-November 2017 and 54 patients with BD and 34 HC were included. Patients with BD who were diagnosed within 12 months were included in the group with short disease duration (SDD) and the others in the group with long disease duration (LDD). Parameters of cardiovascular risk of all participants were recorded and PWV and AIx values were measured from the brachial artery. AIx was significantly higher in all patients with BD, patients with BD with SDD and patients with BD with LDD, than in HC (p = 0.005, p = 0.011, p = 0.004, respectively). Pulse wave velocity values were not different from HC in patients with BD. When patients with BD with SDD and LDD were compared with each other, PWV was significantly higher in patients with BD with LDD (p = 0.030). There was a moderate correlation between PWV and disease duration (Rho = 0.414, p = 0.002). Augmentation index is higher in patients with BD than HC regardless of disease duration.

Applications of arterial stiffness markers in peripheral arterial disease

Arterial stiffness has been analyzed in many different population groups with the objective of identifying cardiovascular risk early and performing specific therapeutic interventions. Increased arterial stiffness affects the capacity of the aorta and elastic arteries to adapt to pressure variations during the cardiac cycle. The main markers of arterial stiffness are pulse wave velocity (PWV), augmentation index (AIx) and central aortic pressure. They can be measured noninvasively. Patients with coronary disease or on hemodialysis who have elevated PWV or AIx have increased mortality. The association with peripheral arterial disease has been studied little. The objective of this review is to demonstrate the applicability and utility of assessing measures of arterial stiffness in patients with peripheral arterial disease.

Comparison of Two Measurement Devices for Pulse Wave Velocity in Children: Which Tool Is Useful to Detect Vascular Alterations Caused by Overweight?

Vascular alterations may lead to manifest cardiovascular disease in future life. There is a tremendous time delay between the onset and obvious clinical appearance of vascular alterations. Pulse wave velocity (PWV) is one subclinical parameter to detect vascular alterations at a very early stage. Different techniques exist to measure PWV non-invasively as a vascular parameter-all with their own technique-inherent advantages, challenges, and pitfalls. The aim of this study was to compare two techniques to measure PWV, to assess their agreement, and interchangeability. In 780 (♀ = 49.4%) healthy children and adolescents (mean age: 11.61 ± 2.11 years), PWV was obtained with two different techniques. Ultrasound-measured local PWV (PWVβ) at the carotid artery was graphically compared by a Bland-Altman plot with aortic PWV (aPWV), measured oscillometrically on the brachial artery. Reproducibility was assessed with the concordance correlation coefficient by Lin (ρc). Furthermore, participants were categorized by BMI as normal weight (N) or overweight/obese (O) to identify differences in PWVβ and aPWV caused by an increased BMI. Mean PWVβ was lower (4.01 ± 0.44 m/s) than mean aPWV (4.67 ± 0.34 m/s). The two methods differ by mean Δ0.66 ± 0.47 m/s (95% CI: 0.62 to 0.69 m/s; p < 0.001). Bland-Altman analysis indicated the 95% limits of agreement (-0.26 to 1.57) without any evidence of systemic difference. Lin's ρc represented a weak concordance between PWVβ and aPWV (ρc = 0.122; 95% CI: 0.093-0.150). There was no difference in PWVβ between N and O, whereas aPWV was higher in O: 4.81 ± 0.42 m/s than in N: 4.65 ± 0.32 m/s (p < 0.001). The difference, Δ0.16 m/s, 95% CI [-0.25; -0.08], was significant, t ₍₁₂₁₎ = -3.76, p < 0.001, with a medium-sized effect. PWVβ (ultrasound) and aPWV (oscillometry) show a level of disagreement that includes clinically important discrepancies. A discrimination between normal and altered vascular function was possible with aPWV but not with PWVβ.

Ambulatory pulse wave monitoring: current and future. Opinion paper of Russian Experts

The predictive value of vascular biomarkers such as pulse wave velocity (PWV), central arterial pressure (CAP), and augmentation index (AIx), obtained through pulse wave analysis (PWA) in resting conditions, has been documented in a variety of patient groups and populations. There are appropriate recommendations on their clinical use in clinical practice guidelines of various scientific societies. Operator-independent methods are currently available for estimating vascular biomarkers also in ambulatory conditions. The acceptable accuracy and reproducibility of ambulatory PWA makes it be a promising tool for evaluating vascular biomarkers in daily-life conditions. This approach may provide an opportunity to further improve the early cardiovascular screening in subjects at risk. However, there is no sufficient evidence to support the routine clinical use of PWA in ambulatory conditions at the moment. In particular, long-term outcome studies are needed to show the predictive value of ambulatory PWV, CAP and AIx values.

Arterial stiffness and subclinical aortic damage of reclassified subjects as stage 1 hypertension according to the new 2017 ACC/AHA blood pressure guidelines

Background: The 2017 ACC/AHA blood pressure (BP) guidelines generated controversies due to the new proposed BP cut-off values defining hypertension. We aimed to assess aortic stiffness of subjects who are reclassified as stage 1 hypertensive according to the new guidelines and compare them with the subjects of "elevated BP" category. Patients and methods. Data from the "Corinthia" study, an observational, cross-sectional survey of 2,043 participants were analyzed. Subjects were classified into 4 groups: group A: systolic pressure (SBP) 120-129 and diastolic pressure (DBP) < 80 mmHg, group B: SBP 130-139 or DBP 80-89 mmHg, group B1: SBP 130-139 and DBP < 80 mmHg and group B2: SBP 130-139 and DBP 80-89 mmHg. Aortic stiffness was assessed by carotid-to-femoral pulse wave velocity (PWV). A value of PWV > 10m/s was consider indicative of asymptomatic organ damage while values of PWV exceeded the 90 % percentile for each age group were consider as abnormal. Results: Groups B, B1 and B2 have significantly increased PWV compared to group A, independently from age and other risk factors (PWV: 9.2 ± 2.8 vs 9.4 ± 2.7 vs 8.6 ± 2.5 vs 8.1 ± 2.3 m/s, p < 0.01, respectively). The prevalence of PWV > 10 m/s and abnormal PWV values in group A was significantly lower than the corresponding prevalence in randomly selected, age-matched subjects from group B (13.5 % vs 24.4 %, p = 0.027 and 5.6 % vs 14.2 %, p = 0.022, respectively). Conclusions: The reclassified subjects as stage 1 hypertensive by the new guidelines have a significantly increased aortic stiffness and greater prevalence in asymptomatic aortic damage compared to subjects with elevated BP. This finding may indirectly explain the increased cardiovascular risk of this group.

Short-term vascular hemodynamic responses to isometric exercise in young adults and in the elderly

Background

Vascular aging is known to induce progressive stiffening of the large elastic arteries, altering vascular hemodynamics under both rest and stress conditions. In this study, we aimed to investigate changes in vascular hemodynamics in response to isometric handgrip exercise across ages.

Participants and methods

We included 62 participants, who were divided into three age categories: 20–40 (n=22), 41–60 (n=20), and 61–80 (n=20) years. Vascular hemodynamics were measured using the Mobil-o-Graph^® based on the pulsatile pressure changes in the brachial artery. One-way ANOVA test was performed to analyze the changes induced by isometric handgrip exercise.

Results

After isometric handgrip exercise, aortic pulse wave velocity (PWV) increased by 0.10 m/s in the youngest, 0.06 m/s in the middle-age, and 0.02 m/s in the oldest age category. Changes in PWV strongly correlated with those in central systolic blood pressure (cSBP) (r=0.878, P<0.01). After isometric exercise, the mean change of systolic blood pressure (SBP) was −1.9% in the youngest, 0.6% in the middle-aged, and 8.2% in the oldest subjects. Increasing handgrip strength was associated with an increase in SBP and cSBP (1.08 and 1.37 mmHg per 1 kg increase in handgrip strength, respectively, P=0.01). Finally, PWV was significantly associated with increasing handgrip strength with an increase of 0.05 m/s per 1 kg higher handgrip strength (P=0.01).

Conclusion

This study found increased blood pressure levels after isometric challenge and a strong association between handgrip strength and change in blood pressure levels and aortic stiffness in elderly subjects.

Exercise, Arterial Crosstalk-Modulation, and Inflammation in an Aging Population: The ExAMIN AGE Study

Background: Age is a key determinant for the development of cardiovascular disease and higher age coincides with an increased prevalence of obesity and physical inactivity. The study examines the influence of physical activity on aging processes of physiological systems focusing on the mechanisms of vascular aging.

Methods/Design: The study consists of two parts. The cross-sectional approach aims at examining the association of physical fitness and cardiovascular risk with large and small artery function in healthy older active (HOA, n = 40) and sedentary (HOS, n = 40) persons as well as older sedentary individuals with increased cardiovascular risk (OSR, n = 80) aged 50–80 years. In the interventional approach, the OSR group is randomized into a 12-week walking-based high intensity interval training (HIIT) group or a control condition, aiming at examining the effects of HIIT on arterial function in diseased older adults. Active lifestyle is defined as >9 metabolic equivalent of task (MET) per week and sedentary as ≤3 MET/week. Inclusion criteria for OSR are overweight or obesity (body mass index ≥30 kg/m²) plus at least one additional cardiovascular risk factor. The primary outcome is arterial stiffness as determined by aortic pulse wave velocity (PWV). The secondary outcomes are retinal arterial and venous diameters. Further cardiovascular assessments include peripheral PWV, central haemodynamics, retinal endothelial function, carotid intima media thickness, cardiac strain and diastolic function as well as autonomic function and inflammation. Physical fitness is measured by a treadmill-based spiroergometry to determine peak oxygen uptake.

Discussion: The aim of the study is to demonstrate the importance of and need for specific physical activity programs for seniors to achieve healthier aging as a long-term goal. Vascular function defines disease- and age-related end organ damage and represents the potential to contain health at older age. This research will identify cardiovascular biomarkers that best resemble underlying cardiovascular risk in age and disease. The integrated approach will help define new recommendations for treatment guidance of exercise therapy in an aging population.

ClinicalTrials. gov: NCT02796976; registered 02 June 2016 (retrospectively registered).

Mechanisms of pulse pressure amplification dipping pattern during sleep time: the SAFAR study

The difference in pulse pressure (PP) between peripheral arteries and the aorta, called pulse pressure amplification (PPamp), is a well-described physiological phenomenon independently associated with cardiovascular events. Recent studies suggest that it exhibits circadian variability. Our aim was to detect the factors associated with the circadian variability of PPamp. In 497 consecutive subjects (aged 54 years, 56.7% male, 79.7% hypertensives), we assessed the circadian pattern of peripheral and central arterial hemodynamics by 24-hour evaluation of brachial and aortic blood pressure (BP), augmentation index (AI), and pulse wave velocity (PWV) using a validated oscillometric device (Mobil-O-Graph). All parameters exhibited a circadian variation. Sleep dipping (decrease) pattern was observed for PPamp, brachial and aortic systolic BP, mean BP, and PWV, whereas a rising pattern (higher sleep than wake values) was observed for brachial PP, aortic PP, and AI. The factors independently associated with the less sleep dipping in PPamp were older age, lower height, the use of antihypertensive medication, and sleep decrease in arterial stiffness (PWV), whereas female gender, the presence of hypertension, sleep increase of pressure wave reflections (AI), sleep decrease in heart rate, and mean BP were associated with a greater sleep-dipping in PPamp. These data provide further pathophysiological understanding of the mechanisms leading to PPamp dipping. Several implications regarding the clinical use of the aortic and brachial BP, especially during sleep time, are raised that should be addressed in future research.

Comparison of effects between calcium channel blocker and diuretics in combination with angiotensin II receptor blocker on 24-h central blood pressure and vascular hemodynamic parameters in hypertensive patients: study design for a multicenter, double-blinded, active-controlled, phase 4, randomized trial

Background

Hypertension is a risk factor for coronary heart disease and stroke, and is one of the leading causes of death. Although over a billion people are affected worldwide, only half of them receive adequate treatment. Current guidelines on antihypertensive treatment recommend combination therapy for patients not responding to monotherapy, but as the number of pills increase, patient compliance tends to decrease. As a result, fixed-dose combination drugs with different antihypertensive agents have been developed and widely used in recent years. CCBs have been shown to be better at reducing central blood pressure and arterial stiffness than diuretics. Recent studies have reported that central blood pressure and arterial stiffness are associated with cardiovascular outcomes. This trial aims to compare the efficacy of combination of calcium channel blocker (CCB) or thiazide diuretic with an angiotensin receptor blocker (ARB).

Methods

This is a multicenter, double-blinded, active-controlled, phase 4, randomized trial, comparing the antihypertensive effects of losartan/amlodipine and losartan/hydrochlorothiazide in patients unresponsive to treatment with losartan. The primary endpoint is changes in mean sitting systolic blood pressure (msSBP) after 4 weeks of treatment. Secondary endpoints are changes in msSBP, mean 24-h ambulatory mobile blood pressure, mean 24-h ambulatory mobile central SBP, mean 24-h ambulatory carotid-femoral pulse wave velocity, ambulatory augmentation index, and microalbuminuria/proteinuria after 20 weeks of treatment. The sample size will be 119 patients for each group in order to confer enough power to test for non-inferiority regarding the primary outcome.

Conclusion

The investigators aim to prove that combination of a CCB with ARB shows non-inferiority in lowering blood pressure compared with a combination of thiazide diuretic and ARB. We also hope to distinguish the subset of patients that are more responsive to certain types of combination drugs. The results of this study should aid physicians in selecting appropriate combination regimens to treat hypertension in certain populations.

Trial registration

ClinicalTrials.gov NCT02294539. Registered 12 November 2014.

Twenty-Four-Hour Ambulatory Pulse Wave Analysis in Hypertension Management: Current Evidence and Perspectives

The predictive value of vascular biomarkers such as pulse wave velocity (PWV), central arterial pressure (CAP), and augmentation index (AIx), obtained through pulse wave analysis (PWA) in resting conditions, has been documented in a variety of patient groups and populations. This allowed to make appropriate recommendations in clinical practice guidelines of several scientific societies. Due to advances in technologies, largely operator-independent methods are currently available for estimating vascular biomarkers also in ambulatory conditions, over the 24 h. According to the acceptable accuracy and reproducibility of 24-h ambulatory PWA, it appears to be a promising tool for evaluating vascular biomarkers in daily life conditions. This approach may provide an opportunity to further improve the early cardiovascular screening in subjects at risk. However, concerning the clinical use of PWA over the 24 h in ambulatory conditions at the moment, there is no sufficient evidence to support its routine clinical use. In particular, long-term outcome studies are needed to show the predictive value of 24-h PWV, CAP, and AIx values, provided by these devices, over and beyond peripheral blood pressure, and to answer the many technical and clinical questions still open. To this regard, the VASOTENS Registry, an international observational prospective study recently started, will help providing answers on a large sample of hypertensive patients recruited worldwide.

Pulse wave velocity is associated with cognitive impairment in hemodialysis patients

Cognitive impairment in hemodialysis patients is common and associated with adverse outcomes. So far, the underlying pathogenesis remains unclear. Therefore, we examined the potential relationship between cognitive impairment and three different categories of risk factors with particular focus on arterial stiffness measured by pulse wave velocity (PWV). A total of 201 chronic hemodialysis patients underwent cognitive testing under standardized conditions using the Montreal Cognitive Assessment (MoCA). Demographic data including cardiovascular risk factors, dialysis-associated factors as well as factors related to chronic kidney disease (CKD) were analyzed. To account for arterial stiffness, PWV was measured by ambulatory blood pressure monitoried with an oscillometric device that records brachial blood pressure along with pulse waves. In our cohort, 60.2% of patients showed pathological MoCA test results indicating cognitive impairment. PWV was significantly associated with cognitive impairment apart from age, educational level, diabetes, and hypercholesterolemia. High prevalence of cognitive impairment in hemodialysis patients was confirmed. For the first time, an association between cognitive impairment and arterial stiffness was detected in a larger cohort of hemodialysis patients. Concerning the underlying pathogenesis of cognitive impairment, current results revealed a potential involvement of arterial stiffness, which has to be further evaluated in future studies.