Cardiovascular risk in white coat hypertension: An evaluation of the ankle brachial index

Disparity in association of obesity measures with ankle and brachial systolic blood pressures in Europeans and South Asians

Obesity causes increases in brachial systolic-blood-pressures (SBP), risks of type 2 diabetes (T2DM) and cardiovascular diseases (CVD). Brachial and ankle SBPs have differential relationship with T2DM and CVD. Our objective was to study the relationship of obesity measures with brachial and ankle SBPs. A population of 1098 adults (South Asians n = 699; 41.70% male and 58.3% female) were recruited over 5 years from primary care practices in England. Their four limbs SBPs were measured using Doppler machine and body-mass-index (BMI) and waist-to-height-ratio (WHtR) calculated. Linear regressions were performed between SBPs and obesity measures, after adjustments for sex, age, ethnicity, T2DM and CVD. The mean age of all participants was 51.3 (SD = 17.2), European was 57.7 (SD 17.2) and South Asian was 47.8 (SD = 16.1). The left posterior tibial [Beta = 1.179, P = 4.559 × 10⁻¹⁵] and the right posterior tibial SBP [Beta = 1.178, P = 1.114 × 10⁻¹³] most significantly associated with the BMI. In South Asians, although the left brachial [Beta = 25.775, P = 0.032] and right brachial SBP [Beta = 22.792, P = 0.045] were associated to the WHtR, the left posterior tibial SBP [Beta = 39.894, P = 0.023], association was the strongest. For the first time, we have demonstrated that ankle SBPs had significant association with generalised obesity than brachial systolic blood pressures (SBP), irrespective of ethnicity. However, with respect to visceral obesity, the association with ankle SBP was more significant in South Asians compared to Europeans.

Defining the relationship between arm and leg blood pressure readings: a systematic review and meta-analysis

OBJECTIVES

To define the relationship between arm and leg blood pressure (BP) to inform the interpretation of leg BP readings in routine clinical practice where arm readings are not available.

METHODS

Systematic review of all existing studies comparing arm and leg BP measurements. A search strategy was designed in MEDLINE and adapted to be run across six further databases. Articles were deemed eligible for inclusion if they measured and reported arm and leg BP taken in the supine position and/or the difference between the two. Mean values for arm-leg BP difference and measures of precision [95% confidence intervals (CIs) or SD] were extracted and entered into a random-effects meta-analysis.

RESULTS

A total of 887 articles were screened and 44 were included in the descriptive analyses, including 9771 patients. In the general population, ankle SBP was 17.0 mmHg (95% CI 15.4-21.3 mmHg) higher than arm BP in the supine position. For DBP, there was no difference between arm and ankle BP (-0.3 mmHg, 95% CI -1.5-1.0 mmHg). In patients with vascular disease, SBP was -33.3 mmHg (95% CI -59.1 to -7.6 mmHg) lower in the ankle compared with the arm.

CONCLUSION

This is the first review to provide empirical data defining the difference between BP in the arm and leg in the general population. Findings suggest a diagnostic threshold of 155/90 mmHg could be used for diagnosing hypertension when only ankle measurements are available in routine practice.

The association of circulating miR-30a, miR-29 and miR-133 with white-coat hypertension

AIM

The aim of the present study was to investigate the association of circulating miRNAs with white-coat hypertension (WCH) and further analyze whether miRNAs could be as potential biomarkers for WCH.

METHOD

Quantitative reverse transcriptase PCR (qRT-PCR) was used to evaluate the expression of selected miRNAs. The area under the receiver-operating characteristic curve was used to evaluate diagnostic accuracy.

RESULTS

MiR-30a yielded an AUC of 0.984 (95% CI: 0.001-1.00; p < 0.001) and 0.816 (95% CI: 0.718-0.915; p < 0.001); miR-29 yielded an AUC of 0.955 (95% CI: 0.913-0.998; p < 0.001) and 0.799 (95% CI: 0.697-0.902; p < 0.001); miR-133 yielded an AUC of 0.949 (95% CI: 0.900-0.999; p < 0.001) and 0.713 (95% CI: 0.593-0.834; p < 0.001), respectively.

CONCLUSION

The study suggested that miR-30a, miR-29 and miR-133 have great potential to be noninvasive screening tools for WCH detection.

Use of noninvasive procedures in the cardiovascular risk assessment of hypertensive and normotensive individuals

BACKGROUND

Arterial hypertension is associated with a high prevalence of vascular alterations. The use of noninvasive procedures to assess peripheral arterial diseases in the ranking of cardiovascular risks has been increasingly valued in clinical practice and should be adopted in nursing.

OBJECTIVE

To identify the cardiovascular risk of hypertensive and normotensive individuals through the use of different noninvasive procedures to assess the vascular function and integrity: ankle-brachial index, pulse pressure, and delta brachial-brachial and delta ankle-brachial indexes.

METHODS

Quantitative, descriptive, and cross-sectional study undertaken at a health service in a Brazilian city. The research variables were age, sex, blood pressure, abdominal circumference, body mass index, ankle-brachial index, pulse pressure, and delta brachial-brachial and delta ankle-brachial indexes.

RESULTS

Fifty-four (43.1%) normotensive and 69 (56.9%) hypertensive individuals participated in the study. Alterations were identified in ankle-brachial index, corresponding to mild and moderate arterial obstruction, among hypertensive individuals only (7.2%), with higher pulse pressure indices (P < 0.0001). The assessment of the correlation between the ankle-brachial index and pulse pressure showed no correlation in the normotensive group and a statistically significant correlation among hypertensive patients (Pearson's coefficient = -0.45, P < 0.0001, r(2) = 0.21). A statistically significant difference (P < 0.05) was found in the analysis of the mean delta brachial-brachial (6.2 ± 0.71 mm Hg for normotensive and 10.16 ± 1.45 mm Hg for hypertensive individuals) and delta ankle-brachial index (0.06 ± 0.01 for normotensive and 0.11 ± 0.01 for hypertensive individuals).

CONCLUSIONS

The use of the proposed cardiovascular risk predictors shows more frequent alterations among hypertensive than normotensive individuals.