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Takami T, Hoshide S, Kario K. Differential impact of antihypertensive drugs on cardiovascular remodeling: a review of findings and perspectives for HFpEF prevention. Hypertens Res 2022; 45:53-60. [PMID: 34621033 DOI: 10.1038/s41440-021-00771-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/08/2021] [Accepted: 09/12/2021] [Indexed: 12/24/2022]
Abstract
Heart failure (HF) is an important health problem worldwide whose stages have traditionally been classified from A to D. In addition, HF can be categorized as that with preserved ejection fraction (HFpEF) and that with reduced ejection fraction (HFrEF). Hypertension and arterial stiffness in stage A HF are major drivers of the progression to left ventricular hypertrophy (LVH), a criterion of stage B HF. Although the pathogenesis of HFpEF is heterogeneous, affected patients tend to be older than HFrEF patients and have a greater prevalence of hypertension, which is closely associated with arterial stiffness and LVH. Thus, to treat HFpEF, the optimal intervention for improving prognosis is an aggressive approach to early-stage, i.e., Stage A and B, HF. This paper reviews the findings on arterial stiffness and LVH using conventional antihypertensive drugs such as angiotensin receptor II blockers (ARBs) and a new drug class for HF, ARB/neprilysin inhibitor (ARNi). Previous studies have suggested that the combination of an ARB with an L-T-type calcium channel blocker might be recommended for the improvement of arterial stiffness and regression of LVH. More recent research has shown that ARNi also improves central BP, which leads to a reduced afterload and a significant reduction in LVH. For optimal treatment of HFpEF, drug therapy should directly address arterial stiffness as well as hypertension.
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Affiliation(s)
- Takeshi Takami
- Department of Internal Medicine, Clinic Jingumae, Nara, Japan
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Department of Internal Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Internal Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan.
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Tomiyama H, Shiina K. State of the Art Review: Brachial-Ankle PWV. J Atheroscler Thromb 2020; 27:621-636. [PMID: 32448827 PMCID: PMC7406407 DOI: 10.5551/jat.rv17041] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 04/22/2020] [Indexed: 12/11/2022] Open
Abstract
The brachial-ankle pulse wave velocity (brachial-ankle PWV), which is measured simply by wrapping pressure cuffs around the four extremities, is a simple marker to assess the stiffness of the medium- to large- sized arteries. The accuracy and reproducibility of its measurement have been confirmed to be acceptable. Risk factors for cardiovascular disease, especially advanced age and high blood pressure, are reported to be associated with an increase of the arterial stiffness. Furthermore, arterial stiffness might be involved in a vicious cycle with the development/progression of hypertension, diabetes mellitus and chronic kidney disease. Increase in the arterial stiffness is thought to contribute to the development of cardiovascular disease via pathophysiological abnormalities induced in the heart, brain, kidney, and also the arteries themselves. A recent independent participant data meta-analysis conducted in Japan demonstrated that the brachial-ankle PWV is a useful marker to predict future cardiovascular events in Japanese subjects without a previous history of cardiovascular disease, independent of the conventional model for the risk assessment. The cutoff point may be 16.0 m/s in individuals with a low risk of cardiovascular disease (CVD), and 18.0 m/s in individuals with a high risk of CVD and subjects with hypertension. In addition, the method of measurement of the brachial-ankle PWV can also be used to calculate the inter-arm systolic blood pressure difference and ankle-brachial pressure index, which are also useful markers for cardiovascular risk assessment.
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Affiliation(s)
| | - Kazuki Shiina
- Department of Cardiology, Tokyo Medical University, Tokyo, Japan
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Eplerenone improves endothelial function and arterial stiffness and inhibits Rho-associated kinase activity in patients with idiopathic hyperaldosteronism: a pilot study. J Hypertens 2020; 37:1083-1095. [PMID: 30418321 DOI: 10.1097/hjh.0000000000001989] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Primary aldosteronism is one of the most common cause of secondary hypertension. It is well known that the incidence of cardiovascular events is higher in patients with primary aldosteronism than in patients with essential hypertension. In a previous study, we showed that aldosterone-producing adenoma is associated with vascular function and structure. The aim of this study was to evaluate the effects of eplerenone on vascular function in the macrovasculature and microvasculature, arterial stiffness and Rho-associated kinase (ROCK) activity in patients with idiopathic hyperaldosteronism (IHA). METHODS Vascular function, including reactive hyperemia index (RHI), flow-mediated vasodilation (FMD) and nitroglycerine-induced vasodilation (NID), arterial stiffness including brachial-ankle pulse wave velocity (baPWV) and brachial intima-media thickness (IMT) and ROCK activity in peripheral leukocytes were measured before and after 12 weeks of treatment with eplerenone in 50 patients with IHA. RESULTS After 12 weeks, eplerenone decreased the aldosterone renin ratio but did not alter SBP and DBP. Eplerenone treatment increased log RHI from 0.56 ± 0.25 to 0.69 ± 0.25 (P < 0.01) and NID from 12.8 ± 5.8 to 14.9 ± 6.9% (P = 0.02) and it decreased baPWV from 1540 ± 263 to 1505 ± 281 (P = 0.04) and ROCK activity from 1.20 ± 0.54 to 0.89 ± 0.42 (P < 0.01), whereas there was no significant change in FMD (increase from 4.6 ± 3.4 to 4.6 ± 3.6%, P = 0.99) or brachial IMT (decrease from 0.28 ± 0.07 to 0.28 ± 0.04 mm, P = 0.14). CONCLUSION Eplerenone improves microvascular endothelial function, vascular smooth muscle function, arterial stiffness and ROCK activity in patients with IHA. CLINICAL TRIAL REGISTRATION INFORMATION URL for Clinical Trial: http://UMIN; Registration Number for Clinical Trial: UMIN000003409.
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Do treatment-induced changes in arterial stiffness affect left ventricular structure? A meta-analysis. J Hypertens 2019; 37:253-263. [DOI: 10.1097/hjh.0000000000001918] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Ye L, Yang X, Hu J, Chen Q, Wang J, Li X. Impact of antihypertensive agents on arterial stiffness in hypertensive patients. Int J Cardiol 2018; 273:207-212. [PMID: 29960763 DOI: 10.1016/j.ijcard.2018.06.092] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 06/01/2018] [Accepted: 06/21/2018] [Indexed: 10/28/2022]
Abstract
AIMS The present network meta-analysis was performed to comprehensively compare the ability of different types of antihypertensive agents to ameliorate arterial stiffness in hypertensive patients. METHODS AND RESULTS To conduct this network meta-analysis, we searched PubMed, the Embase database, and the https://clinicaltrials.gov/ website for all relevant articles concerning clinical trials on hypertension therapy. The last search date was 10 August 2017. As a result, 28 eligible articles were enrolled in our meta-analysis. According to the included studies, there was no significant difference in pulse wave velocity (PWV) between these treatments. The eight types of antihypertension agents outperformed placebo in controlling systolic blood pressure (SBP). Angiotensin-converting enzyme inhibitor (ACEI) outperformed angiotensin II receptor blocker (ARB) in SBP; and angiotensin receptor-neprilysin inhibitor (ARNI) outperformed diuretic (D)in SBP. CONCLUSIONS This study found that the eight antihypertensive agents show obvious effect on reducing SBP other than arterial stiffness.
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Affiliation(s)
- Liwen Ye
- Department of Geriatric Cardiology, The Second Affiliated Hospital of Chongqing Medical University, No.76, Linjiang Road, Chongqing 400010, China
| | - Xixi Yang
- Department of Geriatric Cardiology, The Second Affiliated Hospital of Chongqing Medical University, No.76, Linjiang Road, Chongqing 400010, China
| | - Jie Hu
- Department of Geriatric Cardiology, The Second Affiliated Hospital of Chongqing Medical University, No.76, Linjiang Road, Chongqing 400010, China
| | - Qingwei Chen
- Department of Geriatric Cardiology, The Second Affiliated Hospital of Chongqing Medical University, No.76, Linjiang Road, Chongqing 400010, China.
| | - Jian Wang
- Department of Geriatric Cardiology, The Second Affiliated Hospital of Chongqing Medical University, No.76, Linjiang Road, Chongqing 400010, China
| | - Xingsheng Li
- Department of Geriatric Cardiology, The Second Affiliated Hospital of Chongqing Medical University, No.76, Linjiang Road, Chongqing 400010, China
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Lee SR, Chae IH, Kim HL, Kang DY, Kim SH, Kim HS. Predictors of candesartan's effect on vascular reactivity in patients with coronary artery disease. Cardiovasc Ther 2017; 35. [PMID: 28796934 PMCID: PMC5639377 DOI: 10.1111/1755-5922.12291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 06/23/2017] [Accepted: 08/06/2017] [Indexed: 11/27/2022] Open
Abstract
Introduction and Aims Endothelial dysfunction and arterial stiffness have a prognostic value on adverse long‐term outcomes in coronary artery disease (CAD) patients. We evaluated the efficacy on vascular reactivity of candesartan and analyzed predictors to control the candesartan's effect on vascular reactivity in CAD patients. Method Patients were prospectively enrolled and prescribed candesartan for 6 months. The effect on vascular reactivity was evaluated by the change in flow‐mediated dilation (FMD) and pulse wave velocity (PWV). Results A total of 124 patients completed the study. The better responder in FMD change (≥1.3%) showed significantly lower baseline FMD than the poor responder (P < .001). In receiver operating characteristic analysis, baseline FMD 7.5% showed optimal predictive value (sensitivity 79%, specificity 79%) for predicting better responder. The baseline endothelial dysfunction (FMD <7.5%) was the only significant predictor of the better responder to candesartan. The better responder in PWV change (≤−100 cm/s) showed greater blood pressure lowering and significantly higher baseline PWV than the poor responder (both P < .05). The poor responder in both FMD and PWV showed a higher prevalence of previous myocardial infarction (38.7% vs 17.2%, P = .013). Conclusion The candesartan's effect on vascular reactivity is more pronounced in patients with more severe endothelial dysfunction and arterial stiffness. Poor responders on both FMD and PWV showed higher prevalence of previous myocardial infarction.
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Affiliation(s)
- So-Ryoung Lee
- Division of Cardiology, Department of Internal Medicine/Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - In-Ho Chae
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hack-Lyoung Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Do-Yoon Kang
- Division of Cardiology, Department of Internal Medicine/Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Sang-Hyun Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Hyo-Soo Kim
- Division of Cardiology, Department of Internal Medicine/Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
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Chen W, Li S, Fernandez C, Sun D, Lai CC, Zhang T, Bazzano L, Urbina EM, Deng HW. Temporal Relationship Between Elevated Blood Pressure and Arterial Stiffening Among Middle-Aged Black and White Adults: The Bogalusa Heart Study. Am J Epidemiol 2016; 183:599-608. [PMID: 26960706 DOI: 10.1093/aje/kwv274] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 07/23/2015] [Indexed: 11/12/2022] Open
Abstract
This study assessed the temporal relationship between elevated blood pressure (BP) and arterial stiffness in a biracial (black-white) cohort of middle-aged adults aged 32-51 years from the semirural community of Bogalusa, Louisiana. Measurements of aortic-femoral pulse wave velocity (afPWV; n = 446) and large- and small-arterial compliance (n = 381) were obtained at 2 time points between 2000 and 2010, with an average follow-up period of 7 years. A cross-lagged path analysis model was used to examine the temporal relationship of elevated BP to arterial stiffness and elasticity. The cross-lagged path coefficients did not differ significantly between blacks and whites. The path coefficient (ρ2) from baseline BP to follow-up afPWV was significantly greater than the path coefficient (ρ1) from baseline afPWV to follow-up BP (ρ2 = 0.20 vs. ρ1 = 0.07 (P = 0.048) for systolic BP; ρ2 = 0.19 vs. ρ1 = 0.05 (P = 0.034) for diastolic BP). The results for this 1-directional path from baseline BP to follow-up afPWV were confirmed, although marginally significant, by using large- and small-artery elasticity measurements. These findings provide strong evidence that elevated BP precedes large-artery stiffening in middle-aged adults. Unlike the case in older adults, the large-arterial wall is not stiff enough in youth to alter BP levels during young adulthood.
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Tomiyama H, Matsumoto C, Shiina K, Yamashina A. Brachial-Ankle PWV: Current Status and Future Directions as a Useful Marker in the Management of Cardiovascular Disease and/or Cardiovascular Risk Factors. J Atheroscler Thromb 2016; 23:128-46. [DOI: 10.5551/jat.32979] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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The impact of angiotensin receptor blockers on arterial stiffness: a meta-analysis. Hypertens Res 2015; 38:613-20. [PMID: 25854987 DOI: 10.1038/hr.2015.51] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 02/04/2015] [Accepted: 02/20/2015] [Indexed: 12/30/2022]
Abstract
Some studies reported a protective role of angiotensin receptor blockers (ARBs) against arterial stiffness. Therefore, we performed a meta-analysis of published clinical trials to systematically assess the impact of ARBs on arterial stiffness as measured by using pulse wave velocity (PWV). Eligible articles were identified by searching PubMed, EMBASE, Cochrane, Wanfang and CNKI databanks before 31 July 2014. The data were extracted independently and in duplicate. Forty articles including 53 clinical trials qualified, including 1650 and 1659 subjects in ARB treatment and control groups, respectively. Overall reductions in carotid-femoral PWV (cfPWV) and brachial-ankle PWV (baPWV) were statistically significant, with an average of -42.52 cm s(-1) (95% CI: -81.82 to -3.21; P=0.034) and -107.08 cm s(-1) (95% CI: -133.98 to -80.18; P<0.0005), respectively, after receiving ARBs. Subgroup analysis by ARB type revealed that telmisartan (weighted mean difference or WMD=-100.82 cm s(-1); P<0.0005) and valsartan (WMD=-104.59 cm s(-1); P<0.0005) significantly reduced baPWV, but only valsartan reduced cfPWV (WMD=-65.58; P=0.030). cfPWV was significantly reduced in comparisons of ARBs with placebo (WMD=-79.65 cm s(-1); P=0.001), and baPWV was significantly reduced with calcium channel blockers (WMD=-130.74 cm s(-1); P<0.0005). There were low probabilities of publication bias. Taken together, our findings support the important role of ARB treatment in improving arterial stiffness.
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Zhang Y, Agnoletti D, Wang JG, Xu Y, Safar ME. Natriuresis and blood pressure reduction in hypertensive patients with diabetes mellitus: the NESTOR study. ACTA ACUST UNITED AC 2014; 9:21-8. [PMID: 25539895 DOI: 10.1016/j.jash.2014.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 10/08/2014] [Accepted: 10/08/2014] [Indexed: 11/27/2022]
Abstract
The antihypertensive effect of indapamide has never been clearly understood, particularly in hypertensive patients with diabetes mellitus. A total of 565 patients were randomly selected to receive either indapamide 1.5 mg or enalapril 10 mg daily for 12 months. Brachial blood pressure (BP) and plasma and urinary electrolytes were measured at baseline and at the end of follow-up. Sodium and potassium levels and excretion rates were measured in overnight urine collections. After 12 months' treatment, similar significant reductions were observed in systolic and diastolic BP and pulse pressure levels in both treatment arms (P < .001). However, age, body mass index, diabetes duration, and plasma sodium reductions were shown to be major, independent factors influencing BP reduction with indapamide, but not with enalapril. Regression coefficients were positive for age and plasma sodium reductions (P ≤ .009) but negative for body mass index and diabetes duration (P ≤ .008). Similar findings were observed for pulse pressure. These results were more notable in elderly patients, did not differ regardless of whether BP reduction was measured in absolute or percent values, and were associated with increased sodium and potassium excretion rates.Indapamide is more effective than enalapril at reducing BP in elderly diabetic hypertensives with marked sodium retention.
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Affiliation(s)
- Yi Zhang
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China; Diagnosis and Therapeutic Center, Hotel-Dieu, Assistance Publique - Hopitaux de Paris, Paris Descartes University, Paris, France
| | - Davide Agnoletti
- Diagnosis and Therapeutic Center, Hotel-Dieu, Assistance Publique - Hopitaux de Paris, Paris Descartes University, Paris, France
| | - Ji-Guang Wang
- Centre for Epidemiological Studies and Clinical Trials, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yawei Xu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Michel E Safar
- Diagnosis and Therapeutic Center, Hotel-Dieu, Assistance Publique - Hopitaux de Paris, Paris Descartes University, Paris, France.
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Shupenina EY, Vasyuk YA, Khadzegova AB, Ivanova SV, Nadina EV, Khuchinaeva AM. A COMPARISON OF THE MAIN ANTIHYPERTENSIVE DRUGS FROM THE VIEWPOINT OF AORTIC STIFFNESS MODIFICATION IN ARTERIAL HYPERTENSION. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2014. [DOI: 10.15829/1728-8800-2014-2-76-79] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
A plenty of trials confirm the importance of aortic wall stiffness evaluation during estimation of the cardiovascular risk and the need for novel drugs influencing this parameter. Most of hypotensive medications modify arterial wall siffness by one or another way. So the usage of drug combination might be more effective. Insufficient impact of betaadrenoblockers on central artrial pressure is linked to peripheral vasoconstriction. The drugs within this class having vasodilatory properties significantly reduce central aortic pressure.
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Affiliation(s)
- E. Yu. Shupenina
- Moscow State Medical and Stomatology University n. a. Evdokimov; Moscow, Russia
| | - Yu. A. Vasyuk
- Moscow State Medical and Stomatology University n. a. Evdokimov; Moscow, Russia
| | - A. B. Khadzegova
- Moscow State Medical and Stomatology University n. a. Evdokimov; Moscow, Russia
| | - S. V. Ivanova
- Moscow State Medical and Stomatology University n. a. Evdokimov; Moscow, Russia
| | - E. V. Nadina
- Moscow State Medical and Stomatology University n. a. Evdokimov; Moscow, Russia
| | - A. M. Khuchinaeva
- Moscow State Medical and Stomatology University n. a. Evdokimov; Moscow, Russia
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Liu M, Li GL, Li Y, Wang JG. Effects of Various Antihypertensive Drugs on Arterial Stiffness and Wave Reflections. ACTA ACUST UNITED AC 2013; 1:97-107. [PMID: 26587429 PMCID: PMC4315340 DOI: 10.1159/000354108] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We reviewed trials that tested the efficacy of antihypertensive drugs in reducing arterial stiffness and wave reflections as assessed by pulse wave velocity and augmentation index, respectively. Regardless of cross-over or parallel-group comparison design, placebo-controlled trials demonstrated that antihypertensive drugs were effective in reducing pulse wave velocity. In actively-controlled parallel-group comparison studies, this effect on arterial stiffness was more evident for angiotensin-converting enzyme inhibitors or angiotensin receptor blockers than other classes of antihypertensive drugs, particularly when brachial-ankle pulse wave velocity was measured. Regardless of cross-over or parallel-group comparison or placebo- or actively-controlled design, the reviewed trials showed that β-blockers were inferior to all the other classes of antihypertensive drugs in reducing augmentation index. However, these studies had a small sample size and a short follow-up time and did not link the changes in measurements of arterial function with cardiovascular events. Whether the superiority or inferiority is clinically relevant for cardiovascular protection and prevention remains to be investigated.
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Affiliation(s)
- Ming Liu
- Centre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ge-Le Li
- Centre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yan Li
- Centre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ji-Guang Wang
- Centre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Li RX, Luo J, Balaram SK, Chaudhry FA, Shahmirzadi D, Konofagou EE. Pulse wave imaging in normal, hypertensive and aneurysmal human aortas in vivo: a feasibility study. Phys Med Biol 2013; 58:4549-62. [PMID: 23770991 DOI: 10.1088/0031-9155/58/13/4549] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Arterial stiffness is a well-established biomarker for cardiovascular risk, especially in the case of hypertension. The progressive stages of an abdominal aortic aneurysm (AAA) have also been associated with varying arterial stiffness. Pulse wave imaging (PWI) is a noninvasive, ultrasound imaging-based technique that uses the pulse wave-induced arterial wall motion to map the propagation of the pulse wave and measure the regional pulse wave velocity (PWV) as an index of arterial stiffness. In this study, the clinical feasibility of PWI was evaluated in normal, hypertensive, and aneurysmal human aortas. Radiofrequency-based speckle tracking was used to estimate the pulse wave-induced displacements in the abdominal aortic walls of normal (N = 15, mean age 32.5 ± 10.2 years), hypertensive (N = 13, mean age 60.8 ± 15.8 years), and aneurysmal (N = 5, mean age 71.6 ± 11.8 years) human subjects. Linear regression of the spatio-temporal variation of the displacement waveform in the anterior aortic wall over a single cardiac cycle yielded the slope as the PWV and the coefficient of determination r(2) as an approximate measure of the pulse wave propagation uniformity. The aortic PWV measurements in all normal, hypertensive, and AAA subjects were 6.03 ± 1.68, 6.69 ± 2.80, and 10.54 ± 6.52 m s(-1), respectively. There was no significant difference (p = 0.15) between the PWVs of the normal and hypertensive subjects while the PWVs of the AAA subjects were significantly higher (p < 0.001) compared to those of the other two groups. Also, the average r(2) in the AAA subjects was significantly lower (p < 0.001) than that in the normal and hypertensive subjects. These preliminary results suggest that the regional PWV and the pulse wave propagation uniformity (r(2)) obtained using PWI, in addition to the PWI images and spatio-temporal maps that provide qualitative visualization of the pulse wave, may potentially provide valuable information for the clinical characterization of aneurysms and other vascular pathologies that regionally alter the arterial wall mechanics.
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Affiliation(s)
- Ronny X Li
- Department of Biomedical Engineering, Columbia University, New York, NY, USA
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Paulis L, Becker ST, Lucht K, Schwengel K, Slavic S, Kaschina E, Thöne-Reineke C, Dahlöf B, Baulmann J, Unger T, Steckelings UM. Direct Angiotensin II Type 2 Receptor Stimulation in
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-Arginine-Methyl Ester–Induced Hypertension. Hypertension 2012; 59:485-92. [DOI: 10.1161/hypertensionaha.111.185496] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Ludovit Paulis
- From the Center for Cardiovascular Research (L.P., S.T.R.B., K.L., K.S., S.S., E.K., C.T.-R., T.U., U.M.S.) and Department of Experimental Medicine (C.T.-R.), Charité-University Medicine, Berlin, Germany; Institute of Pathophysiology (L.P.), Faculty of Medicine, Comenius University and Institute of Normal and Pathological Physiology of the Slovak Academy of Sciences Joint Laboratory, Bratislava, Slovak Republic; Sahlgrenska University Hospital/Östra (B.D.), Gothenburg, Sweden; Clinic of Medicine II
| | - Sophie T.R. Becker
- From the Center for Cardiovascular Research (L.P., S.T.R.B., K.L., K.S., S.S., E.K., C.T.-R., T.U., U.M.S.) and Department of Experimental Medicine (C.T.-R.), Charité-University Medicine, Berlin, Germany; Institute of Pathophysiology (L.P.), Faculty of Medicine, Comenius University and Institute of Normal and Pathological Physiology of the Slovak Academy of Sciences Joint Laboratory, Bratislava, Slovak Republic; Sahlgrenska University Hospital/Östra (B.D.), Gothenburg, Sweden; Clinic of Medicine II
| | - Kristin Lucht
- From the Center for Cardiovascular Research (L.P., S.T.R.B., K.L., K.S., S.S., E.K., C.T.-R., T.U., U.M.S.) and Department of Experimental Medicine (C.T.-R.), Charité-University Medicine, Berlin, Germany; Institute of Pathophysiology (L.P.), Faculty of Medicine, Comenius University and Institute of Normal and Pathological Physiology of the Slovak Academy of Sciences Joint Laboratory, Bratislava, Slovak Republic; Sahlgrenska University Hospital/Östra (B.D.), Gothenburg, Sweden; Clinic of Medicine II
| | - Katja Schwengel
- From the Center for Cardiovascular Research (L.P., S.T.R.B., K.L., K.S., S.S., E.K., C.T.-R., T.U., U.M.S.) and Department of Experimental Medicine (C.T.-R.), Charité-University Medicine, Berlin, Germany; Institute of Pathophysiology (L.P.), Faculty of Medicine, Comenius University and Institute of Normal and Pathological Physiology of the Slovak Academy of Sciences Joint Laboratory, Bratislava, Slovak Republic; Sahlgrenska University Hospital/Östra (B.D.), Gothenburg, Sweden; Clinic of Medicine II
| | - Svetlana Slavic
- From the Center for Cardiovascular Research (L.P., S.T.R.B., K.L., K.S., S.S., E.K., C.T.-R., T.U., U.M.S.) and Department of Experimental Medicine (C.T.-R.), Charité-University Medicine, Berlin, Germany; Institute of Pathophysiology (L.P.), Faculty of Medicine, Comenius University and Institute of Normal and Pathological Physiology of the Slovak Academy of Sciences Joint Laboratory, Bratislava, Slovak Republic; Sahlgrenska University Hospital/Östra (B.D.), Gothenburg, Sweden; Clinic of Medicine II
| | - Elena Kaschina
- From the Center for Cardiovascular Research (L.P., S.T.R.B., K.L., K.S., S.S., E.K., C.T.-R., T.U., U.M.S.) and Department of Experimental Medicine (C.T.-R.), Charité-University Medicine, Berlin, Germany; Institute of Pathophysiology (L.P.), Faculty of Medicine, Comenius University and Institute of Normal and Pathological Physiology of the Slovak Academy of Sciences Joint Laboratory, Bratislava, Slovak Republic; Sahlgrenska University Hospital/Östra (B.D.), Gothenburg, Sweden; Clinic of Medicine II
| | - Christa Thöne-Reineke
- From the Center for Cardiovascular Research (L.P., S.T.R.B., K.L., K.S., S.S., E.K., C.T.-R., T.U., U.M.S.) and Department of Experimental Medicine (C.T.-R.), Charité-University Medicine, Berlin, Germany; Institute of Pathophysiology (L.P.), Faculty of Medicine, Comenius University and Institute of Normal and Pathological Physiology of the Slovak Academy of Sciences Joint Laboratory, Bratislava, Slovak Republic; Sahlgrenska University Hospital/Östra (B.D.), Gothenburg, Sweden; Clinic of Medicine II
| | - Björn Dahlöf
- From the Center for Cardiovascular Research (L.P., S.T.R.B., K.L., K.S., S.S., E.K., C.T.-R., T.U., U.M.S.) and Department of Experimental Medicine (C.T.-R.), Charité-University Medicine, Berlin, Germany; Institute of Pathophysiology (L.P.), Faculty of Medicine, Comenius University and Institute of Normal and Pathological Physiology of the Slovak Academy of Sciences Joint Laboratory, Bratislava, Slovak Republic; Sahlgrenska University Hospital/Östra (B.D.), Gothenburg, Sweden; Clinic of Medicine II
| | - Johannes Baulmann
- From the Center for Cardiovascular Research (L.P., S.T.R.B., K.L., K.S., S.S., E.K., C.T.-R., T.U., U.M.S.) and Department of Experimental Medicine (C.T.-R.), Charité-University Medicine, Berlin, Germany; Institute of Pathophysiology (L.P.), Faculty of Medicine, Comenius University and Institute of Normal and Pathological Physiology of the Slovak Academy of Sciences Joint Laboratory, Bratislava, Slovak Republic; Sahlgrenska University Hospital/Östra (B.D.), Gothenburg, Sweden; Clinic of Medicine II
| | - Thomas Unger
- From the Center for Cardiovascular Research (L.P., S.T.R.B., K.L., K.S., S.S., E.K., C.T.-R., T.U., U.M.S.) and Department of Experimental Medicine (C.T.-R.), Charité-University Medicine, Berlin, Germany; Institute of Pathophysiology (L.P.), Faculty of Medicine, Comenius University and Institute of Normal and Pathological Physiology of the Slovak Academy of Sciences Joint Laboratory, Bratislava, Slovak Republic; Sahlgrenska University Hospital/Östra (B.D.), Gothenburg, Sweden; Clinic of Medicine II
| | - U. Muscha Steckelings
- From the Center for Cardiovascular Research (L.P., S.T.R.B., K.L., K.S., S.S., E.K., C.T.-R., T.U., U.M.S.) and Department of Experimental Medicine (C.T.-R.), Charité-University Medicine, Berlin, Germany; Institute of Pathophysiology (L.P.), Faculty of Medicine, Comenius University and Institute of Normal and Pathological Physiology of the Slovak Academy of Sciences Joint Laboratory, Bratislava, Slovak Republic; Sahlgrenska University Hospital/Östra (B.D.), Gothenburg, Sweden; Clinic of Medicine II
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Tomiyama H, Yamashina A. Arterial Stiffness in Prehypertension: A Possible Vicious Cycle. J Cardiovasc Transl Res 2012; 5:280-6. [DOI: 10.1007/s12265-011-9345-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Accepted: 12/21/2011] [Indexed: 12/31/2022]
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16
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Masugata H, Senda S, Inukai M, Murao K, Himoto T, Hosomi N, Murakami K, Noma T, Kohno M, Okada H, Goda F. Association of cardio-ankle vascular index with brain natriuretic peptide levels in hypertension. J Atheroscler Thromb 2011; 19:255-62. [PMID: 22056595 DOI: 10.5551/jat.10314] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIMS Plasma brain natriuteric peptide (BNP) is an established marker of cardiovascular events in individuals without heart failure. Although the cardio-ankle vascular index (CAVI) is clinically used as a parameter of arterial stiffness, its usefulness for predicting cardiovascular events has not been fully examined. This study aimed to evaluate the association among CAVIs, plasma BNP levels and left ventricular (LV) hypertrophy and dysfunction in hypertensive patients. METHODS We enrolled 136 hypertensive patients (69±10 years) who had been taking antihypertensive medications for at least one year. Echocardiography was performed to evaluate LV hypertrophy and function. Plasma BNP levels and CAVIs were also measured simultaneously. RESULTS CAVI was correlated with plasma BNP (r =0.245, p =0.004). Multiple linear regression analysis revealed three independent determinants of CAVI: age (β =0.568, p <0.001), diameter of ascending aorta (β =0.289, p <0.001), and diabetes (β =0.207, p =0.003). In addition, multiple linear regression analysis revealed two independent determinants of the plasma BNP level: left atrial diameter (β =0.334, p <0.001) and CAVI (β =0.256, p =0.002). CONCLUSION The present study indicates that increased CAVI is independently associated with elevated plasma BNP produced by increased LV afterload, that is, arterial stiffness, in hypertensive patients. Moreover, the present study raises the possibility that CAVI may be as useful as the plasma BNP level for predicting the risk of cardiovascular events in hypertensive patients.
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