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Omboni S, Alfie J, Arystan A, Avolio A, Barin E, Bokusheva J, Bulanova N, Butlin M, Cuffaro P, Derevyanchenko M, Grigoricheva E, Gurevich A, Konradi A, Muiesan ML, Paini A, Pereira T, Statsenko ME, Tan I. Association of 24-h central hemodynamics and stiffness with cardiovascular events and all-cause mortality. The VASOTENS Registry. J Hypertens 2024; 42:1590-1597. [PMID: 38747378 DOI: 10.1097/hjh.0000000000003763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2024]
Abstract
OBJECTIVES In hemodialysis patients, central hemodynamics, stiffness, and wave reflections assessed through ambulatory blood pressure monitoring (ABPM) showed superior prognostic value for cardiovascular (CV) events than peripheral blood pressures (BPs). No such evidence is available for lower-risk hypertensive patients. METHODS In 591 hypertensive patients (mean age 58 ± 14 years, 49% males), ambulatory brachial and central BP, pulse wave velocity (PWV), and augmentation index (AIx) were obtained with a validated upper arm cuff-based pulse wave analysis technology. Information on treatment for hypertension (73% of patients), dyslipidemia (27%), diabetes (8%), CV disease history (25%), was collected. Patients were censored for CV events or all-cause death over 4.2 years. RESULTS One hundred and four events (24 fatal) were recorded. Advanced age [hazard ratio and 95% confidence interval: 1.03 (1.01, 1.05), P = 0.0001], female sex [1.57 (1.05, 2.33), P = 0.027], CV disease [2.22 (1.50, 3.29), P = 0.0001], increased 24-h central pulse pressure (PP) [1.56 (1.05, 2.31), P = 0.027], PWV [1.59 (1.07, 2.36), P = 0.022], or AIx [1.59 (1.08, 2.36), P = 0.020] were significantly associated with a worse prognosis (univariate Cox regression analysis). The prognostic power of peripheral and central BPs was lower. However, PWV [1.02 (0.64, 1.63), P = 0.924], AIx [1.06 (0.66, 1.69), P = 0.823], and central PP [1.18 (0.76, 1.82), P = 0.471], were not significant predictors in multivariate analyses. CONCLUSIONS In hypertensive patients, ambulatory central PP, PWV, and AIx are associated with an increased risk of CV morbidity and all-cause mortality. However, this association is not independent of other patient characteristics.
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Affiliation(s)
- Stefano Omboni
- Clinical Research Unit, Italian Institute of Telemedicine, Varese, Italy
- Department of Cardiology, Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Jose Alfie
- Servicio de Clínica Médica y Sección Hipertensión Arterial, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Ayana Arystan
- Department of Functional Diagnostics, Medical Center Hospital of President's Affairs Administration of The Republic of Kazakhstan, Astana, Kazakhstan
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Alberto Avolio
- Macquarie Medical School, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Edward Barin
- Macquarie Medical School, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Jamilya Bokusheva
- Department of Functional Diagnostics, Medical Center Hospital of President's Affairs Administration of The Republic of Kazakhstan, Astana, Kazakhstan
| | | | - Mark Butlin
- Macquarie Medical School, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Paula Cuffaro
- Servicio de Clínica Médica y Sección Hipertensión Arterial, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | | | - Alexandra Gurevich
- Almazov National Medical Research Centre, Saint Petersburg, Russian Federation
| | - Alexandra Konradi
- Almazov National Medical Research Centre, Saint Petersburg, Russian Federation
| | - Maria Lorenza Muiesan
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Anna Paini
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Telmo Pereira
- H&TRC - Health & Technology Research Center, Coimbra Health School, Polytechnic University of Coimbra, Coimbra, Portugal
| | | | - Isabella Tan
- Macquarie Medical School, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
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Bulum T, Brkljačić N, Tičinović Ivančić A, Čavlović M, Prkačin I, Tomić M. In Association with Other Risk Factors, Smoking Is the Main Predictor for Lower Transcutaneous Oxygen Pressure in Type 2 Diabetes. Biomedicines 2024; 12:381. [PMID: 38397984 PMCID: PMC10886561 DOI: 10.3390/biomedicines12020381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/01/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
Type 2 diabetes mellitus (T2DM) significantly increases the risk of peripheral artery disease (PAD), and diabetes is the leading cause of nontraumatic amputations. This study investigated the risk factors for transcutaneous oxygen pressure (TcPO2) in T2DM, a noninvasive method to quantify skin oxygenation and the underlying microvascular circulation. The study included 119 T2DM patients (91 male/28 female). TcPO2 measurements were conducted with the Tina TCM4 Series transcutaneous monitor (Radiometer, Copenhagen, Sweden) and skin electrodes. Patients with TcPO2 < 40 mmHg were younger (p = 0.001), had significantly higher systolic blood pressure (SBP) (p = 0.023), glycated hemoglobin (HbA1c) (p = 0.013), fasting plasma glucose (fPG) (p = 0.038), total cholesterol (p = 0.006), LDL cholesterol (p = 0.004), and had more frequent smoking habits (p = 0.001) than those with TcPO2 ≥ 40 mmHg. The main predictors for the TcPO2 value (R2 = 0.211) obtained via stepwise regression analysis were age, smoking, SBP, HbA1c, fPG, and total and LDL cholesterol. Among all the listed predictors, smoking, HbA1c, and LDL cholesterol were found to be the most significant, with negative parameter estimates of -3.051310 (p = 0.0007), -2.032018 (p = 0.0003), and -2.560353 (p = 0.0046). The results of our study suggest that in association with other risk factors, smoking is the main predictor for lower TcPO2 in T2DM.
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Affiliation(s)
- Tomislav Bulum
- Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, 10000 Zagreb, Croatia
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Neva Brkljačić
- Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, 10000 Zagreb, Croatia
| | | | - Maja Čavlović
- Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, 10000 Zagreb, Croatia
| | - Ingrid Prkačin
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Internal Medicine, Merkur University Hospital, 10000 Zagreb, Croatia
| | - Martina Tomić
- Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, 10000 Zagreb, Croatia
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Guimarães Filho GC, de Oliveira Vitorino PV, Inuzuka S, Barroso AS, Pacífico Alves Filho RP, Melo VA, de Oliveira Urzeda LF, Lima Sousa AL, Coca A, Veiga Jardim PCB, Barroso WKS. Pharmacological treatment of hypertension guided by peripheral or central blood pressure: a comparison between the two strategies. Front Cardiovasc Med 2023; 10:1247146. [PMID: 37771662 PMCID: PMC10525392 DOI: 10.3389/fcvm.2023.1247146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 08/28/2023] [Indexed: 09/30/2023] Open
Abstract
Background Arterial hypertension treatment guided by central blood pressures (CPB) rather than peripheral blood pressures (PBP) measurement has the potential to show greater effectiveness in preventing or even regressing stiffness and target organ damage (TOD). Objective This study aimed to compare the parameters of CBP and PBP measurements, arterial stiffness, TOD and renal profile in patients with anti-hypertensive treatment guided by CBP or PBP targets. Methods A randomized clinical trial was conducted in central group (CG) and peripheral group (PG). Patients were randomized, evaluated every 3 months for BP and antihypertensive adjustments during a one-year follow up. The procedures in V1 and V5: anthropometric assessment; CBP/PBP measurements, carotid ultrasound; echocardiography; laboratory tests. Paired and unpaired t-tests and the χ2 were used (significance level: 5%). Results The study evaluated 59 participants (30CG/29PG). The augmentation index (AIx) was higher in the CG (27.3% vs. 20.3%, p = 0.041). Intergroup analysis has found central diastolic BP lower in the CG (78.9 vs. 84.3 mmHg, p = 0.024) and the Alx difference between groups ceased to exist after a one-year follow-up. Intragroup comparisons, after intervention, showed a lower frequency of changed PWV (p < 0.001) and LVMI (p = 0.018) in the CG. The PG showed a higher frequency of changed PWV (p < 0.001) and LVMI (p = 0.003). Conclusion The intervention guided by central BP reduced the central diastolic BP and AIx compared to the PG. There was a reduction in the frequency of changed PWV and LVMI in the CG.
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Affiliation(s)
- Gilberto Campos Guimarães Filho
- Hypertension League and Graduate Program, Department of Cardiology, Medicine School Federal University of Goiás, Goiânia, Brazil
| | | | - Sayuri Inuzuka
- Hypertension League and Graduate Program, Department of Cardiology, Medicine School Federal University of Goiás, Goiânia, Brazil
| | - Adriana Sebba Barroso
- Hypertension League and Graduate Program, Department of Cardiology, Medicine School Federal University of Goiás, Goiânia, Brazil
| | | | - Victoria Alves Melo
- Hypertension League and Graduate Program, Department of Cardiology, Medicine School Federal University of Goiás, Goiânia, Brazil
| | - Luiz Fernando de Oliveira Urzeda
- Hypertension League and Graduate Program, Department of Cardiology, Medicine School Federal University of Goiás, Goiânia, Brazil
| | - Ana Luiza Lima Sousa
- Hypertension League and Graduate Program, Department of Cardiology, Medicine School Federal University of Goiás, Goiânia, Brazil
| | - Antonio Coca
- Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clínic (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Paulo César Brandão Veiga Jardim
- Hypertension League and Graduate Program, Department of Cardiology, Medicine School Federal University of Goiás, Goiânia, Brazil
| | - Weimar Kunz Sebba Barroso
- Hypertension League and Graduate Program, Department of Cardiology, Medicine School Federal University of Goiás, Goiânia, Brazil
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Gutteridge D, Tully P, Smith A, Loetscher T, Keage H. Cross-sectional associations between short and mid-term blood pressure variability, cognition, and vascular stiffness in older adults. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2023; 5:100181. [PMID: 37711969 PMCID: PMC10497990 DOI: 10.1016/j.cccb.2023.100181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 08/11/2023] [Accepted: 08/31/2023] [Indexed: 09/16/2023]
Abstract
Background High blood pressure variability (BPV), particularly in older age, appears to be an independent risk factor for incident dementia. The current study aimed to investigate the association between different BPV measures (short- and mid-term BPV including circadian patterns) and cognitive functioning as well as vascular stiffness measures to better understand the role that BPV plays in cognitive impairment. Methods 70 older adults (60-80-year-olds) without dementia completed a cognitive test battery and had their blood pressure (BP) assessed via a 24-hour ambulatory BP monitor (divided into sleep and wake for short-term BPV) and 4-day morning and evening home-based BP monitor (for day-to-day BPV). Arterial stiffness was evaluated via pulse wave analysis and pulse wave velocity (PWV) and cerebrovascular pulsatility was assessed via transcranial doppler sonography of the middle cerebral arteries. Results High systolic as well as diastolic short- and mid-term BPV were associated with poorer cognitive functioning, independent of the mean BP. Higher short-term BPV was associated with poorer attention and psychomotor speed, whilst day-to-day BPV was negatively linked with executive functioning. Circadian BP patterns (dipping and morning BP surge) showed no significant relationships with cognition after adjusting for covariates. Higher systolic short-term BPV was associated with higher arterial stiffness (PWV) and higher diastolic day-to-day BPV was linked with lower arterial stiffness. No significant associations between BPV measures and cerebrovascular pulsatility were present. Conclusion High BPV, independently of the mean BP, is associated with lower cognitive performance and increased arterial stiffness in older adults without clinically-relevant cognitive impairment. This highlights the role of systolic and diastolic BPV as a potential early clinical marker for cognitive impairment.
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Affiliation(s)
- D.S. Gutteridge
- Cognitive Ageing and Impairment Neuroscience Laboratory (CAIN), University of South Australia, Adelaide, SA, Australia
| | - P.J. Tully
- Faculty of Medicine and Health, School of Psychology, University of New England, Armidale, NSW, Australia
| | - A.E. Smith
- Alliance for Research in Exercise Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - T. Loetscher
- Cognitive Ageing and Impairment Neuroscience Laboratory (CAIN), University of South Australia, Adelaide, SA, Australia
| | - H.A. Keage
- Cognitive Ageing and Impairment Neuroscience Laboratory (CAIN), University of South Australia, Adelaide, SA, Australia
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Bublitz MH, Nillni Y, Nugent NR, Sanapo L, Habr N, Bourjeily G. Posttraumatic stress disorder, diurnal cortisol, and ambulatory blood pressure in early and late pregnancy. J Trauma Stress 2023; 36:239-246. [PMID: 36464928 PMCID: PMC11079916 DOI: 10.1002/jts.22895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 10/03/2022] [Accepted: 10/07/2022] [Indexed: 12/12/2022]
Abstract
Posttraumatic stress disorder (PTSD) affects 1 in 20 reproductive-aged women and is associated with cardiovascular disease morbidity and mortality. The pathophysiology linking PTSD to cardiovascular disease in nonpregnant adults is proposed to include hypothalamic and autonomic dysregulation; however, the pathways explaining this association in pregnancy are unclear. We examined diurnal cortisol and ambulatory blood pressure (BP) among 254 pregnant women at approximately 12 and 32 gestational weeks. Participants were, on average, 31 years old (SD = 5), 24.4% reported their ethnicity as Hispanic, and 62.2% reported their race as White. PTSD symptoms were measured using the PTSD Checklist for DSM-5 (PCL-5). Hierarchical linear regression analyses were performed to examine associations pregnancy between PTSD and cortisol at awakening, 30 min after awakening, and bedtime in early and late pregnancy, as well as associations between PTSD symptoms and daytime and nighttime systolic (SBP) and diastolic BP (DBP) and BP variability. Logistic regression analyses were conducted to test associations between PTSD symptoms and BP dipping. The results showed a positive association between PTSD symptoms and nighttime BP and BP variability at 32 gestational weeks, ∆R2 = .036-.067. PTSD symptoms were negatively associated with awakening cortisol at 12 gestational weeks in unadjusted models. These findings contribute to understanding the associations between PTSD and adverse cardiovascular conditions in pregnancy. More research is needed to replicate these findings and examine whether PTSD interventions are effective at modifying pathways and decreasing the risk for cardiovascular complications in pregnancy.
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Affiliation(s)
- Margaret H. Bublitz
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Women’s Medicine Collaborative, The Miriam Hospital, Providence, Rhode Island, USA
| | - Yael Nillni
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- Women’s Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Nicole R. Nugent
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Laura Sanapo
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Women’s Medicine Collaborative, The Miriam Hospital, Providence, Rhode Island, USA
| | - Naya Habr
- Women’s Medicine Collaborative, The Miriam Hospital, Providence, Rhode Island, USA
| | - Ghada Bourjeily
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Women’s Medicine Collaborative, The Miriam Hospital, Providence, Rhode Island, USA
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Relationship of 24-h ambulatory blood pressure variability with micro and macrovascular parameters and hypertension status. J Hypertens 2023; 41:74-82. [PMID: 36453654 DOI: 10.1097/hjh.0000000000003300] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
OBJECTIVES Increased blood pressure variability (BPV) has been associated with an increased risk of subclinical organ damage and cardiovascular events, independently of elevated average BP values. We aimed to investigate the association of BPV indices with micro- and macrovascular parameters, some of them not previously studied. METHODS We evaluated 344 individuals (233 never-treated/newly diagnosed hypertensive and 111 normotensive individuals). BPV was assessed using average real variability (ARV) during 24-h, daytime and night-time ambulatory blood pressure monitoring, and systolic weighted standard deviation (wSD). Retinal microvascular diameter was assessed by nonmydriatic retinal photography. Arterial stiffness was assessed by pulse wave velocity (PWV) and aortic augmentation index (AIx); subendocardial variability ratio (SEVR) was used as an index of myocardial perfusion. Carotid intima-media thickness (cIMT) was measured by ultrasound. Data were analyzed using multiple regression analysis. RESULTS After adjusting for potential confounders, PWV and cIMT were independently associated with ARV components in the total sample (P < 0.023 and P < 0.014, respectively). Within hypertensives only PWV and cIMT were independently associated with ARV components (P < 0.002 for PWV and P < 0.003 for cIMT). In contrast, within normotensives, only retinal parameters and AIx were associated with ARV components (P < 0.017 and P = 0.013, respectively). None of the univariate correlations between vascular parameters and wSD remained significant after adjustment for potential confounders. CONCLUSION Short-term BPV as assessed by ARV is independently associated with macrovascular parameters in untreated hypertensive patients, and with microvascular parameters in normotensive individuals.
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McCallinhart PE, Lee YU, Lee A, Anghelescu M, Tonniges JR, Calomeni E, Agarwal G, Lincoln J, Trask AJ. Dissociation of pulse wave velocity and aortic wall stiffness in diabetic db/db mice: The influence of blood pressure. Front Physiol 2023; 14:1154454. [PMID: 37035668 PMCID: PMC10080125 DOI: 10.3389/fphys.2023.1154454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 03/10/2023] [Indexed: 04/11/2023] Open
Abstract
Introduction: Vascular stiffness is a predictor of cardiovascular disease and pulse wave velocity (PWV) is the current standard for measuring in vivo vascular stiffness. Mean arterial pressure is the largest confounding variable to PWV; therefore, in this study we aimed to test the hypothesis that increased aortic PWV in type 2 diabetic mice is driven by increased blood pressure rather than vascular biomechanics. Methods and Results: Using a combination of in vivo PWV and ex vivo pressure myography, our data demonstrate no difference in ex vivo passive mechanics, including outer diameter, inner diameter, compliance (Db/db: 0.0094 ± 0.0018 mm2/mmHg vs. db/db: 0.0080 ± 0.0008 mm2/mmHg, p > 0.05 at 100 mmHg), and incremental modulus (Db/db: 801.52 ± 135.87 kPa vs. db/db: 838.12 ± 44.90 kPa, p > 0.05 at 100 mmHg), in normal versus diabetic 16 week old mice. We further report no difference in basal or active aorta biomechanics in normal versus diabetic 16 week old mice. Finally, we show here that the increase in diabetic in vivo aortic pulse wave velocity at baseline was completely abolished when measured at equivalent pharmacologically-modulated blood pressures, indicating that the elevated PWV was attributed to the concomitant increase in blood pressure at baseline, and therefore "stiffness." Conclusions: Together, these animal model data suggest an intimate regulation of blood pressure during collection of pulse wave velocity when determining in vivo vascular stiffness. These data further indicate caution should be exerted when interpreting elevated PWV as the pure marker of vascular stiffness.
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Affiliation(s)
- Patricia E. McCallinhart
- Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH, United States
- Center for Cardiovascular Research, Nationwide Children’s Hospital, Columbus, OH, United States
| | - Yong Ung Lee
- Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH, United States
- Tissue Engineering Program and Surgical Research, Columbus, OH, United States
| | - Avione Lee
- Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH, United States
- Tissue Engineering Program and Surgical Research, Columbus, OH, United States
| | - Mircea Anghelescu
- Department of Biomedical Sciences, Philadelphia College of Osteopathic Medicine (PCOM), Suwanee, GA, United States
| | - Jeffrey R. Tonniges
- Biophysics Graduate Program at The Ohio State University, Columbus, OH, United States
| | - Ed Calomeni
- Dorothy M. Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Gunjan Agarwal
- Biophysics Graduate Program at The Ohio State University, Columbus, OH, United States
- Dorothy M. Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Joy Lincoln
- Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH, United States
- Center for Cardiovascular Research, Nationwide Children’s Hospital, Columbus, OH, United States
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Aaron J. Trask
- Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH, United States
- Center for Cardiovascular Research, Nationwide Children’s Hospital, Columbus, OH, United States
- Dorothy M. Davis Heart and Lung Research Institute, College of Medicine, The Ohio State University, Columbus, OH, United States
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, United States
- *Correspondence: Aaron J. Trask,
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Turana Y, Shen R, Nathaniel M, Chia Y, Li Y, Kario K. Neurodegenerative diseases and blood pressure variability: A comprehensive review from HOPE Asia. J Clin Hypertens (Greenwich) 2022; 24:1204-1217. [PMID: 36196471 PMCID: PMC9532897 DOI: 10.1111/jch.14559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/25/2022] [Accepted: 07/31/2022] [Indexed: 11/19/2022]
Abstract
Asia has an enormous number of older people and is the primary contributor to the rise in neurodegenerative diseases such as Alzheimer's and Parkinson's disease. The therapy of many neurodegenerative diseases has not yet progressed to the point where it is possible to alter the course of the disease. Mid-life hypertension is an important predictor of later-life cognitive impairment and brain neurodegenerative conditions. These findings highlight the pivotal role of preventing and managing hypertension as a risk factor for neurodegenerative disease. Autonomic dysfunction, neuropsychiatric and sleep disturbances can arise in neurodegenerative diseases, resulting in blood pressure variability (BPV). The BPV itself can worsen the progression of the disease. In older people with neurodegenerative disease and hypertension, it is critical to consider 24-h blood pressure monitoring and personalized blood pressure therapy.
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Affiliation(s)
- Yuda Turana
- School of Medicine and Health SciencesAtma Jaya Catholic University of IndonesiaNorth JakartaJakartaIndonesia
- Master Study Program in Biomedical SciencesSchool of Medicine and Health SciencesAtma Jaya Catholic University of IndonesiaNorth JakartaJakartaIndonesia
| | - Robert Shen
- School of Medicine and Health SciencesAtma Jaya Catholic University of IndonesiaNorth JakartaJakartaIndonesia
- Master Study Program in Biomedical SciencesSchool of Medicine and Health SciencesAtma Jaya Catholic University of IndonesiaNorth JakartaJakartaIndonesia
| | - Michael Nathaniel
- School of Medicine and Health SciencesAtma Jaya Catholic University of IndonesiaNorth JakartaJakartaIndonesia
| | - Yook‐Chin Chia
- Department of Medical SciencesSchool of Medical and Life SciencesSunway UniversityBandar SunwayMalaysia
- Department of Primary Care MedicineFaculty of MedicineUniversity of MalayaKuala LumpurMalaysia
| | - Yan Li
- Department of Cardiovascular MedicineShanghai Key Lab of HypertensionShanghai Institute of HypertensionNational Research Centre for Translational MedicineRuijin HospitalShanghai Jiaotong University School of MedicineShanghaiChina
| | - Kazuomi Kario
- Division of Cardiovascular MedicineDepartment of MedicineJichi Medical University School of MedicineTochigiJapan
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AKSOY MNM, CAN Y, KOCAYİĞİT İ, AĞAÇ MT. Systolic Blood Pressure Variability and Its Relationship with Surrogate Markers of Cardiovascular Risk in Hypertensive Patients. KONURALP TIP DERGISI 2021. [DOI: 10.18521/ktd.890622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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10
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Heiston EM, Gilbertson NM, Eichner NZM, Malin SK. A Low-Calorie Diet with or without Exercise Reduces Postprandial Aortic Waveform in Females with Obesity. Med Sci Sports Exerc 2021; 53:796-803. [PMID: 32925495 DOI: 10.1249/mss.0000000000002515] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE Arterial stiffness is considered a predictor of cardiovascular disease. Females have higher values of arterial stiffness than males, suggesting a greater risk of heart-related complications. Although a low-calorie diet (LCD) reduces fasting arterial stiffness, in part through weight loss, it is unknown if interval exercise (INT) adds to the benefit of LCD on fasting and postprandial arterial stiffness in females with obesity. METHODS Twenty-five females (47 ± 2.6 yr, 37.6 ± 1.3 kg·m-2) were randomized to 13 d of LCD (n = 12; mixed meals of ~1200 kcal·d-1) or LCD + INT (n = 13; 60 min·d-1 of supervised 3-min intervals at 90% HRpeak and 50% HRpeak). Arterial stiffness (augmentation index [AIx] and carotid-femoral pulse wave velocity [cfPWV]) and blood biochemistries were measured during a 75-g oral glucose tolerance test before and after the intervention to determine fasting and postprandial arterial stiffness as well as insulin sensitivity (simple index of insulin sensitivity [SIIS]) and inflammation (C-reactive protein, interleukin 8, and tumor necrosis factor alpha). RESULTS Although LCD + INT increased V˙O2peak and HDL compared with LCD (P = 0.04 and P < 0.01, respectively), both interventions decreased body fat, LDL, total cholesterol, and triglycerides (all P < 0.01) and increased SIIS (P = 0.03). Despite no effect on fasting AIx (P = 0.27), LCD and LCD + INT decreased AIx60min (-7.4% ± 4.3% vs -7.0% ± 5.0%, P = 0.04) and tAUC120min (-663 ± 263 vs -457 ± 406, P = 0.03). There were no changes in fasting cfPWV (P = 0.91) or cfPWV120min (P = 0.62). Increased SIIS and decreased interleukin 8 were associated with reduced fasting AIx (r = -0.44, P = 0.03, and r = 0.40, P = 0.055), whereas decreased C-reactive protein correlated with reduced postprandial AIx60min (r = 0.43, P = 0.04). CONCLUSION Independent of exercise, 13 d of LCD reduces postprandial AIx in females with obesity. Insulin sensitivity and inflammation correlated with improved arterial stiffness, suggesting unique mechanisms regulate fasted versus postprandial arterial stiffness.
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Affiliation(s)
- Emily M Heiston
- Department of Kinesiology, University of Virginia, Charlottesville, VA
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Triantafyllidi H, Benas D, Schoinas A, Birmpa D, Trivilou P, Varytimiadi E, Voutsinos D, Ikonomidis I. Hypertension-mediated organ damage regression associates with blood pressure variability improvement three years after successful treatment initiation in essential hypertension. J Clin Hypertens (Greenwich) 2021; 23:1150-1158. [PMID: 33554428 PMCID: PMC8678708 DOI: 10.1111/jch.14209] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/13/2020] [Accepted: 12/19/2020] [Indexed: 11/30/2022]
Abstract
Blood pressure variability (BPV) has been associated with the development, progression, and severity of cardiovascular (CV) organ damage and an increased risk of CV morbidity and mortality. We aimed to explore any association between short‐term BPV reduction and hypertension‐mediated organ damage (HMOD) regression in hypertensive patients 3‐year post‐treatment initiation regarding BP control. 24‐h ambulatory blood pressure monitoring (24 h ABPM) was performed at baseline in 180 newly diagnosed and never‐treated hypertensive patients. We measured 24 h average systolic (24 h SBP) and diastolic BP (24 h DBP) as well as 24 h systolic (sBPV) and diastolic BPV (dBPV). Patients were initially evaluated and 3 years later regarding arterial stiffness (PWV), left ventricular hypertrophy (LVMI), carotid intima‐media thickness (cIMT), 24 h microalbumin levels (MAU), and coronary flow reserve (CFR). Successful BP treatment was defined as 24 h SBP/DBP < 130/80 mm Hg based on 2nd ABPM and subsequently, patients were characterized as controlled (n = 119, age = 53 ± 11 years) or non‐controlled (n = 61, age = 47 ± 11 years) regarding their BP levels. In the whole population and the controlled group, 24 h SBP/DBP, sBPV/dBPV, LVMI, and IMT were decreased. Additionally, LVMI improvement was related with both sBPV (p < .001) and dBPV reduction (r = .18, p = .02 and r = .20, p = .03, respectively). In non‐controlled hypertensives, PWV was increased. In multiple linear regression analysis, sBPV and dBPV reduction predicted LVMI improvement in total population and controlled group independently of initial office SBP, mean BP, and 24 h‐SBP levels. In middle‐aged hypertensive patients, a 3‐year antihypertensive treatment within normal BP limits, confirmed by 24‐h ABPM, leads to CV risk reduction associated with sBPV and dBPV improvement.
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Affiliation(s)
- Helen Triantafyllidi
- 2nd Department of Cardiology Medical School, University of Athens, ATTIKON Hospital, Athens, Greece
| | - Dimitrios Benas
- 2nd Department of Cardiology Medical School, University of Athens, ATTIKON Hospital, Athens, Greece
| | - Antonios Schoinas
- 2nd Department of Cardiology Medical School, University of Athens, ATTIKON Hospital, Athens, Greece
| | - Dionyssia Birmpa
- 2nd Department of Cardiology Medical School, University of Athens, ATTIKON Hospital, Athens, Greece
| | - Paraskevi Trivilou
- 2nd Department of Cardiology Medical School, University of Athens, ATTIKON Hospital, Athens, Greece
| | - Efthimia Varytimiadi
- 2nd Department of Cardiology Medical School, University of Athens, ATTIKON Hospital, Athens, Greece
| | - Dimitrios Voutsinos
- 2nd Department of Cardiology Medical School, University of Athens, ATTIKON Hospital, Athens, Greece
| | - Ignatios Ikonomidis
- 2nd Department of Cardiology Medical School, University of Athens, ATTIKON Hospital, Athens, Greece
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12
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Tatasciore A, Di Nicola M, Tommasi R, Santarelli F, Palombo C, Parati G, De Caterina R. From short-term blood pressure variability to atherosclerosis: Relative roles of vascular stiffness and endothelial dysfunction. J Clin Hypertens (Greenwich) 2020; 22:1218-1227. [PMID: 32639102 DOI: 10.1111/jch.13871] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 03/11/2020] [Accepted: 03/14/2020] [Indexed: 12/14/2022]
Abstract
Both arterial blood pressure (BP) average levels and short-term BP variability (BPV) relate to hypertension-mediated organ damage, in particular increased carotid artery intima-media thickness (IMT) and carotid-femoral pulse wave velocity (PWV). Endothelial dysfunction possibly mediates such damage. The authors aimed at further investigating such role in hypertensive patients. In 189 recently diagnosed, untreated hypertensive patients the authors evaluated, in a cross-sectional design, the relationships of BP average levels and short-term systolic (S) BPV (standard deviation of awake SBP or of 24-hour-weighted SBP) with IMT and PWV, and how much these relationships are explained by endothelial function parameters-brachial artery flow-mediated dilation (FMD) and digital reactive hyperemia index (RHI). Multivariable models assessed the strength of these relationships to derive a plausible pathogenetic sequence. Both average SBP values and our measures of SBPV were significantly related to IMT (24-hour mean SBP: r = .156, P = .034; 24-hour-weighted SBPV: r = .157, P = .033) and to PWV (24-hour mean SBP: r = .179, P = .015; 24-hour-weighted SBPV: r = .175; P = .018), but only poorly related to FMD or RHI (P > .05 for all). At univariable regression analysis, FMD and RHI were both related to IMT, (P < .001), but not to PWV. When FMD and RHI were added to average SBP and SBPV parameters in a multivariable model, both significantly (P < .005) contributed to predict IMT, but not PWV. Thus, endothelial dysfunction relates to IMT independently of BP parameters, but appears to play a minor role in the association between BP variability-related variables and arterial stiffening.
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Affiliation(s)
- Alfonso Tatasciore
- Institute of Cardiology and Center of Excellence on Aging, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Marta Di Nicola
- Laboratory of Biostatistics, Department of Medical, Oral and Biotechnological Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Roberto Tommasi
- Institute of Cardiology and Center of Excellence on Aging, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Francesco Santarelli
- Institute of Cardiology and Center of Excellence on Aging, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Carlo Palombo
- Cardiovascular and Thoracic Department, University of Pisa, Pisa, Italy
| | - Gianfranco Parati
- Istituto Auxologico Italiano, IRCCS, Milan, Italy.,Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Raffaele De Caterina
- Cardiovascular and Thoracic Department, University of Pisa, Pisa, Italy.,Fondazione Villa Serena per la Ricerca, Pescara, Italy
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13
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Abstract
Arterial blood pressure (BP) is a continuous variable, with a physiology characterized by significant variability stemming from the complex interaction among haemodynamic factors, neuronal reflexes, as well as hormonal, behavioural, and environmental stimuli. The homoeostatic response accounts for the physiologic variability in BP in normotensive individuals, which is more evident in hypertensive patients. Blood pressure variability is a complex phenomenon, which could be classified in various types: very short term (beat to beat), short term (during 24 h), mid-term (day by day), long term (<5 years), and very long term (>5 years). Accurate measurement of BP variability represents a complex and often controversial endeavour, despite several methodological approaches are available. Albeit a prognostic significance has been demonstrated for some indicators of BP variability, the clinical significance of this measurement is still uncertain. In fact, none of the indicators presently available for BP variability, including early morning BP rise, substantially affects, and redefines, the cardiovascular risk of the hypertensive patient, over and beyond the mere BP values. Accordingly, in defining the cardiovascular risk, the focus should be on the absolute BP values, which remain the most relevant risk factor, and the one more susceptible to modification with both non-pharmacologic and pharmacologic treatment.
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Affiliation(s)
- Enrico Agabiti Rosei
- Clinica Medica, Dipartimento di Scienze Cliniche e Sperimentali, Università degli Studi di Brescia
| | - Giulia Chiarini
- Clinica Medica, Dipartimento di Scienze Cliniche e Sperimentali, Università degli Studi di Brescia
| | - Damiano Rizzoni
- Clinica Medica, Dipartimento di Scienze Cliniche e Sperimentali, Università degli Studi di Brescia
- Divisione di Medicina, Istituto Clinico Città di Brescia
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14
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Omboni S, Posokhov I, Parati G, Arystan A, Tan I, Barkan V, Bulanova N, Derevyanchenko M, Grigoricheva E, Minyukhina I, Mulè G, Orlova I, Paini A, Peixoto Maldonado JM, Pereira T, Ramos-Becerra CG, Tilea I, Waisman G. Variable association of 24-h peripheral and central hemodynamics and stiffness with hypertension-mediated organ damage: the VASOTENS Registry. J Hypertens 2020; 38:701-715. [DOI: 10.1097/hjh.0000000000002312] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Hong K, Yu ES, Chun BC. Risk factors of the progression to hypertension and characteristics of natural history during progression: A national cohort study. PLoS One 2020; 15:e0230538. [PMID: 32182265 PMCID: PMC7077816 DOI: 10.1371/journal.pone.0230538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 03/02/2020] [Indexed: 11/26/2022] Open
Abstract
Background Although the high disease burden that results from cardiovascular complications of hypertension, factors related to the progression to hypertension in the normotensive population are not actively reported. The purpose of this study was to estimate the rate of the progression to hypertension and to reveal the associated risk factors. Methods The study included normotensive participants from the National Health Insurance Service-National Health Screening Cohort, and contained a 10% sample of all adults who received a national health screening test in either 2002 or 2003. At the end of the study in 2015, the patients were divided into two groups based on whether or not they progressed to hypertension. Cox proportional hazard modeling was performed to identify risk factors for progression. Subgroup analysis using logistic regression was employed to reveal factors influencing the different natural history of the progression. Results Among the 75,335 included participants, the progression rate to hypertension was 66.39% (50,013), with an adjusted incidence rate of 8.62 per 100 person-year in the aged 40–64 group and 12.68 in the aged 65 or above group. Age, BMI, hemoglobin, and family history of hypertension and other diseases were related to the progression. Among the progression group, 78.21% (39,116) participants skipped a pre-hypertensive status; this group consisted of older females with lower pulse pressure and more alcohol consumption compared to people who had pre-hypertensive status before the progression. Conclusion Substantial risk factors for the progression to hypertension should be carefully managed even in normotensive participants who receive health screening tests.
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Affiliation(s)
- Kwan Hong
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
- Graduate School of Public Health, Korea University, Seoul, Korea
| | - Eun Sun Yu
- Graduate School of Public Health, Korea University, Seoul, Korea
- National Health Insurance Service, Wonju-si, Korea
| | - Byung Chul Chun
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
- Graduate School of Public Health, Korea University, Seoul, Korea
- * E-mail:
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16
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Miyauchi S, Nagai M, Dote K, Kato M, Oda N, Kunita E, Kagawa E, Yamane A, Higashihara T, Takeuchi A, Tsuchiya A, Takahari K. Visit-to-visit Blood Pressure Variability and Arterial Stiffness: Which Came First: The Chicken or the Egg? Curr Pharm Des 2020; 25:685-692. [PMID: 30931845 DOI: 10.2174/1381612825666190329122024] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 03/25/2019] [Indexed: 11/22/2022]
Abstract
Earlier studies have shown that visit-to-visit blood pressure (BP) variability (VVV) served as a significant independent risk factor of stroke, specifically, in the high-risk elderly of cardiovascular disease (CVD). Although the mechanism is not clearly understood, arterial remodeling such as carotid artery, coronary artery and large aortic artery would be a strong moderator in the relationship between VVV and CVD incidence. Recent studies have provided evidence that VVV predicted the progression of arterial stiffness. While the class of antihypertensive agents is suggested to be an important determinant of VVV, long-acting calcium channel blockers use (CCBs) is associated with the reduction of VVV, and thus, is suggested to decrease the arterial stiffness. Specifically, the relationship between VVV and coronary arterial remodeling has never been reviewed until now. This article summarizes the recent literature on these topics. In the elderly hypertensives, strict BP control using CCBs could play a pivotal role in suppressing arterial stiffening via VVV reduction.
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Affiliation(s)
- Shunsuke Miyauchi
- Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Michiaki Nagai
- Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Keigo Dote
- Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Masaya Kato
- Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Noboru Oda
- Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Eiji Kunita
- Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Eisuke Kagawa
- Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Aya Yamane
- Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan
| | | | - Arinori Takeuchi
- Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Akane Tsuchiya
- Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan
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17
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Del Giorno R, Balestra L, Heiniger PS, Gabutti L. Blood pressure variability with different measurement methods: Reliability and predictors. A proof of concept cross sectional study in elderly hypertensive hospitalized patients. Medicine (Baltimore) 2019; 98:e16347. [PMID: 31305424 PMCID: PMC6641853 DOI: 10.1097/md.0000000000016347] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Blood pressure variability (BPV) is an independent cardiovascular risk factor in hypertensive patients. The best method for quantifying BPV is still an object of debate. The existence of different BPV patterns, particularly age and arterial stiffness related, is postulated. Our aims were:Cross-sectional study in 108 elderly hypertensive hospitalized patients. Each patient underwent blood pressure measurements with 5 different modalities: 24 hour BP and pulse wave velocity (PWV) monitoring (24hBPM), measurement by nurses or physicians, self-measurement and beat-to-beat monitoring. Differences between maximum and minimum values (ΔBP), averages of the absolute differences between consecutive values (ARV) and coefficients of variation (CV) were calculated.ΔBP showed the wider values' dispersion (Δ systolic blood pressure (SBP): 66.4 ± 22.9 and Δ diastolic blood pressure [DBP]: 45.0 ± 13.5 mmHg). ARV and CV were highest with nurses' measurements (SBP-ARV 9.2 ± 6.2; DBP-ARV 6.9 ± 5.2; SBP-CV 7.6 ± 5.3; DBP-CV 9.6 ± 5.5). The strongest correlation was found comparing physicians' SBP measurements and 24hBPM ARVs (R2 0.23, P <.05). 24hBPM ΔSBP in a multivariate analysis was significantly associated with age (β -3.85, SE 0.83; P <.001) and PWV (β 20.29, SE 3.70; P <.001). Calcium antagonists were associated with a lower ΔSBP (β -14.6, SE 6.1, P <.05) while diuretics and alpha-blockers with a significant increase (β 14.4 SE 5.4, P <.01; β 26.9 SE 11.7, P <.05).Age, PWV, diuretics, alpha-blockers, but also measurements obtained by nurses, increase BP variability while calcium antagonists reduce it. BP profiles in elderly in-hospital patients potentially provide important information; they should, however, be interpreted cautiously.
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Affiliation(s)
- Rosaria Del Giorno
- Department of Internal Medicine and Nephrology, Regional Hospital of Bellinzona and Valli, Bellinzona
| | - Lorenzo Balestra
- Department of Internal Medicine and Nephrology, Regional Hospital of Bellinzona and Valli, Bellinzona
| | | | - Luca Gabutti
- Department of Internal Medicine and Nephrology, Regional Hospital of Bellinzona and Valli, Bellinzona
- Institute of Biomedicine, University of Southern Switzerland, Lugano, Switzerland
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18
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Adaptation of the method of pulse wave velocity measurement for screening examinations in outpatient practice. КЛИНИЧЕСКАЯ ПРАКТИКА 2019. [DOI: 10.17816/clinpract10148-56] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background. Estimation of the parameters of arterial stiffness allows one to make conclusions about the development of CVD long before clinical manifestations of the target organ damage. The determination of the pulse wave velocity (PWV) is the «gold standard» for the arterial wall stiffness assessment. The oscillometric method of PWV measurement has a number of advantages (convenience and high speed) over the most common «two-point» techniques.
Objective. The purpose of this work was to adapt the PWV measurement using the oscillometric method for screening outpatient examinations. Using a BPLab Vasotens diagnostic oscillometric system (Russia), PWV was measured in 152 patients, and a formula was obtained for recalculating PWV values in the supine position on the basis of PWV values in the sitting position.
Methods. Using a BPLab Vasotens diagnostic system, PWV was measured in 152 patients, and a formula was derived for recalculating PWV values in the supine position on the basis of PWV values in the sitting position.
Results. Measuring aortal PWV in the sitting position gave an opportunity of a simultaneous study of the central and peripheral BP parameters and the arterial wall stiffness. The obtained data may be used during patients’ screening in the outpatient setting.
Conclusion. The use of the screening procedure for the PWV measurement in the outpatient practice will allow concluding on the CVD development long before clinical manifestations of the target organs damage and will rid the patient of a possibility of a wrong estimation of their cardiovascular risk.
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19
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Massunaga ND, França CN, Bianco HT, Ferreira CE, Kato JT, Póvoa RM, Figueiredo Neto AM, Izar MCO, Fonseca FAH. Circulating microparticles and central blood pressure according to antihypertensive strategy. Clinics (Sao Paulo) 2019; 74:e1234. [PMID: 31721907 PMCID: PMC6827330 DOI: 10.6061/clinics/2019/e1234] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 08/18/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES This prospective, randomized, open-label study aimed to compare the effects of antihypertensive treatment based on amlodipine or hydrochlorothiazide on the circulating microparticles and central blood pressure values of hypertensive patients. METHODS The effects of treatments on circulating microparticles were assessed during monotherapy and after the consecutive addition of valsartan and rosuvastatin followed by the withdrawal of rosuvastatin. Each treatment period lasted for 30 days. Central blood pressure and pulse wave velocity were measured at the end of each period. Endothelial, monocyte, and platelet circulating microparticles were determined by flow cytometry. Central blood pressure values and pulse wave velocity were recorded at the end of each treatment period. RESULTS No differences in brachial blood pressure were observed between the treatment groups throughout the study. Although similar central blood pressure values were observed during monotherapy, lower systolic and diastolic central blood pressure values and early and late blood pressure peaks were observed in the amlodipine arm after the addition of valsartan alone or combined with rosuvastatin. Hydrochlorothiazide-based therapy was associated with a lower number of endothelial microparticles throughout the study, whereas a higher number of platelet microparticles was observed after rosuvastatin withdrawal in the amlodipine arm. CONCLUSIONS Despite similar brachial blood pressure values between groups throughout the study, exposure to amlodipine was associated with lower central blood pressure values after combination with valsartan, indicating a beneficial interaction. Differences between circulating microparticles were modest and were mainly influenced by rosuvastatin withdrawal in the amlodipine arm.
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Affiliation(s)
- Nayara D. Massunaga
- Departamento de Medicina, Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, SP, BR
- Corresponding author. E-mail:
| | - Carolina N. França
- Departamento de Medicina, Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, SP, BR
- Universidade Santo Amaro (UNISA), Sao Paulo, SP, BR
- Corresponding author. E-mail:
| | - Henrique T. Bianco
- Departamento de Medicina, Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, SP, BR
| | - Carlos E.S. Ferreira
- Departamento de Medicina, Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, SP, BR
- Hospital Israelita Albert Einstein, Sao Paulo, SP, BR
| | - Juliana T. Kato
- Departamento de Medicina, Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, SP, BR
| | - Rui M.S. Póvoa
- Departamento de Medicina, Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, SP, BR
| | - Antonio M. Figueiredo Neto
- Instituto Nacional de Ciencia e Tecnologia de Fluidos Complexos, Universidade Sao Paulo, Sao Paulo, SP, BR
| | - Maria Cristina O. Izar
- Departamento de Medicina, Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, SP, BR
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Noninvasive central systolic blood pressure, not peripheral systolic blood pressure, independently predicts the progression of carotid intima-media thickness in a Chinese community-based population. Hypertens Res 2018; 42:392-399. [DOI: 10.1038/s41440-018-0175-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 07/20/2018] [Accepted: 09/04/2018] [Indexed: 01/22/2023]
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21
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Rizzoni D, Agabiti-Rosei C. Relationships between blood pressure variability and indices of large artery stiffness: does the microvasculature play a role? Hypertens Res 2016; 40:348-350. [PMID: 28003646 DOI: 10.1038/hr.2016.174] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Damiano Rizzoni
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Istituto Clinico Città di Brescia, Division of Medicine, Brescia, Italy
| | - Claudia Agabiti-Rosei
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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