1
|
Mizoguchi T, Sugiura T, Kawada Y, Yamamoto J, Yokoi M, Nakasuka K, Mori K, Kikuchi S, Ito T, Kitada S, Goto T, Seo Y. Association Between Aortic Stiffness and Exercise Tolerance in Patients at the Risk Stage of Heart Failure. Circ J 2023; 87:1075-1084. [PMID: 36948631 DOI: 10.1253/circj.cj-22-0772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
BACKGROUND The number of patients with heart failure (HF) has increased, and it is crucial to prevent the development of HF in patients at risk of HF. The present study aimed to risk stratify patients in Stage A and B HF based on associations between exercise-induced changes in aortic stiffness and exercise tolerance. METHODS AND RESULTS Patients in Stage A and B HF who performed a cardiopulmonary exercise test were enrolled in the study (n=106; median age 65.0 years [interquartile range 52.8-73.0 years]). Exercise tolerance was examined by the percentage of predicted peak oxygen consumption (%V̇O2peak). The ascending aortic pressure waveform was estimated non-invasively. Aortic stiffness was assessed using the augmentation index (AIx) and reflection magnitude (RM). Multivariable regression analysis showed that AIx measured both before and after exercise was significantly associated with %V̇O2peak (β=-0.221 [P=0.049] and β=-0.342 [P=0.003], respectively). When participants were divided into %V̇O2peak subgroups using a cut-off value of 60%, RM decreased immediately after exercise and remained lower 5 min after exercise in the group with preserved exercise tolerance, but recovered to baseline levels 5 min after exercise in the group with reduced exercise tolerance. CONCLUSIONS Exercise-induced increases in aortic stiffness were associated with exercise tolerance in patients at risk of HF, suggesting that exercise-induced changes in aortic stiffness may be useful to stratify high-risk patients.
Collapse
Affiliation(s)
- Tatsuya Mizoguchi
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Tomonori Sugiura
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Yu Kawada
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Junki Yamamoto
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Masashi Yokoi
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Kosuke Nakasuka
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Kento Mori
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Shohei Kikuchi
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Tsuyoshi Ito
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Shuichi Kitada
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Toshihiko Goto
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Yoshihiro Seo
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| |
Collapse
|
2
|
Yofoglu LK, Karachalias F, Georgakis MK, Tountas C, Argyris AA, Zhang Y, Papaioannou TG, Blacher J, Weber T, Vlachopoulos C, Safar M, Protogerou AD. Association of Pressure Wave Reflections With Left Ventricular Mass: a Systematic Review and Meta-Analysis. Hypertension 2023; 80:e29-e42. [PMID: 36583390 DOI: 10.1161/hypertensionaha.122.19980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Pressure wave reflections (PWRs) within the circulation are assessed at various arterial sites by various noninvasive methods. We aimed at reviewing the conflicting data regarding the hypothesis that higher PWRs are associated with higher left ventricular mass and tested whether this association stands for all available indices of PWRs, all (proximal or distal to the heart) sites of assessment, and is modified by sex, age and heart rate. METHODS Based on a predefined protocol applying the Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines, we identified eligible for meta-analysis data regarding: augmentation index, augmentation pressure, backward pressure (Pb), reflection index, and their association with left ventricular mass index (19 studies, total population n=8686). RESULTS We found statistically significant associations, independent from blood pressure level, for all indices of PWRs at all arterial sites (carotid augmentation index; odds ratio; standardized beta coefficient [β]: 0.14 [95% CI, 0.07% to 0.21%], per SD increase), radial augmentation index (β: 0.21; 0.11 to 0.31), central augmentation pressure (β: 0.15; 0.03 to 0.27), central Pb (β: 0.23; 0.05 to 0.42), and central reflection index (β: 0.14; 0.06 to 0.22), except for aortic augmentation index as estimated by generalized transfer functions. Meta-regression analysis showed that the association between carotid augmentation index and left ventricular mass was higher among populations with higher heart rate (P=0.036, beta: 0.017 [95% CI, 0.001 to 0.033]) and tended to be higher in middle-aged (P=0.07, beta: -0.001; -0.021 to 0.001). CONCLUSIONS A clinically meaningful association between PWRs and left ventricular mass, assessed at either central or peripheral arterial sites by most available methods was shown, suggesting that PWR reduction strategies might be useful. Based on the present evidence, such trials should target middle-aged populations with high normal heart rate.
Collapse
Affiliation(s)
- Lazaros K Yofoglu
- Cardiovascular Prevention and Research Unit, Clinic/Laboratory of Pathophysiology, Medical School, National and Kapodistrian University of Athens, Greece (L.K.Y., F.K., C.T., A.A.A., A.D.P.)
| | - Fotios Karachalias
- Cardiovascular Prevention and Research Unit, Clinic/Laboratory of Pathophysiology, Medical School, National and Kapodistrian University of Athens, Greece (L.K.Y., F.K., C.T., A.A.A., A.D.P.)
| | - Marios K Georgakis
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Germany (M.K.G.)
| | - Christos Tountas
- Cardiovascular Prevention and Research Unit, Clinic/Laboratory of Pathophysiology, Medical School, National and Kapodistrian University of Athens, Greece (L.K.Y., F.K., C.T., A.A.A., A.D.P.)
| | - Antonios A Argyris
- Cardiovascular Prevention and Research Unit, Clinic/Laboratory of Pathophysiology, Medical School, National and Kapodistrian University of Athens, Greece (L.K.Y., F.K., C.T., A.A.A., A.D.P.)
| | - Yi Zhang
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, China (Y.Z.)
| | - Theodoros G Papaioannou
- Biomedical Engineering Unit, 1st Department of Cardiology, "Hippokration" Hospital, Medical School of the National and Kapodistrian University of Athens, Greece (T.G.P.)
| | - Jacques Blacher
- Paris Descartes University, AP-HP, Diagnosis and Therapeutic Center, Hôtel-Dieu, Paris, France (J.B., M.S.)
| | - Thomas Weber
- Cardiology Department, Klinikum Wels-Grieskirchen, Austria (T.W.)
| | | | - Michel Safar
- Paris Descartes University, AP-HP, Diagnosis and Therapeutic Center, Hôtel-Dieu, Paris, France (J.B., M.S.)
| | - Athanase D Protogerou
- Cardiovascular Prevention and Research Unit, Clinic/Laboratory of Pathophysiology, Medical School, National and Kapodistrian University of Athens, Greece (L.K.Y., F.K., C.T., A.A.A., A.D.P.)
| |
Collapse
|
3
|
Arterial Blood-Flow Acceleration Time on Doppler Ultrasound Waveforms: What Are We Talking About? J Clin Med 2023; 12:jcm12031097. [PMID: 36769746 PMCID: PMC9917724 DOI: 10.3390/jcm12031097] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/13/2023] [Accepted: 01/24/2023] [Indexed: 02/01/2023] Open
Abstract
In recent years, the assessment of systolic acceleration in lower-extremity peripheral artery disease (PAD) has been brought back into the spotlight, whatever measure is used: time (in s) or acceleration (in cm.s-2). Acceleration time (also called systolic rise time) and maximal acceleration are two different but very useful measurements of growing interest in PAD. A background of the historical development, physics rationale, semantics, and methods of measurement, as well as their strengths and weaknesses, are discussed herein. Acceleration time is a powerful tool for predicting significant arterial stenosis or for estimating the overall impact of PAD as it is highly correlated to the ankle or toe pressure indexes. It could even become a new diagnostic criterion for critical limb ischemia. Similarly, maximal systolic acceleration ratios are highly predictive of carotid or renal stenosis. However, the literature lacks reference standards or guidelines for the assessment of such variables, and their measurement techniques seem to differ between authors. We propose herein a semantic and measurement statement order to clarify and help standardize future research.
Collapse
|
4
|
Liu Y, Hirata A, Okamura T, Sugiyama D, Hirata T, Kadota A, Kondo K, Ohkubo T, Miura K, Okayama A, Ueshima H. Impact of resting heart rate on cardiovascular mortality according to serum albumin levels in a 24-year follow-up study on a general Japanese population: NIPPON DATA80. J Epidemiol 2021; 33:227-235. [PMID: 34511560 PMCID: PMC10043153 DOI: 10.2188/jea.je20210114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BackgroundElevated resting heart rate (RHR) is associated with an increased risk for cardiovascular disease (CVD) and all-cause mortality. However, the findings of cohort studies differed. Thus, the impact of RHR on CVD mortality might be different according to the background of the population. Therefore, we examined the relationship of RHR and CVD mortality according to serum ALB levels in a Japanese general population.MethodsIn total, 8363 individuals without a history of CVD were followed-up for 24.0 years. The participants were divided into four groups according to the quartiles of RHR (Q1-Q4), and they were further classified into the high and low ALB groups based on a median value of 44 g/L. We estimated the multivariable-adjusted hazard ratios (HRs) of CVD mortality in each RHR group based on ALB levels, and the interaction between RHR and ALB groups on CVD mortality was evaluated.ResultsWe found no significant association between RHR and CVD mortality. However, the Q4 of RHR was significantly associated with an increased risk for CVD mortality (HR: 1.27 [95% confidence interval, CI: 1.02-1.57]) in participants with a low ALB level. Meanwhile, the Q4 of RHR was significantly correlated with a decreased risk for CVD morality in those with a high ALB level (HR: 0.61 [95% CI: 0.47-0.79]) after adjusting for covariates. A significant interaction between RHR and ALB for CVD mortality was shown (p<0.001).ConclusionsThe impact of RHR on CVD mortality differed according to ALB levels in a general Japanese population.
Collapse
Affiliation(s)
- Yiwei Liu
- Department of Preventive Medicine and Public Health, Keio University School of Medicine
| | - Aya Hirata
- Department of Preventive Medicine and Public Health, Keio University School of Medicine
| | - Tomonori Okamura
- Department of Preventive Medicine and Public Health, Keio University School of Medicine
| | | | - Takumi Hirata
- Department of Public Health, Hokkaido University Faculty of Medicine
| | - Aya Kadota
- Department of Public Health, Shiga University of Medical Science
| | - Keiko Kondo
- Department of Public Health, Shiga University of Medical Science
| | - Takayoshi Ohkubo
- Department of Hygiene and Public Health, Teikyo University School of Medicine
| | - Katsuyuki Miura
- Department of Public Health, Shiga University of Medical Science.,Center for Epidemiologic Research in Asia, Shiga University of Medical Science
| | | | - Hirotsugu Ueshima
- Department of Public Health, Shiga University of Medical Science.,Center for Epidemiologic Research in Asia, Shiga University of Medical Science
| |
Collapse
|
5
|
Stock JM, Chirinos JA, Edwards DG. Lower-body dynamic exercise reduces wave reflection in healthy young adults. Exp Physiol 2021; 106:1720-1730. [PMID: 33999464 DOI: 10.1113/ep089581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/14/2021] [Indexed: 11/08/2022]
Abstract
NEW FINDINGS What is the central question of this study? There is a paradoxical reduction in augmentation index during lower-body dynamic (LBD) exercise in the face of an increase in central pressure. To determine causality, the amplitudes of forward and backward pressure waves were assessed separately using wave separation analysis. What is the main finding and its importance? Reflection magnitude decreased during LBD exercise in healthy young adults and was attributable to an increased forward pressure wave amplitude and decreased backward pressure wave amplitude. This vasoactive response might limit the adverse effects of wave reflection during LBD exercise, optimizing ventricular-arterial interactions. ABSTRACT Acute lower-body dynamic (LBD) exercise decreases surrogate measures of wave reflection, such as the augmentation index. However, the augmentation index is influenced by the combined effects of wave reflection timing, magnitude and other confounding factors external to wave reflection, which make it difficult to discern the origin of changes in surrogate measures. The relative contributions of forward (Pf) and backward (Pb) pressure wave amplitudes to central pressure can be determined by wave separation analysis. Reflection magnitude (RM = Pb/Pf) and the timing of apparent wave reflection return can also be determined. We tested the hypothesis that acute LBD exercise decreases RM and reflected wave transit time (RWTT). Applanation tonometry was used to record radial artery pressure waveforms in 25 adults (24 ± 4 years of age) at baseline and during light-, moderate- and vigorous-intensity exercise. Wave separation analysis was conducted offline using a personalized physiological flow wave to determine Pf, Pb, RM and RWTT. The RM decreased during all intensities of exercise compared with baseline (all P < 0.001; baseline, 43 ± 5%; light, 33 ± 6%; moderate, 23 ± 7%; vigorous, 17 ± 5%). The reduction in RM was attributable to the combined effect of increased Pf and decreased Pb during exercise. The RWTT decreased during all intensities of exercise compared with baseline (all P < 0.04; baseline, 156 ± 17 ms; light, 144 ± 15 ms; moderate, 129 ± 16 ms; vigorous, 121 ± 17 ms). Lastly, in a stepwise multilinear regression, Pf, but not Pb and RWTT, contributed to increased central pulse pressure during LBD exercise. These data show that wave reflection decreased and that central pulse pressure is most influenced by Pf during LBD exercise.
Collapse
Affiliation(s)
- Joseph M Stock
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, USA
| | - Julio A Chirinos
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David G Edwards
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, USA
| |
Collapse
|
6
|
Stock JM, Chouramanis NV, Chirinos JA, Edwards DG. Dynamic and isometric handgrip exercise increases wave reflection in healthy young adults. J Appl Physiol (1985) 2020; 129:709-717. [PMID: 32853105 PMCID: PMC7654685 DOI: 10.1152/japplphysiol.00281.2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/30/2020] [Accepted: 08/19/2020] [Indexed: 02/03/2023] Open
Abstract
Early return and increased magnitude of wave reflection augments pulsatile load, wastes left ventricular effort, and is associated with cardiovascular events. Acute handgrip (HG) exercise increases surrogate measures of wave reflection such as augmentation index. However, augmentation index does not allow distinguishing between timing versus magnitude of wave reflection and is affected by factors other than wave reflection per se. Wave separation analysis decomposes central pressure into relative contributions of forward (Pf) and backward (Pb) pressure wave amplitudes to calculate reflection magnitude (RM = Pb/Pf) and determine the timing of apparent wave reflection return. We tested the hypothesis that acute dynamic and isometric HG exercise increases RM and decreases reflected wave transit time (RWTT). Applanation tonometry was used to record radial artery pressure waveforms in 30 adults (25 ± 4 yr) at baseline and during dynamic and isometric HG exercise. Wave separation analysis was performed offline using a physiological flow wave to derive Pf, Pb, RM, and RWTT. We found that RM increased during dynamic and isometric HG exercise compared with baseline (P = 0.04 and P < 0.01, respectively; baseline 40 ± 5, dynamic 43 ± 6, isometric 43 ± 7%). Meanwhile, RWTT decreased during dynamic and isometric HG exercise compared with baseline (P = 0.03 and P < 0.001, respectively; baseline 164 ± 23, dynamic 155 ± 23, isometric 148 ± 20 ms). Moreover, the changes in RM and RWTT were not different between dynamic and isometric HG exercise. The present data suggest that wave reflection timing (RWTT) and magnitude (RM) are important factors that contribute to increased central blood pressure during HG exercise.NEW & NOTEWORTHY This study demonstrated that wave reflection magnitude is increased while reflected wave transit time is decreased during handgrip exercise in healthy young adults. The larger backward pressure waves and earlier return of these pressure waves were not different between dynamic and isometric handgrip exercise. These acute changes in wave reflection during handgrip exercise transiently augment pulsatile load.
Collapse
Affiliation(s)
- Joseph M Stock
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware
| | - Nicholas V Chouramanis
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware
| | - Julio A Chirinos
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - David G Edwards
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware
| |
Collapse
|
7
|
Effects of Whey Protein Supplementation on Aortic Stiffness, Cerebral Blood Flow, and Cognitive Function in Community-Dwelling Older Adults: Findings from the ANCHORS A-WHEY Clinical Trial. Nutrients 2020; 12:nu12041054. [PMID: 32290271 PMCID: PMC7230701 DOI: 10.3390/nu12041054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 12/19/2022] Open
Abstract
ANCHORS A-WHEY was a 12-week randomized controlled trial (RCT) designed to examine the effect of whey protein on large artery stiffness, cerebrovascular responses to cognitive activity and cognitive function in older adults. Methods: 99 older adults (mean ± SD; age 67 ± 6 years, BMI 27.2 ± 4.7kg/m2, 45% female) were randomly assigned to 50g/daily of whey protein isolate (WPI) or an iso-caloric carbohydrate (CHO) control for 12 weeks (NCT01956994). Aortic stiffness was determined as carotid-femoral pulse wave velocity (cfPWV). Aortic hemodynamic load was assessed as the product of aortic systolic blood pressure and heart rate (Ao SBP × HR). Cerebrovascular response to cognitive activity was assessed as change in middle-cerebral artery (MCA) blood velocity pulsatility index (PI) during a cognitive perturbation (Stroop task). Cognitive function was assessed using a computerized neurocognitive battery. Results: cfPWV increased slightly in CHO and significantly decreased in WPI (p < 0.05). Ao SBP × HR was unaltered in CHO but decreased significantly in WPI (p < 0.05). Although emotion recognition selectively improved with WPI (p < 0.05), WPI had no effect on other domains of cognitive function or MCA PI response to cognitive activity (p > 0.05 for all). Conclusions: Compared to CHO, WPI supplementation results in favorable reductions in aortic stiffness and aortic hemodynamic load with limited effects on cognitive function and cerebrovascular function in community-dwelling older adults.
Collapse
|
8
|
Uemura K, Nishikawa T, Kawada T, Sugimachi M. Comprehensive analysis of effective reflection distance and its association with wave reflection strength under diverse hemodynamic conditions in anesthetized dogs. J Biomech 2020; 104:109753. [PMID: 32209244 DOI: 10.1016/j.jbiomech.2020.109753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 03/10/2020] [Accepted: 03/13/2020] [Indexed: 11/27/2022]
Abstract
Pressure wave reflection is associated with cardiovascular risk. The conceptual distance to a theoretical major reflection site, termed effective reflection distance (ERD), has been associated with aging and augmentation index (AIx) clinically. However, it remains unclear whether and how ERD varies and associates with AIx when the hemodynamic condition is acutely perturbed in a patient. The objective of this study was to address this issue in rigorously controlled animal experiments. In 13 anesthetized dogs, we measured arterial pressure, aortic flow and femoral arterial flow, while altering the hemodynamic condition over wide ranges by administering zatebradine (bradycardic agent), nitroprusside (vasodilator), noradrenaline (vasoconstrictor), dobutamine (inotrope), and dextran (volume-expander). Using the measured data, we determined ERD based on an arterial model comprising a tube with a complex frequency-dependent load (ERDTL), which has been considered a physiologically valid model. We also determined ERD based on wave separation (ERDWSA) and pressure-based analyses (ERDAW). ERDTL was shortened significantly in response to nitroprusside or dobutamine infusion, and was significantly and negatively associated with AIx in multiple regression analysis using pooled data. ERDWSA or ERDAW did not necessarily correlate with ERDTL in terms of responses to drug administration or association with AIx. In conclusion, under diverse hemodynamic conditions, ERDTL changes sensitively and shows physiologically reasonable association with AIx. This result substantiates the importance of paying close attention to medications during clinical analysis of wave reflection. Caution is required when using ERDWSA or ERDAW as an alternative to ERDTL.
Collapse
Affiliation(s)
- Kazunori Uemura
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Suita 564-8565, Japan.
| | - Takuya Nishikawa
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Suita 564-8565, Japan
| | - Toru Kawada
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Suita 564-8565, Japan
| | - Masaru Sugimachi
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Suita 564-8565, Japan
| |
Collapse
|
9
|
Kouvas N, Tsioufis C, Vogiatzakis N, Sanidas E, Konstantinidis D, Kintis K, Dimitriadis K, Kakosaiou Z, Tsioufis P, Kouremeti M, Katsiki N, Tousoulis D. Heart Rate and Blood Pressure: "Connecting the Dots" in Epidemiology and Pathophysiology. Angiology 2017; 69:660-665. [PMID: 29232971 DOI: 10.1177/0003319717746524] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
There is robust evidence from epidemiological and clinical studies showing that elevated heart rate (HR) constitutes a powerful predictor of morbidity and mortality in patients with hypertension, underlining the significance of HR measurement in them. Autonomous nervous system dysfunction and atherosclerosis are important features in the pathogenesis of the untoward events. However, the relationship between HR and blood pressure (BP) is complex and differs depending on the type of BP measurement which is considered. This differentiation implicates complex physiological mechanisms and is of clinical importance regarding the divergent effect of the different types of antihypertensive agents on these parameters. The aim of this review is to summarize the current evidence on the relationship between HR and BP based on epidemiological, clinical, and experimental studies.
Collapse
Affiliation(s)
- Nikos Kouvas
- 1 First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Costas Tsioufis
- 1 First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Nikolaos Vogiatzakis
- 1 First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Elias Sanidas
- 2 Department of Cardiology, LAIKO General Hospital, Athens, Greece
| | - Dimitrios Konstantinidis
- 1 First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Konstantinos Kintis
- 1 First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Kyriakos Dimitriadis
- 1 First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Zoi Kakosaiou
- 1 First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Panagiotis Tsioufis
- 1 First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Mairi Kouremeti
- 1 First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Niki Katsiki
- 3 Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - Dimitrios Tousoulis
- 1 First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| |
Collapse
|
10
|
Tan I, Kiat H, Barin E, Butlin M, Avolio AP. Effects of pacing modality on noninvasive assessment of heart rate dependency of indices of large artery function. J Appl Physiol (1985) 2016; 121:771-780. [PMID: 27471239 DOI: 10.1152/japplphysiol.00445.2016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 07/26/2016] [Indexed: 01/09/2023] Open
Abstract
Studies investigating the relationship between heart rate (HR) and arterial stiffness or wave reflections have commonly induced HR changes through in situ cardiac pacing. Although pacing produces consistent HR changes, hemodynamics can be different with different pacing modalities. Whether the differences affect the HR relationship with arterial stiffness or wave reflections is unknown. In the present study, 48 subjects [mean age, 78 ± 10 (SD), 9 women] with in situ cardiac pacemakers were paced at 60, 70, 80, 90, and 100 beats per min under atrial, atrioventricular, or ventricular pacing. At each paced HR, brachial cuff-based pulse wave analysis was used to determine central hemodynamic parameters, including ejection duration (ED) and augmentation index (AIx). Wave separation analysis was used to determine wave reflection magnitude (RM) and reflection index (RI). Arterial stiffness was assessed by carotid-femoral pulse wave velocity (cfPWV). Pacing modality was found to have significant effects on the HR relationship with ED (P = 0.01), central aortic pulse pressure (P = 0.01), augmentation pressure (P < 0.0001), and magnitudes of both forward and reflected waves (P = 0.05 and P = 0.003, respectively), but not cfPWV (P = 0.57) or AIx (P = 0.38). However, at a fixed HR, significant differences in pulse pressure amplification (P < 0.001), AIx (P < 0.0001), RM (P = 0.03), and RI (P = 0.03) were observed with different pacing modalities. These results demonstrate that although the HR relationships with arterial stiffness and systolic loading as measured by cfPWV and AIx were unaffected by pacing modality, it should still be taken into account for studies in which mixed pacing modalities are present, in particular, for wave reflection studies.
Collapse
Affiliation(s)
- Isabella Tan
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Hosen Kiat
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia; Cardiac Health Institute, Sydney, Australia; and
| | - Edward Barin
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia; Macquarie Heart, Sydney, Australia
| | - Mark Butlin
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia;
| | - Alberto P Avolio
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| |
Collapse
|
11
|
Catalano M, Scandale G, Carzaniga G, Cinquini M, Minola M, Antoniazzi V, Dimitrov G, Carotta M. Aortic augmentation index in patients with peripheral arterial disease. J Clin Hypertens (Greenwich) 2014; 16:782-7. [PMID: 25228305 PMCID: PMC8031844 DOI: 10.1111/jch.12406] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 07/22/2014] [Accepted: 07/22/2014] [Indexed: 01/09/2023]
Abstract
Aortic augmentation index (AIx) is used to investigate arterial stiffness. The authors tested the hypothesis that patients with peripheral arterial disease (PAD) demonstrate a higher AIx and also evaluated several related factors. In 97 patients with PAD, identified by ankle-brachial pressure index (ABPI ≤ 0.9), and 97 controls (ABPI ≥ 0.91< 1.4), AIx (%) was determined using tonometry of the radial artery. There was no significant difference between patients and controls in characteristics of age, sex, height, diastolic blood pressure, mean blood pressure, and heart rate. AIx was higher in patients with PAD (32 ± 9 vs 28 ± 9; P = .001). In multivariate regression analysis, AIx was independently associated with heart rate (β = -0.40, P = .0005). This study showed that AIx increased in patients with PAD and that heart rate is a determinant of AIx. Further studies are necessary to assess the pathophysiological and clinical importance of AIx in patients with PAD.
Collapse
Affiliation(s)
- Mariella Catalano
- Research Center on Vascular Diseases and Angiology UnitUniversity of MilanMilanItaly
| | - Giovanni Scandale
- Research Center on Vascular Diseases and Angiology UnitUniversity of MilanMilanItaly
| | - Gianni Carzaniga
- Research Center on Vascular Diseases and Angiology UnitUniversity of MilanMilanItaly
| | - Michela Cinquini
- Laboratory for the Development of New Pharmacological StrategiesDepartment of OncologyMario Negri Institute for Pharmacological ResearchMilanItaly
| | - Marzio Minola
- Research Center on Vascular Diseases and Angiology UnitUniversity of MilanMilanItaly
| | - Valeria Antoniazzi
- Research Center on Vascular Diseases and Angiology UnitUniversity of MilanMilanItaly
| | - Gabriel Dimitrov
- Research Center on Vascular Diseases and Angiology UnitUniversity of MilanMilanItaly
| | - Maria Carotta
- Research Center on Vascular Diseases and Angiology UnitUniversity of MilanMilanItaly
| |
Collapse
|
12
|
Kim DH, Braam B. Assessment of arterial stiffness using applanation tonometry. Can J Physiol Pharmacol 2013; 91:999-1008. [PMID: 24289069 DOI: 10.1139/cjpp-2013-0010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Augmentation index (AIx) and pulse wave velocity (PWV) assess functional and structural aspects of the vascular wall and are independent markers of cardiovascular morbidity and mortality. Like blood pressure, many factors, genetic, structural, and physiological, affect AIx and PWV. AIx and PWV can be assessed noninvasively using applanation tonometry. The technique is simple, but comes with a number of practical and technical limitations that have not been well documented and (or) explored. This review considers pulse wave analysis in the context of cardiovascular disease, and considers its limitations. Data are presented indicating that the placement of the probe is critical, and that the amplitude of the obtained signal is related to the variability in measurements. On a more theoretical note, issues are discussed regarding the applied transfer functions that are built in the devices to assess central AIx from peripheral waveforms. Altogether, PWV and its analysis are useful additions to the arsenal of parameters that can be used to assess vascular health and to estimate vascular risk. Yet, our analysis underscores the necessity for precise operating procedures, and calls for transparency regarding the applied transfer functions of commercial devices.
Collapse
Affiliation(s)
- David H Kim
- a Department of Medicine, Division of Nephrology and Immunology, University of Alberta Hospital, 11-132 Clinical Sciences Building, Edmonton AB T6G 2G3, Canada
| | | |
Collapse
|
13
|
van der Graaf AM, Zeeman GG, Groen H, Roberts C, Dekker GA. Non-invasive assessment of maternal hemodynamics in early pregnancy. Pregnancy Hypertens 2013; 3:261-9. [PMID: 26103806 DOI: 10.1016/j.preghy.2013.07.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 07/25/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Non-invasive assessment of maternal hemodynamics in early pregnancy may be promising in evaluating maternal hemodynamic (mal)adaptation to pregnancy. We explored usage of applanation tonometry and Doppler ultrasound for assessment of cardiac output (CO), systemic vascular resistance (SVR) and arterial stiffness in early pregnancy. METHODS Pregnant healthy nulliparous women were studied during first trimester. Radial artery pressure waveform (augmentation index(AIx)), carotid-femoral pulse wave velocity (PWV) and cardiac output (CO) were measured by applanation tonometry (SphygmoCor), electrocardiogram and Doppler ultrasound (USCOM) and related to maternal demographic characteristics and literature concerning advanced pregnancy and non-pregnant subjects. RESULTS 116 women were studied during gestational age range of 7(+2)-14weeks. Systolic and diastolic central blood pressure were correlated with systolic and diastolic brachial blood pressure respectively. Both measures of arterial stiffness (heart rate corrected AIx(AIx@75) and PWV) were correlated. AIx@75, PWV and SVR were correlated with central mean arterial pressure. CO was negatively correlated with AIx and associated with BMI. PWV was associated with age and BMI, whereas SVR was associated with age. CONCLUSIONS Applanation tonometry and Doppler Ultrasound for assessment of maternal hemodynamics in early pregnancy revealed similar associations between different hemodynamic parameters and maternal characteristics as have previously been reported in advanced pregnancy and non-pregnant subjects. The SphygmoCor and the USCOM appear to be reliable methods for the assessment of maternal hemodynamics in early pregnancy. Obtaining a comprehensive hemodynamic profile using these modalities may offer insight in maternal (mal)adaptation to pregnancy. Future work needs to be done relating such measures to pregnancy outcome.
Collapse
Affiliation(s)
- Anne Marijn van der Graaf
- Department of Obstetrics and Gynecology, Lyell McEwin Hospital, University of Adelaide, Adelaide, South Australia, Australia; Department of Obstetrics and Gynecology, University Medical Center Groningen, Groningen, The Netherlands; GUIDE, University Medical Center Groningen, Groningen, The Netherlands.
| | - Gerda G Zeeman
- Department of Obstetrics and Gynecology, University Medical Center Groningen, Groningen, The Netherlands.
| | - Henk Groen
- Department of Epidemiology, University Medical Center Groningen, Groningen, The Netherlands.
| | - Claire Roberts
- Department of Obstetrics and Gynecology, Lyell McEwin Hospital, University of Adelaide, Adelaide, South Australia, Australia.
| | - Gus A Dekker
- Department of Obstetrics and Gynecology, Lyell McEwin Hospital, University of Adelaide, Adelaide, South Australia, Australia.
| |
Collapse
|
14
|
Heart rate and blood pressure: any possible implications for management of hypertension? Curr Hypertens Rep 2013; 14:478-84. [PMID: 22972532 DOI: 10.1007/s11906-012-0306-3] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Hypertension is a common clinical problem and a major risk factor for cardiovascular disease and stroke. Elevated heart rate is associated with elevated blood pressure, increased risk for hypertension, and, among hypertensives, increased risk for cardiovascular disease. Despite these important relationships, heart rate is generally not a major consideration in choosing antihypertensive medications. In part, this is due to a lack of evidence supporting heart rate lowering as a therapeutic strategy in hypertension. Additionally, while there is a positive correlation between heart rate and peripheral blood pressure, there is an inverse relationship between heart rate and central blood pressure. The use of antihypertensive medications, specifically medications that affect heart rate, may not reliably reduce central blood pressure to a similar extent as observed peripherally. We review the relationship between heart rate and peripheral and central blood pressure, with a focus on the implications for chronotropic therapy in hypertension.
Collapse
|
15
|
Maio R, Miceli S, Sciacqua A, Leone GG, Bruni R, Naccarato P, Martino F, Sesti G, Perticone F. Heart rate affects endothelial function in essential hypertension. Intern Emerg Med 2013; 8:211-9. [PMID: 21559746 DOI: 10.1007/s11739-011-0618-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Accepted: 04/27/2011] [Indexed: 10/18/2022]
Abstract
Increased heart rate (HR) is a risk factor for cardiovascular morbidity and mortality in the general population and in some clinical conditions. Endothelial dysfunction is an adverse prognostic factor for cardiovascular events. The aim of the study was to evaluate the effect of HR on central hemodynamic parameters and endothelial function in hypertension. We evaluated forearm blood flow (FBF) response to intra-arterial infusion of acetylcholine (ACh) and sodium nitroprusside (SNP) in 30 patients with HR ≤60 min(-1) and 30 with HR ≥80 min(-1). The FBF was measured by strain-gauge plethysmography. Transesophageal atrial pacing was used to increase the HR. Radial artery applanation tonometry and pulse wave analysis were used to derive central aortic pressures and correlate hemodynamic indices. The FBF response to ACh is lower in hypertensives with HR ≤60 min(-1) than in those with HR ≥80 min(-1) (10.6 ± 4.2 vs. 13.6 ± 5.1 ml × 100 ml(-1) of tissue × min(-1), P < 0.001). Vascular resistance decreases to 9.3 ± 2.8 U in patients with lower HR versus 7.2 ± 2.1 U in those with higher HR (P = 0.002). The FBF response to SNP is similar in both groups. Central systolic and pulse pressure are higher in bradycardic patients than in those with HR ≥80 min(-1) (140 ± 8 vs. 131 ± 8 mmHg, P = 0.0001 and 49 ± 10 vs. 39 ± 11 mmHg, P = 0.0001). All central hemodynamic parameters decrease during incremental atrial pacing. Augmentation index is the strongest predictor of endothelial dysfunction at multivariate analysis. These findings demonstrate that low HR affects endothelium-dependent vasodilation in hypertension. Increased central aortic pressure and hemodynamic correlates seem to be the underlying mechanisms by which bradycardia interferes with endothelium-dependent reactivity.
Collapse
Affiliation(s)
- Raffaele Maio
- Department of Experimental and Clinical Medicine G. Salvatore, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Heffernan KS, Manini TM, Hsu FC, Blair SN, Nicklas BJ, Kritchevsky SB, Newman AB, Sutton-Tyrrell K, Church TS, Haskell WL, Fielding RA. Relation of pulse pressure to long-distance gait speed in community-dwelling older adults: findings from the LIFE-P study. PLoS One 2012. [PMID: 23185357 PMCID: PMC3503986 DOI: 10.1371/journal.pone.0049544] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background Reduced gait speed is associated with falls, late-life disability, hospitalization/institutionalization and cardiovascular morbidity and mortality. Aging is also accompanied by a widening of pulse pressure (PP) that contributes to ventricular-vascular uncoupling. The purpose of this study was to test the hypothesis that PP is associated with long-distance gait speed in community-dwelling older adults in the Lifestyle Interventions and Independence for Elders Pilot (LIFE-P) study. Methods Brachial blood pressure and 400-meter gait speed (average speed maintained over a 400-meter walk at “usual” pace) were assessed in 424 older adults between the ages of 70–89 yrs at risk for mobility disability (mean age = 77 yrs; 31% male). PP was calculated as systolic blood pressure (BP) – diastolic BP. Results Patients with a history of heart failure and stroke (n = 42) were excluded leaving 382 participants for final analysis. When categorized into tertiles of PP, participants within the highest PP tertile had significantly slower gait speed than those within the lowest PP tertile (p<0.05). Following stepwise multiple regression, PP was significantly and inversely associated with 400-meter gait speed (p<0.05). Other significant predictors of gait speed included: handgrip strength, body weight, age and history of diabetes mellitus (p<0.05). Mean arterial pressure, systolic BP and diastolic BP were not predictors of gait speed. Conclusions Pulse pressure is associated long-distance gait speed in community-dwelling older adults. Vascular senescence and altered ventricular-vascular coupling may be associated with the deterioration of mobility and physical function in older adults.
Collapse
Affiliation(s)
- Kevin S Heffernan
- Department of Exercise Science, Human Performance Laboratory, Syracuse University, Syracuse, New York, United States of America.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Steppan J, Tran H, Benjo AM, Pellakuru L, Barodka V, Ryoo S, Nyhan SM, Lussman C, Gupta G, White AR, Daher JP, Shoukas AA, Levine BD, Berkowitz DE. Alagebrium in combination with exercise ameliorates age-associated ventricular and vascular stiffness. Exp Gerontol 2012; 47:565-72. [PMID: 22569357 DOI: 10.1016/j.exger.2012.04.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Revised: 04/20/2012] [Accepted: 04/21/2012] [Indexed: 01/06/2023]
Abstract
Advanced glycation end-products (AGEs) initiate cellular inflammation and contribute to cardiovascular disease in the elderly. AGE can be inhibited by Alagebrium (ALT), an AGE cross-link breaker. Moreover, the beneficial effects of exercise on aging are well recognized. Thus, we investigated the effects of ALT and exercise (Ex) on cardiovascular function in a rat aging model. Compared to young (Y) rats, in sedentary old (O) rats, end-systolic elastance (Ees) decreased (0.9±0.2 vs 1.7±0.4mmHg/μL, P<0.05), dP/dt(max) was attenuated (6054±685 vs 9540±939mmHg/s, P<0.05), ventricular compliance (end-diastolic pressure-volume relationship (EDPVR)) was impaired (1.4±0.2 vs 0.5±0.4mmHg/μL, P<0.05) and diastolic relaxation time (tau) was prolonged (21±3 vs 14±2ms, P<0.05). In old rats, combined ALT+Ex (4weeks) increased dP/dt(max) and Ees (8945±665 vs 6054±685mmHg/s, and 1.5±0.2 vs 0.9±0.2 respectively, O with ALT+Ex vs O, P<0.05 for both). Diastolic function (exponential power of EDPVR and tau) was also substantially improved by treatment with Alt+Ex in old rats (0.4±0.1 vs 0.9±0.2 and 16±2 vs 21±3ms, respectively, O with ALT+EX vs O, P<0.05 for both). Pulse wave velocity (PWV) was increased in old rats (7.0±0.7 vs 3.8±0.3ms, O vs Y, P<0.01). Both ALT and Ex alone decreased PWV in old rats but the combination decreased PWV to levels observed in young (4.6±0.5 vs 3.8±0.3ms, O with ALT+Ex vs Y, NS). These results suggest that prevention of the formation of new AGEs (with exercise) and breakdown of already formed AGEs (with ALT) may represent a therapeutic strategy for age-related ventricular and vascular stiffness.
Collapse
Affiliation(s)
- Jochen Steppan
- Department of Anesthesiology & Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Heffernan KS. How healthy were the arteries of Phidippides? Clin Cardiol 2011; 35:65-8. [PMID: 22125198 DOI: 10.1002/clc.21009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Accepted: 10/25/2011] [Indexed: 12/29/2022] Open
Abstract
Subacute and chronic cardiac adaptations to marathon running may increase risk for sudden death. Herein, it is proposed that cardiac arrhythmogenic remodeling resulting from prolonged strenuous exertion may also have a systemic vascular component. Marathon running reduces coronary perfusion pressure and causes acute endothelial damage, possibly via altering concentrations of circulating angiogenic growth factors with novel vasoregulatory properties. Marathon runners have increased arterial stiffness and augmented pressure from wave reflections contributing to a widening of pulse pressure. Pulsatile hemodynamics may contribute to target organ damage. Moreover, each of these vascular maladaptations (increased arterial stiffness, augmented pressure from wave reflections, and widened pulse pressure) has been associated with atrial fibrillation and may provide a substrate for lethal arrhythmogenesis in the marathon runner.
Collapse
|
19
|
Yang WI, Park S, Youn JC, Son NH, Lee SH, Kang SM, Jang Y. Augmentation index association with reactive hyperemia as assessed by peripheral arterial tonometry in hypertension. Am J Hypertens 2011; 24:1234-8. [PMID: 21901014 DOI: 10.1038/ajh.2011.132] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Augmentation pressure has emerged as a surrogate marker for cardiovascular disease, and endothelial dysfunction has been proposed as related factor. However, the relationship between augmentation pressure and digital endothelial function has not yet been well defined. We investigated the relationship between augmentation pressure and digital reactive hyperemia (RH) in patients with hypertension using peripheral arterial tonometry (PAT), which is regarded as being representative of endothelial function. METHODS One hundred hypertensive patients (64 males; mean age, 49 ± 12 years) without a history of taking antihypertensive medication were enrolled in this study. RESULTS The mean augmentation pressure and augmentation index (AIx) normalized for a heart rate of 75 beats/min (AIx75) were 15 ± 8 mm Hg and 26 ± 11%, respectively. The mean RH-PAT index and log transformed PAT ratio were 2.24 ± 0.55 and 0.62 ± 0.30. There was an inverse relationship between the RH-PAT index and age, male sex, and body mass index. The log transformed PAT ratio also showed inverse relationship with age and male sex. The RH-PAT index and the log transformed PAT ratio showed no relationship with augmentation pressure or AIx75. In a multiple linear regression analysis, age, height, and central systolic BP demonstrated an independent association with augmentation pressure and AIx75. CONCLUSION In patients with hypertension, the RH-PAT index determined using PAT was not associated with augmentation pressure or AIx75. Digital vascular function may be a less important factor for pressure augmentation in patients with hypertension.
Collapse
|
20
|
Park S, Park JB, Lakatta EG. Association of central hemodynamics with estimated 24-h urinary sodium in patients with hypertension. J Hypertens 2011; 29:1502-7. [PMID: 21666493 PMCID: PMC4535170 DOI: 10.1097/hjh.0b013e3283486311] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE High salt intake is known to be the most pivotal environmental factor in the pathogenesis of hypertension. However, the association of high sodium intake with central hemodynamics in hypertensive individuals has not been well defined. Here, we determined the association of estimated 24-h urine sodium and potassium excretion estimated from a spot urine analysis with parameters of central pulse wave analysis in 515 hypertensive individuals. METHODS Fasting spot urine samples were obtained in the early morning after the first void, and estimated 24-h urine sodium and potassium excretion were estimated from measurement of urine sodium, potassium and creatinine. Central hemodynamics and arterial stiffness parameters were assessed via pulse wave analysis of the radial artery. RESULTS The estimated 24-h sodium and potassium excretion values were 150 ± 40 and 49 ± 10 mEq, respectively. There was a step-wise decrease in pulse pressure amplification with increasing estimated 24-h urine sodium excretion. Multiple linear regression analyses revealed that both estimated 24-h urine sodium excretion and sodium/potassium ratio were independently associated with increases in central pulse pressure, augmented aortic pressure and augmentation index and were inversely associated with pulse pressure amplification. CONCLUSION The estimated 24-h urinary sodium excretion is independently associated with central hemodynamics. This may provide the basis for prospective interventional studies of epidemiologic scale to determine the potential beneficial effects of reduced salt consumption on central hemodynamics.
Collapse
Affiliation(s)
- Sungha Park
- Division of Cardiology, Cardiovascular Center, Yonsei University College of Medicine
| | - Jeong Bae Park
- Division of Cardiology, Cheil General Hospital, Kwandong University College of Medicine, Seoul, Korea
| | - Edward G Lakatta
- Laboratory of Cardiovascular Science, Gerontology Research Center, National Institute on Aging, Baltimore, Maryland, USA
| |
Collapse
|
21
|
Zhang YL, Zheng YY, Ma ZC, Sun YN. Radial pulse transit time is an index of arterial stiffness. Hypertens Res 2011; 34:884-7. [DOI: 10.1038/hr.2011.41] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
22
|
Heffernan KS, Suryadevara R, Patvardhan EA, Mooney P, Karas RH, Kuvin JT. Effect of atenolol vs metoprolol succinate on vascular function in patients with hypertension. Clin Cardiol 2011; 34:39-44. [PMID: 21259277 DOI: 10.1002/clc.20841] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We evaluated the effect of atenolol vs metoprolol succinate on vascular function in patients with essential hypertension. HYPOTHESIS Given intrinsic differences between these agents, we hypothesized that atenolol and metoprolol succinate would have disparate effects on vascular function. METHODS This study included 24 patients with hypertension (age 56 ± 2 years, 8 female, body mass index 28 ± 1) and featured a randomized, double-blind, crossover design. Each β-blocker (atenolol or metoprolol succinate) was taken by patients once daily for a 4-week period. Measures of vascular function included peripheral augmentation index (AIx) and pulse wave amplitude reactive hyperemia index from peripheral arterial tonometry, and brachial artery flow-mediated dilation from ultrasound. RESULTS There were similar reductions in mean arterial pressure following treatment with atenolol and metoprolol succinate. Compared with metoprolol succinate, there was a significant increase in peripheral AIx following atenolol therapy (P < 0.05). There were no changes in brachial artery flow-mediated dilation or pulse wave amplitude reactive hyperemia index following either drug treatment. CONCLUSIONS Although atenolol and metoprolol succinate have similar effects on blood-pressure reduction, they have different effects on vascular function. Compared with metoprolol succinate, atenolol increases peripheral AIx. Neither drug has an effect on vascular endothelial function. These findings may have clinical implications, depending on the indication for treatment in an individual patient.
Collapse
Affiliation(s)
- Kevin S Heffernan
- Vascular Function Study Group, Department of Medicine, Division of Cardiology, Molecular Cardiology Research Institute, Tufts Medical Center, Boston, Massachusetts, USA.
| | | | | | | | | | | |
Collapse
|
23
|
Manisty C, Mayet J, Tapp RJ, Parker KH, Sever P, Poulter NR, Poulter NH, Thom SAM, Hughes AD. Wave reflection predicts cardiovascular events in hypertensive individuals independent of blood pressure and other cardiovascular risk factors: an ASCOT (Anglo-Scandinavian Cardiac Outcome Trial) substudy. J Am Coll Cardiol 2010; 56:24-30. [PMID: 20620713 DOI: 10.1016/j.jacc.2010.03.030] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2009] [Revised: 02/12/2010] [Accepted: 03/18/2010] [Indexed: 01/21/2023]
Abstract
OBJECTIVES This study investigated whether wave reflection measured by wave intensity analysis predicts future cardiovascular events in individuals with hypertension and sought to establish whether this relationship is independent of other cardiovascular risk factors and is associated with evidence of increased load on the left ventricle. BACKGROUND Wave reflection may impose an additional load on the left ventricle, and augmentation index, a surrogate of wave reflection, has been reported to predict cardiovascular events in some, but not all studies. METHODS Measurements of brachial and carotid blood pressure (BP) measurement, carotid ultrasound, echocardiography, and blood chemistry analyses were performed on 259 ASCOT (Anglo Scandinavian Cardiac Outcomes Trial) participants approximately 1 year after randomization, and wave intensity analysis was used to calculate wave reflection index (WRI), the ratio of peak forward to peak backward pressure (P(b)/P(f)), and carotid augmentation index (cAI(x)). All participants were followed up for a median period of 5.9 years, accruing 33 cardiovascular events. RESULTS WRI, P(b)/P(f), and to a lesser extent, cAI(x), were correlated. WRI predicted cardiovascular events (hazard ratio: 2.10; 95% confidence interval: 1.10 to 3.99; p = 0.02) in an unadjusted model. Multivariate analysis showed that this association was independent of BP. P(b)/P(f) and cAI(x) did not significantly predict cardiovascular events. WRI was also positively associated with increased left ventricular mass index and elevated B-type natriuretic peptide adjusted for age and sex, and these associations were independent of BP or other cardiovascular risk factors. CONCLUSIONS Higher wave reflection predicts future cardiovascular events independent of conventional risk factors in people with treated hypertension.
Collapse
Affiliation(s)
- Charlotte Manisty
- International Centre for Circulatory Health, Imperial College London & Imperial College Healthcare NHS Trust, London, United Kingdom
| | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Benetos A, Thomas F, Joly L, Blacher J, Pannier B, Labat C, Salvi P, Smulyan H, Safar ME. Pulse pressure amplification a mechanical biomarker of cardiovascular risk. J Am Coll Cardiol 2010; 55:1032-7. [PMID: 20202520 DOI: 10.1016/j.jacc.2009.09.061] [Citation(s) in RCA: 172] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2009] [Revised: 09/04/2009] [Accepted: 09/07/2009] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The aim of this study was to determine whether the carotid/brachial (C/B) ratio is an independent predictor of cardiovascular (CV) risk. BACKGROUND Brachial and carotid pulse pressure (PP) are independent predictors of CV risk, mainly in elderly patients. Because PP is physiologically lower at the brachial than at the carotid arterial site, PP amplification is represented by the C/B ratio and could independently predict CV risk. METHODS In a Paris population (n = 834), brachial and carotid PP were measured from sphygmomanometry and pulse wave analysis. With stepwise multiple regression, carotid PP was calculated from a nomogram including age, sex, body height, brachial PP, and plasma glucose. This model was applied to 125,151 subjects, followed for 12 years, during which 3,997 deaths occurred (735 of CV origin). With Cox regression analysis, multi-adjusted hazard ratios (HRs) were calculated for 1 SD increase of brachial PP, calculated carotid PP, and C/B ratio. RESULTS Brachial PP was significantly associated with both CV and all-cause mortality (HR: 1.16, 95% confidence interval [CI]: 1.13 to 1.19, and HR: 1.13, 95% CI: 1.10 to 1.17, respectively). Calculated carotid PP predicted a similar risk (HR: 1.21, 95% CI: 1.15 to 1.28, and HR: 1.18, 95% CI: 1.12 to 1.25, respectively). Finally, the C/B ratio was a strong risk predictor (HR: 1.22, 95% CI: 1.12 to 1.32, and HR: 1.41, 95% CI: 1.14 to 1.73, respectively). Addition of drug treatment and other confounding variables did not statistically modify the results. CONCLUSIONS Brachial PP, calculated carotid PP, and C/B PP amplification all predict CV mortality. In contrast to brachial and carotid PP, the C/B ratio is less dependent on blood pressure calibration and thus can be directly applicable to large population studies.
Collapse
Affiliation(s)
- Athanase Benetos
- Department of Geriatrics CHU de Nancy, and INSERM U691, University of Nancy, Nancy, France
| | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Cheng HM, Wang KL, Chen YH, Lin SJ, Chen LC, Sung SH, Ding PYA, Yu WC, Chen JW, Chen CH. Estimation of central systolic blood pressure using an oscillometric blood pressure monitor. Hypertens Res 2010; 33:592-9. [DOI: 10.1038/hr.2010.37] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
26
|
Lang CC, Gupta S, Kalra P, Keavney B, Menown I, Morley C, Padmanabhan S. Elevated heart rate and cardiovascular outcomes in patients with coronary artery disease: clinical evidence and pathophysiological mechanisms. Atherosclerosis 2010; 212:1-8. [PMID: 20152981 DOI: 10.1016/j.atherosclerosis.2010.01.029] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2009] [Revised: 01/15/2010] [Accepted: 01/20/2010] [Indexed: 01/01/2023]
Abstract
There is an established body of evidence from epidemiological studies which indicates that an elevated resting heart rate is independently associated with atherosclerosis and increased cardiovascular morbidity and mortality, in both the general population and in patients with established cardiovascular disease. Clinical trial data suggest that in patients with coronary artery disease, an elevated heart rate identifies those at increased risk of adverse cardiovascular outcomes, and that lowering of heart rate may reduce major cardiovascular events in patients with an elevated heart rate and symptom-limiting angina. These results suggest that an increased heart rate may have an adverse impact on the atherosclerotic process and increase the risk of a cardiovascular event in patients with coronary artery disease. The precise pathophysiological mechanisms that link heart rate and cardiovascular outcomes have yet to be defined. Possibilities may include indirect mechanisms related to autonomic dysregulation and those due to an increase in heart rate per se, which can increase the ischaemic burden and exert local haemodynamic forces that can adversely impact on the endothelium and arterial wall. For these reasons, heart rate should be considered as a therapeutic target in the treatment of patients with coronary artery disease.
Collapse
Affiliation(s)
- Chim C Lang
- Ninewells Hospital and Medical School, Dundee, United Kingdom.
| | | | | | | | | | | | | |
Collapse
|
27
|
Papaioannou TG, Stamatelopoulos KS, Georgiopoulos G, Vlachopoulos C, Georgiou S, Lykka M, Lambrinoudaki I, Papamichael CM, Stefanadis CI. Arterial Wave Reflections During the Menstrual Cycle of Healthy Women. Hypertension 2009; 54:1021-7. [DOI: 10.1161/hypertensionaha.109.137703] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Increased wave reflection is an independent factor associated with cardiovascular diseases, risk, and mortality. The influence of the menstrual cycle on wave reflections and particularly on the reproducibility of their measurement has never been examined. The aim of the present study was to examine the reproducibility and variability of wave reflection indices in premenopausal healthy women during their menstrual cycle. Thirty-two women were examined at 3 phases of their menstrual cycle: days 1 to 2 (menstrual phase), days 6 to 14 (late follicular), and days 4 to 7 after ovulation (early luteal phase). Applanation tonometry of the radial artery and aortic pulse wave analysis were performed for the calculation of augmentation pressure, augmentation index, and timing of reflected waves. Reproducibility of these measures was evaluated by intraclass correlation coefficient and Bland-Altman analysis, whereas ANOVA was performed to assess their variability during the menstrual cycle. The SD of augmentation index differences between repeated measurements within the menstrual cycle ranged from 7.6% to 9.9%. Bland-Altman analysis indicated no evidence of systemic bias and no trend for the reproducibility of measurements to vary with their underlying mean value. Intraclass correlation coefficient indicated a moderate reproducibility of augmentation index and augmentation pressure (>0.80) and a rather low reproducibility for timing of reflected waves (0.43). Mean augmentation pressure, augmentation index, and timing of reflected waves did not vary significantly during the menstrual cycle (ANOVA). Measurement of wave reflections at the same phase of the menstrual cycle or statistical adjustment could be suggested for optimal study design and data interpretation.
Collapse
Affiliation(s)
- Theodore G. Papaioannou
- From the Biomedical Engineering Unit, 1st Department of Cardiology, Hippokration Hospital (T.G.P., C.V., C.I.S.), and Vascular Laboratory, Department of Clinical Therapeutics, Alexandra Hospital (K.S.S., G.G., S.G., M.L., I.L., C.M.P.), Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Kimon S. Stamatelopoulos
- From the Biomedical Engineering Unit, 1st Department of Cardiology, Hippokration Hospital (T.G.P., C.V., C.I.S.), and Vascular Laboratory, Department of Clinical Therapeutics, Alexandra Hospital (K.S.S., G.G., S.G., M.L., I.L., C.M.P.), Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - George Georgiopoulos
- From the Biomedical Engineering Unit, 1st Department of Cardiology, Hippokration Hospital (T.G.P., C.V., C.I.S.), and Vascular Laboratory, Department of Clinical Therapeutics, Alexandra Hospital (K.S.S., G.G., S.G., M.L., I.L., C.M.P.), Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Charalambos Vlachopoulos
- From the Biomedical Engineering Unit, 1st Department of Cardiology, Hippokration Hospital (T.G.P., C.V., C.I.S.), and Vascular Laboratory, Department of Clinical Therapeutics, Alexandra Hospital (K.S.S., G.G., S.G., M.L., I.L., C.M.P.), Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Stellios Georgiou
- From the Biomedical Engineering Unit, 1st Department of Cardiology, Hippokration Hospital (T.G.P., C.V., C.I.S.), and Vascular Laboratory, Department of Clinical Therapeutics, Alexandra Hospital (K.S.S., G.G., S.G., M.L., I.L., C.M.P.), Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Marita Lykka
- From the Biomedical Engineering Unit, 1st Department of Cardiology, Hippokration Hospital (T.G.P., C.V., C.I.S.), and Vascular Laboratory, Department of Clinical Therapeutics, Alexandra Hospital (K.S.S., G.G., S.G., M.L., I.L., C.M.P.), Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Irene Lambrinoudaki
- From the Biomedical Engineering Unit, 1st Department of Cardiology, Hippokration Hospital (T.G.P., C.V., C.I.S.), and Vascular Laboratory, Department of Clinical Therapeutics, Alexandra Hospital (K.S.S., G.G., S.G., M.L., I.L., C.M.P.), Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Christos M. Papamichael
- From the Biomedical Engineering Unit, 1st Department of Cardiology, Hippokration Hospital (T.G.P., C.V., C.I.S.), and Vascular Laboratory, Department of Clinical Therapeutics, Alexandra Hospital (K.S.S., G.G., S.G., M.L., I.L., C.M.P.), Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Christodoulos I. Stefanadis
- From the Biomedical Engineering Unit, 1st Department of Cardiology, Hippokration Hospital (T.G.P., C.V., C.I.S.), and Vascular Laboratory, Department of Clinical Therapeutics, Alexandra Hospital (K.S.S., G.G., S.G., M.L., I.L., C.M.P.), Medical School, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
28
|
|
29
|
Heffernan KS, Jae SY, Tomayko E, Ishaque MR, Fernhall B, Wilund KR. Influence of arterial wave reflection on carotid blood pressure and intima-media thickness in older endurance trained men and women with pre-hypertension. Clin Physiol Funct Imaging 2009; 29:193-200. [PMID: 19236433 DOI: 10.1111/j.1475-097x.2009.00856.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Increased carotid intima-media thickness (IMT) with aging is a significant predictor of mortality. Older endurance trained (ET) individuals have lower carotid artery stiffness but similar carotid IMT when compared to sedentary (SED) age-matched peers. The purpose of this study was to examine the contribution of arterial wave reflections to carotid hemodynamics and IMT in older ET and SED with pre-hypertension. Subjects consisted of endurance-trained master athletes and age-matched sedentary controls (mean age 67 years). Carotid artery Beta-stiffness index and IMT was assessed with ultrasonography. Carotid pressure and augmented pressure from wave reflections (obtained from pulse contour analysis) was measured with applanation tonometry. Carotid systolic blood pressure (SBP) and IMT were not different between groups (P>0.05). Carotid stiffness was significantly lower in ET versus SED (7.3 +/- 0.8 versus 9.9 +/- 0.6, P<0.05). Augmented pressure was significantly greater in ET versus SED (17.7 +/- 1.6 versus 13.3 +/- 1.5 mmHg, P<0.05). When adjusting for differences in resting heart rate, there were no group differences in augmented pressure. In conclusion, older ET persons with pre-hypertension have reduced carotid artery stiffness, but similar carotid SBP and carotid IMT when compared to SED. The lack of change in carotid SBP and IMT in older ET may be related to the inability of chronic exercise training to reduce bradycardia-related augmented pressure from wave reflections with aging.
Collapse
Affiliation(s)
- Kevin S Heffernan
- The Exercise and Cardiovascular Research Laboratory, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA.
| | | | | | | | | | | |
Collapse
|
30
|
Heffernan KS, Jae SY, Wilund KR, Woods JA, Fernhall B. Racial differences in central blood pressure and vascular function in young men. Am J Physiol Heart Circ Physiol 2008; 295:H2380-7. [DOI: 10.1152/ajpheart.00902.2008] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Young African-American men have altered macrovascular and microvascular function. In this cross-sectional study, we tested the hypothesis that vascular dysfunction in young African-American men would contribute to greater central blood pressure (BP) compared with young white men. Fifty-five young (23 yr), healthy men (25 African-American and 30 white) underwent measures of vascular structure and function, including carotid artery intima-media thickness (IMT) and carotid artery β-stiffness via ultrasonography, aortic pulse wave velocity, aortic augmentation index (AIx), and wave reflection travel time (Tr) via radial artery tonometery and a generalized transfer function, and microvascular vasodilatory capacity of forearm resistance arteries with strain-gauge plethysmography. African-American men had similar brachial systolic BP (SBP) but greater aortic SBP ( P < 0.05) and carotid SBP ( P < 0.05). African-American men also had greater carotid IMT, greater carotid β-stiffness, greater aortic stiffness and AIx, reduced aortic Tr and reduced peak hyperemic, and total hyperemic forearm blood flow compared with white men ( P < 0.05). In conclusion, young African-American men have greater central BP, despite comparable brachial BP, compared with young white men. Diffuse macrovascular and microvascular dysfunction manifesting as carotid hypertrophy, increased stiffness of central elastic arteries, heightened resistance artery constriction/blunted resistance artery dilation, and greater arterial wave reflection are present at a young age in apparently healthy African-American men, and conventional brachial BP measurement does not reflect this vascular burden.
Collapse
|