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Yu Z, Yang H, Shou B, Cheng Z, Jiang C, Xu J. Association between pulse pressure and carotid plaques in old adults with uncontrolled hypertension: results from a community-based screening in Hangzhou, China. BMC Cardiovasc Disord 2024; 24:249. [PMID: 38734608 PMCID: PMC11088081 DOI: 10.1186/s12872-024-03914-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 05/02/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND There is a broad pulse pressure (PP) and a high prevalence of carotid plaques in old adults. Previous studies have indicated that PP is strongly associated with carotid plaque formation. This study aimed to explore this association in old adults with uncontrolled hypertension. METHODS 1371 hypertensive patients aged ≥ 60 years with uncontrolled hypertension were enrolled in a community-based screening in Hangzhou, China. Carotid plaques were assessed using ultrasonography. Logistic regression models were used to estimate the association between PP and carotid plaques by odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS Carotid plaques were detected in 639 (46.6%) of subjects. Multiple plaques were found in 408 (63.8%) and soft plaques in 218 (34.1%). Elevated PP was associated with a high prevalence of carotid plaques. After adjusting for traditional risk factors, compared to patients within the lowest tertile of PP, those within the highest tertiles had an increased risk of carotid plaques (OR 2.061, CI 1.547-2.745). For each 1-SD increase, the risk increased by 40.1% (OR 1.401, CI 1.237-1.587). There was a nonlinear association between PP and carotid plaques (P nonlinearity = 0.039). The risk increased rapidly after the predicted PP level reached around 60 mmHg. The associations were stronger among participants with multiple and soft plaques. CONCLUSIONS Our findings suggested that PP was independently associated with carotid plaques in old adults with uncontrolled hypertension who have an increased risk of atherosclerosis.
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Affiliation(s)
- Zhecong Yu
- Hangzhou Center for Disease Control and Prevention, Hangzhou, 310000, P. R. China
| | - Haifeng Yang
- Fuyang Center for Disease Control and Prevention, Hangzhou, 311400, P. R. China
| | - Biqi Shou
- Fuyang Center for Disease Control and Prevention, Hangzhou, 311400, P. R. China
| | - Zongxue Cheng
- Hangzhou Center for Disease Control and Prevention, Hangzhou, 310000, P. R. China
| | - Caixia Jiang
- Hangzhou Center for Disease Control and Prevention, Hangzhou, 310000, P. R. China
| | - Jue Xu
- Hangzhou Center for Disease Control and Prevention, Hangzhou, 310000, P. R. China.
- Institute for Chronic Noncommunicable Disease Control and Prevention, Hangzhou Center for Disease Control and Prevention, Hangzhou, 310000, P. R. China.
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Dutra RT, Bensenor IM, Goulart AC, Pereira AC, Lotufo PA, Santos IS. Carotid intima-media thickness and incident hypertension: the Brazilian Longitudinal Study of Adult Health. J Hypertens 2024; 42:129-135. [PMID: 37728130 DOI: 10.1097/hjh.0000000000003567] [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: 09/21/2023]
Abstract
BACKGROUND High blood pressure (BP) increases carotid intima-media thickness (CIMT). On the other hand, it is not clear whether the vascular abnormalities reflected in high CIMT may predict incident hypertension. The present study aims to investigate the association between CIMT and incident hypertension after 4 years of follow-up in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), a multiethnic sample of middle-aged adults from six Brazilian cities. METHODS We analyzed data from 6682 ELSA-Brasil participants (aged 35-74) without hypertension and with complete CIMT data at baseline. After 4 years of follow-up, we describe hypertension incidence, stratifying the sample according to age, sex, and race-specific CIMT quartiles. We also built crude and adjusted Poisson regression models to analyze the association between mean and maximal CIMT values and incident hypertension. RESULTS We found incident hypertension in 987 (14.8%) participants. According to mean CIMT quartile groups, hypertension incidence varied from 10.2% (first quartile group) to 22.4% (fourth quartile group; P for trend <0.001). In fully adjusted models, 0.1 mm increments in mean CIMT values were associated with a 16% [relative risk (RR):1.16; 95% confidence interval (95% CI) 1.10-1.21; P < 0.001] higher risk of incident hypertension, respectively. Results were similar when maximal CIMT values were considered instead of mean CIMT values. CONCLUSION CIMT values at baseline strongly predicted incident hypertension after 4 years of follow-up in this large multiethnic cohort. This highlights the relationship between CIMT and BP and may provide important insights into the significance of this ultrasound measurement.
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Affiliation(s)
- Robertson T Dutra
- Centro de Pesquisa Clínica e Epidemiológica do Hospital Universitário
- Programa de Pós-Graduação em Ciências Médicas
| | - Isabela M Bensenor
- Centro de Pesquisa Clínica e Epidemiológica do Hospital Universitário
- Programa de Pós-Graduação em Ciências Médicas
- Departamento de Clínica Médica
| | - Alessandra C Goulart
- Centro de Pesquisa Clínica e Epidemiológica do Hospital Universitário
- Programa de Pós-Graduação em Ciências Médicas
| | - Alexandre C Pereira
- Laboratório de Genética e Cardiologia Molecular do Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Paulo A Lotufo
- Centro de Pesquisa Clínica e Epidemiológica do Hospital Universitário
- Programa de Pós-Graduação em Ciências Médicas
- Departamento de Clínica Médica
| | - Itamar S Santos
- Centro de Pesquisa Clínica e Epidemiológica do Hospital Universitário
- Programa de Pós-Graduação em Ciências Médicas
- Departamento de Clínica Médica
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Adegoke O, Ojo OO, Ozoh OB, Akinkugbe AO, Odeniyi IA, Bello BT, Agabi OP, Okubadejo NU. The impact of sex on blood pressure and anthropometry trajectories from early adulthood in a Nigerian population: insights into women's cardiovascular disease risk across the lifespan. BMC Womens Health 2022; 22:303. [PMID: 35869545 PMCID: PMC9306031 DOI: 10.1186/s12905-022-01888-7] [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: 08/09/2021] [Accepted: 07/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sex disparities in blood pressure and anthropometry may account for differences in cardiovascular (CV) risk burden with advancing age; modulated by ethnic variability. We explored trajectories of blood pressures (BPs) and anthropometric indices with age on the basis of sex in an urban Nigerian population. METHODS We conducted a secondary analysis on data from 5135 participants (aged 16-92 years; 2671(52%) females) from our population-based cross-sectional study of BP profiles. We utilized the WHO STEPS and standardized methods for documenting BPs, body mass index (BMI) and waist circumference (WC). Data was analyzed using Analysis of variance (ANOVA), Spearman correlation analysis and mean difference in variables (with 95% confidence interval). We explored the influence of age and sex on BP profiles and specific anthropometric indices using generalized regression analysis. RESULTS In those aged 15-44 years, males had significantly higher systolic BP (SBP) and pulse pressure (PP). However, mean SBP and PP rose more steeply in females from 25 to 34 years, intersected with that of males from 45 to 54 years and remained consistently higher. Difference in mean BPs (95% Confidence Interval) (comparing < and > 45 years) was higher in females compared to males for SBP (17.4 (15.8 to 19.0) v. 9.2 (7.7 to 10.7), DBP (9.0 (7.9 to 10.1) v. 7.8 (6.7 to 8.9)), and PP (8.4 (7.3 to 9.5) v. 1.4 (0.3 to 2.5)). Females had significantly higher BMI and WC across all age groups (p < 0.001). Age more significantly correlated with BPs, BMI and WC in females. Interaction models revealed that SBP was significantly predicted by age category in females from (15-54 years), while DBP was only significantly predicted by age in the 15-34-year category (p < 0.01). BMI and WC were significantly predicted by age only in the 25-34-year category in females, (p < 0.01). CONCLUSIONS Our population demonstrates sex disparity in trajectories of SBP, PP, BMI and WC with age; with steeper rise in females. There is a need to focus on CV risk reduction in females, starting before, or during early adulthood.
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Affiliation(s)
- Oluseyi Adegoke
- Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi-Araba, PMB 12003, Lagos State, Nigeria.
- Lagos University Teaching Hospital, Idi-Araba, Lagos State, Nigeria.
| | - Oluwadamilola O Ojo
- Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi-Araba, PMB 12003, Lagos State, Nigeria
- Lagos University Teaching Hospital, Idi-Araba, Lagos State, Nigeria
| | - Obianuju B Ozoh
- Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi-Araba, PMB 12003, Lagos State, Nigeria
- Lagos University Teaching Hospital, Idi-Araba, Lagos State, Nigeria
| | - Ayesha O Akinkugbe
- Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi-Araba, PMB 12003, Lagos State, Nigeria
- Lagos University Teaching Hospital, Idi-Araba, Lagos State, Nigeria
| | - Ifedayo A Odeniyi
- Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi-Araba, PMB 12003, Lagos State, Nigeria
- Lagos University Teaching Hospital, Idi-Araba, Lagos State, Nigeria
| | - Babawale T Bello
- Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi-Araba, PMB 12003, Lagos State, Nigeria
- Lagos University Teaching Hospital, Idi-Araba, Lagos State, Nigeria
| | - Osigwe P Agabi
- Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi-Araba, PMB 12003, Lagos State, Nigeria
- Lagos University Teaching Hospital, Idi-Araba, Lagos State, Nigeria
| | - Njideka U Okubadejo
- Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi-Araba, PMB 12003, Lagos State, Nigeria
- Lagos University Teaching Hospital, Idi-Araba, Lagos State, Nigeria
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Camafort M, Chung WJ, Shin JH. Role of ambulatory blood pressure monitoring in elderly hypertensive patients. Clin Hypertens 2022; 28:22. [PMID: 35773739 PMCID: PMC9248111 DOI: 10.1186/s40885-022-00205-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/10/2022] [Indexed: 01/02/2023] Open
Abstract
Background Arterial hypertension is facing some changes in the last years. Its prevalence is increasing in elderly subjects. This growing prevalence is due to longer survival of the population worldwide, among other factors. On the other hand, recent guidelines have insisted in the relevance of out of office blood pressure measurements, to improve diagnostic and management of hypertension. Therefore, elderly subjects with hypertension could benefit from out of office blood pressure measurements, like ambulatory blood pressure measurements; nevertheless, there are very few or no specific recommendations regarding this. Aim In this review, we will gather the most important information about this subject. Results As hypertension in the elderly has some specific characteristics related to aging of the cardiovascular system, the most important aspect could be that these characteristics make ambulatory blood pressure measurement suitable for its use in elderly. Among those a higher prevalence of white coat hypertension, white coat phenomenon, and a higher nocturnal blood pressure and higher prevalence of nondipper and riser pattern, represent aspects that should be considered for better diagnostic and an improved management. Conclusion As the prevalence of hypertension will grow in the next years, more studies specifically directed to this subject are needed. Supplementary Information The online version contains supplementary material available at 10.1186/s40885-022-00205-6.
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Affiliation(s)
- Miguel Camafort
- ESH Excellence Hypertension Center, Department of Internal Medicine, Geriatrics Section, Hospital Clinic, University of Barcelona, Barcelona, Spain. .,Research Group on Cardiovascular Risk, Nutrition and Aging, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain. .,Research Group CB06/03/0019, Biomedical Network Research Center in Obesity and Nutrition (CIBER-OBN), Institute of Health Carlos III (ISCIII), Ministry of Science, Innovation and Universities, Madrid, Spain.
| | - Wook-Jin Chung
- Department of Cardiovascular Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea.,Gachon Cardiovascular Research Institute, Gachon University, Incheon, Republic of Korea
| | - Jin-Ho Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
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Hammami R, Bahloul A, Charfeddine S, Gargouri R, Ellouze T, Abid L, Triki F, Kammoun S, Mrad IB, Amor HIH. [Maladies cardiaques et Ramadan : revue de la littérature]. Ann Cardiol Angeiol (Paris) 2022; 71:166-172. [PMID: 35039144 DOI: 10.1016/j.ancard.2021.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 09/07/2021] [Indexed: 12/23/2022]
Abstract
We review the literature on the safety of fasting in cardiac patients. We examined the changes of blood pressure among hypertensive patients and the incidence of cardiac events during Ramadan in patients with coronary disease and heart failure. We also assess the modifications of INR levels in cardiac patients who take oral anticoagulant. We found that Ramadan fasting is safe in stable cardiac patients, even under several drugs. Fasting does not affect blood pressure. There is no difference in regards to cardiac event incidence between Ramadan and the non-fasting-months. The level of INR is slightly higher when fasting, it is thus recommended to monitor patients with high bleeding risk during Ramadan.
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Affiliation(s)
- Rania Hammami
- Cardiology department, Hedi Chaker Hospital, Research Unit RU17ES37, Sfax Faculty of Medecine, Sfax, Tunisia.
| | - Amine Bahloul
- Cardiology department, Hedi Chaker Hospital, Research Unit RU17ES37, Sfax Faculty of Medecine, Sfax, Tunisia.
| | - Selma Charfeddine
- Cardiology department, Hedi Chaker Hospital, Research Unit RU17ES37, Sfax Faculty of Medecine, Sfax, Tunisia.
| | - Rania Gargouri
- Cardiology department, Hedi Chaker Hospital, Research Unit RU17ES37, Sfax Faculty of Medecine, Sfax, Tunisia.
| | - Tarek Ellouze
- Cardiology department, Hedi Chaker Hospital, Research Unit RU17ES37, Sfax Faculty of Medecine, Sfax, Tunisia.
| | - Leila Abid
- Cardiology department, Hedi Chaker Hospital, Research Unit RU17ES37, Sfax Faculty of Medecine, Sfax, Tunisia.
| | - Faten Triki
- Cardiology department, Hedi Chaker Hospital, Research Unit RU17ES37, Sfax Faculty of Medecine, Sfax, Tunisia.
| | - Samir Kammoun
- Cardiology department, Hedi Chaker Hospital, Research Unit RU17ES37, Sfax Faculty of Medecine, Sfax, Tunisia.
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Kulecki M, Uruska A, Naskret D, Zozulinska-Ziolkiewicz D. Arterial Stiffness and Type 1 Diabetes: The Current State of Knowledge. Curr Diabetes Rev 2022; 18:e140621194054. [PMID: 35546329 DOI: 10.2174/1573399817666210614113827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 03/01/2021] [Accepted: 04/20/2021] [Indexed: 11/22/2022]
Abstract
The most common cause of mortality among people with type 1 diabetes is cardiovascular diseases. Arterial stiffness allows predicting cardiovascular complications, cardiovascular mortality, and all-cause mortality. There are different ways to measure arterial stiffness; the gold standard is pulse wave velocity. Arterial stiffness is increased in people with type 1 diabetes compared to healthy controls. It increases with age and duration of type 1 diabetes. Arterial stiffness among people with type 1 diabetes positively correlates with systolic blood pressure, obesity, glycated hemoglobin, waist circumference, and waist to hip ratio. It has a negative correlation with the estimated glomerular filtration rate, high-density lipoprotein, and the absence of carotid plaques. The increased arterial stiffness could result from insulin resistance, collagen increase due to inadequate enzymatic glycation, and endothelial and autonomic dysfunction. The insulin-induced decrease in arterial stiffness is impaired in type 1 diabetes. There are not enough proofs to use pharmacotherapy in the prevention of arterial stiffness, but some of the medicaments got promising results in single studies, for example, renin-angiotensin-aldosterone system inhibitors, statins, and SGLT2 inhibitors. The main strategy of prevention of arterial stiffness progression remains glycemic control and a healthy lifestyle.
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Affiliation(s)
- Michal Kulecki
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Poznań, Poland
| | - Aleksandra Uruska
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Poznań, Poland
| | - Dariusz Naskret
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Poznań, Poland
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7
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Filippone EJ, Foy AJ, Naccarelli GV. The diastolic blood pressure J-curve revisited: An update. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2021; 12:100065. [PMID: 38559601 PMCID: PMC10978147 DOI: 10.1016/j.ahjo.2021.100065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/04/2021] [Accepted: 10/15/2021] [Indexed: 04/04/2024]
Abstract
Hypertension remains a leading cause of morbidity and mortality. Recent treatment guidelines stress more strict systolic blood pressure (SBP) targets without regard for abnormally low achieved diastolic blood pressures (DBP). However, as DBP falls below a critical level, adverse events increase, the so-called J-shaped curve. Proponents argue that the low DBP is causative due to reduced coronary perfusion during diastole with obstructive coronary artery disease (CAD), whereas others postulate the J-curve represents reverse causality from underlying comorbidity. Most data are observational, derived from population-based cohorts or post-hoc analyses of randomized controlled trials (RCT) conducted for other reasons. The purpose of this review is to analyze the observational studies performed over the last decade addressing the J-curve, with consideration of earlier data. Overall, a J-curve exists, but it remains uncertain whether low DBP is causative or instead reflects reverse causation from either diseased vasculature (widened pulse pressure) or severe underlying comorbidity. The most convincing data for causation come from studies restricted to patients with documented CAD, with evidence suggesting revascularization may mitigate risk. RCTs are needed to determine if a low DBP should preclude intensification of therapy, especially with documented CAD. Firm recommendations cannot be made with contemporary data.
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Affiliation(s)
- Edward J. Filippone
- Division of Nephrology, Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Andrew J. Foy
- Department of Medicine, Penn State University Heart and Vascular Institute, Penn State M.S Hershey Medical Center and College of Medicine, Hershey, PA, USA
| | - Gerald V. Naccarelli
- Department of Medicine, Penn State University Heart and Vascular Institute, Penn State M.S Hershey Medical Center and College of Medicine, Hershey, PA, USA
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8
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Sung HH, Gi MY, Cha JA, Cho HE, Moon AE, Yoon H. Gender difference in the relationship between lipid accumulation product index and pulse pressure in nondiabetic Korean adults: The Korean National Health and Nutrition Examination Survey 2013-2014. Clin Exp Hypertens 2021; 44:146-153. [PMID: 34821192 DOI: 10.1080/10641963.2021.2007943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The present study was conducted to assess the association between the lipid accumulation product index (LAP) and pulse pressure (PP) by gender in nondiabetic Korean adults. This study used the data of 8,240 nondiabetic adults (3,577 men and 4,663 women) aged ≥ 20 years from the Korean National Health and Nutrition Examination Survey 2013-2014. Key findings from the study were as follows: first, the mean values of age for the overall population, men, and women were 49.59 ± 15.73 years, 49.26 ± 16.04 years, and 49.85 ± 15.47 years, respectively. Second, in women (n = 4,663), after adjustment for related variables and with quartile 1 of LAP as a reference, the odds ratios (ORs) of high PP (PP > 60 mmHg) were significantly higher in quartile 3 [1.735 (95% confidence interval [CI], 1.064-2.831)] and quartile 4 of LAP [2.271 (95% CI, 1.325-3.893)]. Third, high PP in men (n = 3,577) was not associated with the quartiles of LAP. Forth, after adjustment for related variables, the PP level was positively associated with the quartiles of LAP in women (p < .001) but not in men (p = .400). PP was positively associated with LAP in nondiabetic Korean women but not in men.
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Affiliation(s)
- Hyun Ho Sung
- Department of Clinical Laboratory Science, Dongnam Health University, Suwonsi, South Korea
| | - Mi Young Gi
- Department of Nursing, Christian College of Nursing, Gwangju, South Korea
| | - Ju Ae Cha
- Department of Nursing, Chunnam Technouniversity, Gokseong-gun, South Korea
| | - Hye Eun Cho
- Department of Dental Hygiene, Kwangju Womens's University, Gwangsan-gu, South Korea
| | - Ae Eun Moon
- Department of Dental Hygiene, Honam University, Gwangju, South Korea
| | - Hyun Yoon
- Department of Clinical Laboratory Science, Wonkwang Health Science University, Iksan-si, South Korea
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9
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Pagan Lassalle P, DeBlois JP, Keller A, Stoner L, Heffernan KS. Central Blood Pressure and Subclinical Atherosclerotic Risk in Young Hispanic American Women. Ethn Dis 2021; 31:489-500. [PMID: 34720552 DOI: 10.18865/ed.31.4.489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background The incidence of younger women being hospitalized from cardiovascular disease (CVD) events is on the rise. Hispanic women are generally thought to have higher CVD risk factor burden than non-Hispanic White (NHW) women yet Hispanic Americans have lower mortality from CVD. Traditional measures of CVD may not accurately capture CVD risk in Hispanic Americans. Hence, the purpose of this study was to assess the impact of ethnicity on vascular reactivity and central hemodynamic load to gain insight into subclinical CVD risk in young women. Methods Brachial flow-mediated dilation (FMD), low-flow mediated constriction (L-FMC), carotid-femoral pulse wave velocity (cfPWV), and pulse wave analysis (from synthesized aortic pressure waveforms) were measured in 25 Hispanic women and 31 NHW women aged between 18-35 years. FMD and L-FMC were combined to provide an index of total vessel reactivity. Results NHW and Hispanic women did not differ in age or traditional CVD risk factors (P>.05 for all). Compared with NHW women, Hispanic women had greater vascular reactivity (8.7±4.1 vs 11.7±4.1 %, P=.011), lower central pulse pressure (28±5 vs 24±3 mm Hg, P=.001) and lower pressure from wave reflections (12±2 vs 10±1 mm Hg, P=.001). There were no differences in cfPWV between NHW women and Hispanic women (5.4±0.7 vs 5.3±0.7 m/s, P=.73). Conclusion Young Hispanic women have greater vascular reactivity and lower central pulsatile hemodynamic load compared with NHW women, suggesting lower subclinical CVD risk.
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Affiliation(s)
- Patricia Pagan Lassalle
- Syracuse University, Exercise Science, Syracuse NY.,University of North Carolina, Department of Exercise and Sport Science, Chapel Hill, NC
| | | | - Allie Keller
- Syracuse University, Exercise Science, Syracuse NY
| | - Lee Stoner
- University of North Carolina, Department of Exercise and Sport Science, Chapel Hill, NC
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10
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Xia X, Chan KH, Lam KBH, Qiu H, Li Z, Yim SHL, Ho KF. Effectiveness of indoor air purification intervention in improving cardiovascular health: A systematic review and meta-analysis of randomized controlled trials. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 789:147882. [PMID: 34058577 PMCID: PMC7611692 DOI: 10.1016/j.scitotenv.2021.147882] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 05/07/2021] [Accepted: 05/13/2021] [Indexed: 04/13/2023]
Abstract
Indoor air purifiers are increasingly marketed for their health benefits, but their cardiovascular effects remain unclear. We systematically reviewed and meta-analysed randomized controlled trials (RCTs) on the cardiovascular effects of indoor air purification interventions in humans of all ages. We searched Embase, Medline, PubMed, and Web of Science from inception to 22 August 2020. Fourteen cross-over RCTs (18 publications) were included. Systolic blood pressure (SBP) was significantly reduced after intervention (-2.28 (95% CI: -3.92, -0.64) mmHg). There were tendencies of reductions in diastolic blood pressure (-0.35 [-1.52, 0.83] mmHg), pulse pressure (PP) (-0.86 [-2.07, 0.34] mmHg), C-reactive protein (-0.23 [-0.63, 0.18] mg/L), and improvement in reactive hyperaemia index (RHI) (0.10 [-0.04, 0.24]) after indoor air purification, although the effects were not statistically significant. However, when restricting the analyses to RCTs using physical-type purifiers only, significant improvements in PP (-1.56 [-2.98, -0.15] mmHg) and RHI (0.13 [0.01, 0.25]) were observed. This study found potential evidence on the short-term cardiovascular benefits of using indoor air purifiers, especially for SBP, PP and RHI. However, under the Grading of Recommendations Assessment, Development and Evaluation framework, the overall certainty of evidence was very low, which discourage unsubstantiated claims on the cardiovascular benefits of air purifiers. We have also identified several key methodological limitations, including small sample size, short duration of intervention, and the lack of wash-out period. Further RCTs with larger sample size and longer follow-up duration are needed to clarify the cardiovascular benefits of air purification interventions.
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Affiliation(s)
- Xi Xia
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region.
| | - Ka Hung Chan
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, UK; Oxford British Heart Foundation Centre of Research Excellence, University of Oxford, UK.
| | - Kin Bong Hubert Lam
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, UK.
| | - Hong Qiu
- Institute of Environment, Energy and Sustainability, The Chinese University of Hong Kong, Hong Kong Special Administrative Region.
| | - Zhiyuan Li
- Institute of Environment, Energy and Sustainability, The Chinese University of Hong Kong, Hong Kong Special Administrative Region.
| | - Steve Hung Lam Yim
- Institute of Environment, Energy and Sustainability, The Chinese University of Hong Kong, Hong Kong Special Administrative Region; The Department of Geography and Resource Management, The Chinese University of Hong Kong, Hong Kong Special Administrative Region; Asian School of the Environment, Nanyang Technological University, Singapore.
| | - Kin-Fai Ho
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region.
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McGowan NM, Nichols M, Bilderbeck AC, Goodwin GM, Saunders KEA. Blood pressure in bipolar disorder: evidence of elevated pulse pressure and associations between mean pressure and mood instability. Int J Bipolar Disord 2021; 9:5. [PMID: 33521889 PMCID: PMC7847910 DOI: 10.1186/s40345-020-00209-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 10/21/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Bipolar disorder (BD) is associated with excess and premature cardiovascular mortality. Elevated blood pressure (BP) is a leading contributor to cardiovascular risk. However, few studies have examined BP in BD in comparison to other psychiatric disorders. Furthermore, the association between BP and mood instability is not presently clear despite increasing interest in repurposing existing antihypertensive medications as possible novel BD treatments. Thus we examined BP differences between BD and borderline personality disorder (BPD), a disorder with a similar symptom profile through chronic mood instability. METHODS A total of 106 adults (38 BD, 25 BPD, and 43 healthy controls), evaluated in the Automated Monitoring of Symptom Severity (AMoSS) study, completed a week-long home blood pressure monitoring assessment and ecological momentary assessment of mood. We examined group-wise differences in mean BP and BP variability and their association with mood instability. RESULTS BD individuals had a significantly wider resting pulse pressure (40.8 ± 7.4, mmHg) compared to BPD (35.7 ± 5.3, mmHg, P = 0.03) and control participants (37.3 ± 6.3, mmHg, P = 0.036). Systolic BP was negatively associated with sad mood instability, and all measures of mean BP (systolic, diastolic, and mean arterial pressure) were negatively associated with positive mood instability. CONCLUSIONS This study demonstrates BP differences between BD and healthy and clinical controls that are within a normotensive range. Early pulse pressure widening may be a modifiable pathophysiological feature of BD that confers later cardiovascular risk. BP may be an important transdiagnostic predictor of mood instability and a potential explicit treatment target.
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Affiliation(s)
- Niall M McGowan
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK.
| | - Molly Nichols
- Academic Centre, John Radcliffe Hospital, Oxford University Clinical School, Oxford, OX3 9DU, UK
| | - Amy C Bilderbeck
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
| | - Guy M Goodwin
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, OX3 7JX, UK
| | - Kate E A Saunders
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, OX3 7JX, UK
- NIHR Oxford Health Biomedical Research Centre, Oxford, OX3 7JX, UK
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12
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Shojaei M, Jahromi AS, Karamatollah R. Association of obesity and pulse pressure with hypertension in an Iranian urban population. J Family Med Prim Care 2020; 9:4705-4711. [PMID: 33209787 PMCID: PMC7652129 DOI: 10.4103/jfmpc.jfmpc_723_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/11/2020] [Accepted: 07/21/2020] [Indexed: 11/21/2022] Open
Abstract
Objective: Nowadays, obesity is an important health problem and pulse pressure (PP) is a good predictor of cardiovascular events. The aim of study was to determine the association of obesity and PP with hypertension (HTN) in individuals aged 30 years or older in the urban population of Jahrom, Iran. Materials and Methods: In this study, we used a multistage stratified sampling method to select participants among the urban population aged 30 years or older. Height, weight, and blood pressure were obtained by a trained physician. Obesity was defined according to the World Health Organization classification. Angina was assessed with reliable and validate Rose questionnaire. Data were record by SPSS-16. Categorical and continues variables analyzed by Chi-squared, independent t-test, and one-way ANOVA test. Binary logistic regression analysis method was used for the association of PP and obesity with HTN and Rose angina that adjusted for age, gender, education class, marital status, smoking, total cholesterol, triglyceride, low-density lipoprotein, and high-density lipoprotein. A P < 0.05 was considered as statistical significance. Results: The prevalence of obesity was 18.1% that was greater in women (24.8% vs. 9.9%, P < 0.001). The prevalence of Rose angina and HTN in obese individuals were more than in normal weight individuals (24.8% vs. 16.4%, P = 0.027) and (42.0% vs. 31.1%, P < 0.001), respectively. Furthermore, patients in higher PP groups were older, were more possible to had HTN and had greater diastolic blood pressure (DBP), systolic blood pressure (SBP), and mean arterial pressure (MAP) in compared to individuals in the lower PP group. The individuals with HTN had greater DBP, SBP, MAP, PP, and body mass index (BMI) than individuals without HTN. However, individuals who had Rose angina, only had higher PP and BMI in compared to ones without Rose angina. The obese individuals had 1.97 (1.22–3.17, P = 0.005) fold for HTN risk than individuals with normal weight. In addition, PP weakly increased the risk of HTN about 1.09 fold (1.07–1.10, P < 0.001). However, Rose angina was associated only to overweight status (odds ratio = 1.51, confidence interval 95%: 1.03–2.20), P = 0.035) than individuals in normal weight group. Conclusion: Obesity and PP were higher in hypertensive individuals and overweight in individuals with Rose angina. It is time to pay more attention to abnormal BMI.
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Affiliation(s)
- Mohammad Shojaei
- Research Center for Noncommunicable Diseases, Jahrom University of Medical Sciences, Jahrom, Iran
| | | | - Rahmanian Karamatollah
- Research Center for Noncommunicable Diseases, Jahrom University of Medical Sciences, Jahrom, Iran
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13
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Karikkineth AC, AlGhatrif M, Oberdier MT, Morrell C, Palchamy E, Strait JB, Ferrucci L, Lakatta EG. Sex Differences in Longitudinal Determinants of Carotid Intima Medial Thickening With Aging in a Community-Dwelling Population: The Baltimore Longitudinal Study on Aging. J Am Heart Assoc 2020; 9:e015396. [PMID: 33164652 PMCID: PMC7763739 DOI: 10.1161/jaha.119.015396] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Common carotid intima medial thickness (IMT) increases with aging. However, the longitudinal association between IMT and other age-associated hemodynamic alterations in men and in women are not fully explored. Methods and Results We analyzed repeated measures of IMT, blood pressure, and carotid-femoral pulse wave velocity over a 20-year period in 1067 men and women of the Baltimore Longitudinal Study on Aging; participants were ages 20 to 92 years at entry and free of overt cardiovascular disease. Linear mixed-effects models were used to calculate the individual rates of change (Change) of IMT, pulse pressure, mean arterial pressure, and pulse wave velocity, among other covariates. Multivariate regression analysis was used to examine the association of IMTChange with baseline and rates of change of hemodynamic parameters and cardiovascular risk factors. IMT increased at accelerating rates from 0.02 mm/decade at age 50 years to 0.05 mm/decade at age 80 years greater rates in men than in women. IMTChange was positively associated with baseline low-density lipoprotein, low-density lipoproteinChange, and baseline systolic blood pressure and systolic blood pressureChange, but inversely with baseline diastolic blood pressure and diastolic blood pressureChange. When blood pressure was expressed as pulse pressure and MAP, IMTChange was positively associated with baseline pulse pressure and pulse pressureChange and inversely with baseline mean arterial pressure and mean arterial pressureChange. In sex-specific analysis, these associations were observed in women, but not in men. Conclusions In summary, our analyses showed that IMT increases at accelerating rates with aging. Age-associated changes in IMT were modulated by concurrent changes of low-density lipoprotein in both sexes, and of pulsatile and mean blood pressure in women but not men.
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Affiliation(s)
- Ajoy C Karikkineth
- Longitudinal Studies Section Translational Gerontology Branch National Institute on Aging, NIH Baltimore MD
| | - Majd AlGhatrif
- Longitudinal Studies Section Translational Gerontology Branch National Institute on Aging, NIH Baltimore MD.,Laboratory of Cardiovascular Science National Institute on Aging NIH Biomedical Research Center Baltimore MD.,Department of Medicine Johns Hopkins School of Medicine Baltimore MD
| | - Matt T Oberdier
- Longitudinal Studies Section Translational Gerontology Branch National Institute on Aging, NIH Baltimore MD.,Laboratory of Cardiovascular Science National Institute on Aging NIH Biomedical Research Center Baltimore MD
| | - Chris Morrell
- Laboratory of Cardiovascular Science National Institute on Aging NIH Biomedical Research Center Baltimore MD
| | - Elango Palchamy
- Longitudinal Studies Section Translational Gerontology Branch National Institute on Aging, NIH Baltimore MD
| | - James B Strait
- Laboratory of Cardiovascular Science National Institute on Aging NIH Biomedical Research Center Baltimore MD
| | - Luigi Ferrucci
- Longitudinal Studies Section Translational Gerontology Branch National Institute on Aging, NIH Baltimore MD
| | - Edward G Lakatta
- Laboratory of Cardiovascular Science National Institute on Aging NIH Biomedical Research Center Baltimore MD
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14
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Tang KS, Medeiros ED, Shah AD. Wide pulse pressure: A clinical review. J Clin Hypertens (Greenwich) 2020; 22:1960-1967. [DOI: 10.1111/jch.14051] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 08/28/2020] [Accepted: 09/01/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Kevin S. Tang
- The Warren Alpert Medical School of Brown University Providence RI USA
| | - Edward D. Medeiros
- The Warren Alpert Medical School of Brown University Providence RI USA
- Division of Nephrology Rhode Island Hospital Providence RI USA
- Division of Nephrology Providence VA Medical Center Providence RI USA
| | - Ankur D. Shah
- The Warren Alpert Medical School of Brown University Providence RI USA
- Division of Nephrology Rhode Island Hospital Providence RI USA
- Division of Nephrology Providence VA Medical Center Providence RI USA
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15
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School-Based Exercise Intervention Improves Blood Pressure and Parameters of Arterial Stiffness in Children: A Randomized Controlled Trial. Pediatr Exerc Sci 2020; 33:1-7. [PMID: 32937598 DOI: 10.1123/pes.2020-0053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 06/11/2020] [Accepted: 07/26/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE To evaluate the effectiveness of a school-based exercise intervention on endurance performance (EP), blood pressure (BP), and arterial stiffness in children. METHODS A total of 105 students (mean age = 8.2 [0.6] y; 51% girls; body mass index = 17.8 [3.0] kg/m2) were randomized to the intervention group (IG, n = 51) and control group (CG, n = 54). During a 37-week experimental period, the IG received an exercise intervention (2 × 45 min/wk) in addition to their regular school physical education class (3 × 45 min/wk). EP, peripheral and central BP, pulse pressure, augmentation pressure, augmentation index, and aortic pulse wave velocity were assessed. RESULTS Following the intervention, significant changes (P < .05) in EP, peripheral and central systolic BP, pulse pressure, augmentation pressure, augmentation index, and aortic pulse wave velocity were found in the IG. Children in the CG displayed significant changes in peripheral and central diastolic BP. An analysis of the baseline-to-post changes revealed significant between-group differences in EP (P < .001), pulse pressure (P = .028), augmentation pressure (P = .007), and aortic pulse wave velocity (P = .037) that favored the IG and in peripheral and central diastolic BP that favored the CG. CONCLUSION The school-based exercise intervention had beneficial effects not only on EP but also on different hemodynamic parameters.
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16
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Pulse pressure correlates with coronary artery calcification and risk for coronary heart disease: a study of elderly individuals in the rural region of Southwest China. Coron Artery Dis 2020; 30:297-302. [PMID: 30888975 PMCID: PMC6504121 DOI: 10.1097/mca.0000000000000739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Aim This study aimed to define the relationship between pulse pressure (PP) and coronary artery calcification (CAC), a proven surrogate marker for coronary heart disease. Patients and methods A total of 170 participants 50–70 years of age from 11 villages of Yunnan Province of China were enrolled randomly into this study. They were examined routinely for diastolic and systolic blood pressure, PP, and CAC. Results The average PP in the CAC-positive group was significantly higher than that in the CAC-negative group. In the positive CAC group, there were significantly positive correlations between PP and CAC score, volume, mass, as well as density. The area under the receiver operating characteristic curve analysis showed that PP performed well in predicting CAC. Conclusion In conclusion, among the rural people of southwest of China, PP correlates positively with the coronary calcium Agatston score, volume, mass, and density. PP predicted CAC as well as Framingham Risk Score. The measurement of PP widening may serve as an alternative and convenient method for assessing CAC risk in rural populations with poor accessibility and economic disadvantage over coronary computed tomography scanning.
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17
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Georgakis MK, Gill D, Malik R, Protogerou AD, Webb AJS, Dichgans M. Genetically Predicted Blood Pressure Across the Lifespan: Differential Effects of Mean and Pulse Pressure on Stroke Risk. Hypertension 2020; 76:953-961. [PMID: 32623925 PMCID: PMC7418931 DOI: 10.1161/hypertensionaha.120.15136] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Hypertension is the leading risk factor for stroke. Yet, it remains unknown whether blood pressure pulsatility (pulse pressure [PP]) causally affects stroke risk independently of the steady pressure component (mean arterial pressure [MAP]). It is further unknown how the effects of MAP and PP on stroke risk vary with age and stroke cause. Using data from UK Biobank (N=408 228; 38-71 years), we selected genetic variants as instruments for MAP and PP at age ≤55 and >55 years and across age deciles. We applied multivariable Mendelian randomization analyses to explore associations with ischemic stroke, intracerebral hemorrhage, and their subtypes. Higher genetically predicted MAP was associated with higher risk of ischemic stroke and intracerebral hemorrhage across the examined age spectrum. Independent of MAP, higher genetically predicted PP only at age >55 years was further associated with higher risk of ischemic stroke (odds ratio per-SD-increment, 1.23 [95% CI, 1.13-1.34]). Among subtypes, the effect of genetically predicted MAP on large artery stroke was attenuated, whereas the effect of genetically predicted PP was augmented with increasing age. Genetically predicted MAP, but not PP, was associated with small vessel stroke and deep intracerebral hemorrhage homogeneously across age deciles. Neither genetically predicted MAP nor PP were associated with lobar intracerebral hemorrhage. Beyond an effect of high MAP at any age on ischemic and hemorrhagic stroke, our results support an independent causal effect of high PP at older ages on large artery stroke. This finding warrants further investigation for the development of stroke preventive strategies targeting pulsatility in later life.
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Affiliation(s)
- Marios K Georgakis
- From the Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Germany (M.K.G., R.M., M.D.)
| | - Dipender Gill
- Department of Biostatistics and Epidemiology, School of Public Health, Imperial College London, United Kingdom (D.G.)
| | - Rainer Malik
- From the Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Germany (M.K.G., R.M., M.D.)
| | - Athanase D Protogerou
- Cardiovascular Prevention and Research Unit, Department of Pathophysiology, National and Kapodistrian University of Athens, Greece (A.D.P.)
| | - Alastair J S Webb
- Centre for Prevention of Stroke and Dementia, Department of Clinical Neurosciences, University of Oxford, United Kingdom (A.J.S.W.)
| | - Martin Dichgans
- From the Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Germany (M.K.G., R.M., M.D.).,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany (M.D.).,German Centre for Neurodegenerative Diseases (DZNE), Munich, Germany (M.D.)
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18
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Bakris GL, Laffin LJ. Assessing Wide Pulse Pressure Hypertension: Data Beyond the Guidelines. J Am Coll Cardiol 2020; 73:2856-2858. [PMID: 31171091 DOI: 10.1016/j.jacc.2019.03.494] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 03/07/2019] [Indexed: 01/21/2023]
Affiliation(s)
- George L Bakris
- American Heart Association Comprehensive Hypertension Center, Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Chicago Medicine, Chicago, Illinois.
| | - Luke J Laffin
- Section of Preventive Cardiology and Rehabilitation, Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
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19
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LI J, Huang JY, Lo K, Zhang B, Huang YQ, Feng YQ. Association of pulse pressure with all-cause mortality in young adults. Postgrad Med J 2019; 96:461-466. [DOI: 10.1136/postgradmedj-2019-137070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 11/05/2019] [Accepted: 11/13/2019] [Indexed: 01/01/2023]
Abstract
BackgroundPulse blood pressure was significantly associated with all-cause mortality in middle-aged and elderly populations, but less evidence was known in young adults.ObjectiveTo assess the association of pulse pressure (PP) with all-cause mortality in young adults.MethodsThis cohort from the 1999–2006 National Health and Nutrition Examination Survey included adults aged 18–40 years. All included participants were followed up until the date of death or 31 December 2015. PP was categorised into three groups: <50, 50~60, ≥60 mm Hg. Cox proportional hazards models and subgroup analysis were performed to estimate the adjusted HRs and 95% CIs for all-cause mortality.ResultsAfter applying the exclusion criteria, 8356 participants (median age 26.63±7.01 years, 4598 women (55.03%)) were included, of which 265 (3.17%) have died during a median follow-up duration of 152.96±30.45 months. When treating PP as a continuous variable, multivariate Cox analysis showed that PP was an independent risk factor for all-cause mortality (HR 1.94, 95% CI 1.02 to 3.69; p=0.0422). When using PP<50 mm Hg as referent, from the 50~60 mm Hg to the ≥60 mm Hg group, the risks of all-cause mortality for participants with PP ranging 50–60 mm Hg or ≥60 mm Hg were 0.93 (95% CI 0.42 to 2.04) and 1.15 (95% CI 0.32 to 4.07) (P for tend was 0.959). Subgroup analysis showed that PP (HR 2.00, 95% CI 1.05 to 3.82; p=0.0360) was associated with all-cause mortality among non-hypertensive participants.ConclusionAmong young adults, higher PP was significantly associated with an increased risk of all-cause mortality, particularly among those without hypertension.
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20
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Mbutiwi FIN, Lepira FB, Mbutiwi TL, Kumakuma DK, Kumbukama GK, Sylvestre MP. Prevalence and Sex-Specific Distribution of Cardiovascular Risk Factors in University Students in an Urban-Rural Environment of the Democratic Republic of the Congo. J Community Health 2019; 43:761-767. [PMID: 29423726 DOI: 10.1007/s10900-018-0481-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A recent qualitative study on health promotion in non-communicable diseases in Sub-Saharan University students suggested sex differences in knowledge and beliefs concerning a healthy lifestyle. However, the extent to which this is reflected in sex-specific distribution of cardiovascular risk factors among Sub-Saharan African students have not been fully evaluated. The objective of this study was to assess the prevalence and the sex-specific distribution of some modifiable cardiovascular risk factors among students at University of Kikwit in the Democratic Republic of the Congo. This cross-sectional descriptive study included 780 students (62.2% men) at the University of Kikwit between January and March of 2016. Data on physical measurements, lifestyle factors, and medical history were collected. The median age (interquartile range) of the students was 23 years (21-25 years). The modifiable cardiovascular risk factors identified were: alcohol consumption (53.1%), overweight (16.4%), general obesity (1.9%), abdominal obesity (10.4%), tobacco consumption (8.1%), hypertension (7.6%) and high pulse pressure (6.4%). Compared to women, men had a higher prevalence of hypertension (9.9 vs. 3.7%; p = 0.002), tobacco consumption (10.7 vs. 3.7%; p = 0.001), and alcohol consumption (58.4 vs. 44.4%; p < 0.001). In contrast, abdominal obesity was more predominant in women than in men (23.1 vs. 2.7%; p < 0.001). This study suggests a sex-specific distribution of several modifiable cardiovascular risk factors in students at the University of Kikwit. Design of sex-specific, student-targeted health promotion programs may be warranted to reduce the prevalence of risk factors and the subsequent burden of cardiovascular diseases.
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Affiliation(s)
- Fiston Ikwa Ndol Mbutiwi
- University of Montreal Hospital Research Centre (CRCHUM), Pavillon S, Bloc S03.706, 850 Saint-Denis street, Montreal, QC, H2X 0A9, Canada.
- Faculty of Medicine, University of Kikwit, Kikwit, Democratic Republic of the Congo.
| | - François Bompeka Lepira
- Division of Nephrology, Department of Internal Medicine, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo
| | | | - Donat Kenge Kumakuma
- Faculty of Medicine, University of Kikwit, Kikwit, Democratic Republic of the Congo
| | | | - Marie-Pierre Sylvestre
- University of Montreal Hospital Research Centre (CRCHUM), Pavillon S, Bloc S03.706, 850 Saint-Denis street, Montreal, QC, H2X 0A9, Canada
- Department of Social and Preventive Medicine, University of Montreal Public Health School (ESPUM), Montreal, Canada
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21
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Shah N, Qian M, Di Tullio MR, Graham S, Mann DL, Sacco RL, Lip GYH, Labovitz AJ, Ponikowski P, Lok DJ, Anker SD, Teerlink JR, Thompson JLP, Homma S, Freudenberger RS. Pulse pressure and prognosis in patients with heart failure with reduced ejection fraction. Eur J Clin Invest 2019; 49:e13092. [PMID: 30801690 DOI: 10.1111/eci.13092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 01/25/2019] [Accepted: 02/21/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND A high pulse pressure (PP) is associated with adverse cardiovascular (CV) outcomes; however, this relationship may be reversed in patients with heart failure with reduced ejection fraction (HFREF). METHODS Patients from the WARCEF trial with left ventricular ejection fraction ≤35% were included. PP was divided into tertiles: ≤42, 42-54 and >54 mm Hg. Age and ejection fraction adjusted Kaplan-Meier curves were generated to evaluate the relationship between PP and outcomes [mortality, CV mortality, stroke and HF hospitalizations (HFH)]. Cox proportional hazards models were created incorporating PP as a continuous variable. The interaction of PP with New York Heart Association (NYHA) functional class was examined. Linear and restricted cubic splines were used to study nonlinear association between PP and outcomes. RESULTS We included 2,299 patients with a mean(±SD) follow-up of 3.5 ± 1.8 years. The lowest tertile of PP (≤42 mm Hg) was associated with significantly higher CV mortality and HFH. Cox proportional hazards models showed a reduction in CV death and HFH with higher PP, with adjusted hazard ratios (HR) of 0.91 (P = 0.02) and 0.93 (P = 0.04) per 10 mm Hg increase in PP. This relationship was more pronounced in subjects with NYHA functional class III-IV. Spline analysis showed that the association between PP and CV mortality and HFH was only seen at PP values lower than 40 mm Hg. CONCLUSIONS In patients with advanced HFREF, a low PP (<40 mm Hg) portends a worse prognosis, whereas a high PP (>50 mm Hg) predicts a relatively favourable prognosis.
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Affiliation(s)
- Neeraj Shah
- Department of Cardiology, Lehigh Valley Health Network, Allentown, Pennsylvania
| | - Min Qian
- Columbia University Medical Center, New York, New York
| | | | - Susan Graham
- The State University of New York at Buffalo, Buffalo, New York
| | | | | | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | | | | | - Dirk J Lok
- Hospital Deventer, Deventer, the Netherlands
| | - Stefan D Anker
- Innovative Clinical Trials, Department of Cardiology & Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany
| | - John R Teerlink
- University of California San Francisco, San Francisco, California
| | | | | | - Ronald S Freudenberger
- Department of Cardiology, Lehigh Valley Health Network, Allentown, Pennsylvania.,The University of South Florida, Tampa, Florida
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22
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Werhane ML, Thomas KR, Edmonds EC, Bangen KJ, Tran M, Clark AL, Nation DA, Gilbert PE, Bondi MW, Delano-Wood L. Differential Effect of APOE ɛ4 Status and Elevated Pulse Pressure on Functional Decline in Cognitively Normal Older Adults. J Alzheimers Dis 2019; 62:1567-1578. [PMID: 29562507 DOI: 10.3233/jad-170918] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND/OBJECTIVE The APOE ɛ4 allele and increased vascular risk have both been independently linked to cognitive impairment and dementia. Since few studies have characterized how these risk factors affect everyday functioning, we investigated the relationship between APOE ɛ4 genotype and elevated pulse pressure (PP) on functional change in cognitively normal participants from the Alzheimer's Disease Neuroimaging Initiative (ADNI). METHODS 738 normally aging participants underwent APOE genotyping, and baseline PP was calculated from blood pressure indices. The Functional Activities Questionnaire (FAQ) was completed by participants' informant at baseline and 6, 12, 24, 36, and 48-month follow-up visits. Multiple linear regression and multilevel modeling were used to examine the effects of PP and APOE ɛ4 genotype on cross-sectional and longitudinal FAQ scores, respectively. RESULTS Adjusting for demographic and clinical covariates, results showed that both APOE ɛ4 status and elevated PP predicted greater functional difficulty trajectories across four years of follow-up. Interestingly, however, elevated PP was associated with greater functional decline over time in ɛ4 non-carriers versus carriers. CONCLUSION Results show that, although APOE ɛ4 status is the prominent predictor of functional difficulty for ɛ4 carriers, an effect of arterial stiffening on functional difficulty was observed in non-carriers. Future studies are needed in order to clarify the etiology of the association between PP and different brain aging processes, and further explore its utility as a marker of dementia risk. The present study underscores the importance of targeting modifiable risk factors such as elevated PP to prevent or slow functional decline and pathological brain aging.
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Affiliation(s)
- Madeleine L Werhane
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA.,San Diego State University/University of California, San Diego (SDSU/UCSD) Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Kelsey R Thomas
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Emily C Edmonds
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Katherine J Bangen
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - My Tran
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Alexandra L Clark
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA.,San Diego State University/University of California, San Diego (SDSU/UCSD) Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Daniel A Nation
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Paul E Gilbert
- San Diego State University/University of California, San Diego (SDSU/UCSD) Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Mark W Bondi
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Lisa Delano-Wood
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
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Change in visceral adiposity is an independent predictor of future arterial pulse pressure. J Hypertens 2019; 36:299-305. [PMID: 28857792 DOI: 10.1097/hjh.0000000000001532] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Pulse pressure (PP), a marker of arterial stiffness, and body composition are both risk factors for cardiovascular disease. Little is known about whether changes in body composition may be linked to future PP. We sought to determine whether change in amount of abdominal and thigh fat over 5 years predicted PP at 10 years. METHODS Visceral fat as well as abdominal and thigh subcutaneous fat areas were measured by computed tomography at baseline and 5 years later in 284 Japanese Americans (mean age 49.3 years; 50.4% men) without hypertension, heart disease, and glucose-lowering medication use at baseline. PP at 10 years was calculated as the difference between SBP and DBP measured with a mercury sphygmomanometer. The association between change in fat at 5 years and arterial PP at 10 years, adjusted for baseline PP, was examined using linear regression analysis. MAIN RESULTS Change in abdominal visceral fat area at 5 years was positively associated with 10-year PP independent of sex, 5-year change in BMI, and baseline age, BMI, PP, abdominal visceral fat, smoking status, alcohol consumption, physical activity, homeostasis model assessment insulin resistance, and fasting plasma glucose. There were no significant associations between baseline amounts or change in abdominal or thigh subcutaneous fat areas and future PP. CONCLUSION The accumulation of abdominal visceral fat over time independently predicted future PP in Japanese Americans.
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Park HW, Kang MG, Kim K, Koh JS, Park JR, Hwang SJ, Kim HR, Jeong YH, Ahn JH, Jang JY, Kwak CH, Park Y, Hwang JY, Jeong MH, Kim HS, Yoon CH, Kim DI. Association between pulse pressure at discharge and clinical outcomes in patients with acute myocardial infarction: From the KAMIR-Korean-NIH registry. J Clin Hypertens (Greenwich) 2019; 21:774-785. [PMID: 31012548 DOI: 10.1111/jch.13534] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 02/21/2019] [Accepted: 03/08/2019] [Indexed: 11/27/2022]
Abstract
Pulse pressure (PP) is affected by arterial stiffness and is a predictor of cardiovascular events. However, value and utility of PP assessment in patients with acute myocardial infarction (AMI) remain less clear. We aimed to evaluate the association between PP and cardiovascular events in surviving patients with AMI at discharge. A total of 11 944 surviving patients with AMI at discharge from a Korean nationwide registry were included. Blood pressure was checked just before discharge. Noncardiac death and major adverse cardiovascular events (MACEs) including cardiac death, AMI, and stroke after discharge were analyzed. The median follow-up duration was 368 (IQR 339, 388) days. The rate of MACEs and cardiac death was higher in groups with the lowest PP (PP < 20 mm Hg) and highest PP (PP ≥ 71 mm Hg) and lowest in the group with PP of 31-40 mm Hg. With PP of 31-40 mm Hg as reference, univariate analysis showed a U-shaped association between the risk of MACEs (PP ≤ 20 mm Hg: hazard ratio [HR] 2.3; PP ≥ 71 mm Hg: HR 2.7) or cardiac death (PP ≤ 20 mm Hg: HR 2.6; PP ≥ 71 mm Hg: HR 3.1) and PP. In multivariate analysis, the curve changed from being U-shaped to J-shaped, and HR for PP ≥ 71 mm Hg (1.2 for MACEs and 1.4 cardiac death) decreased and HR for PP < 20 (2.1 for MACEs and 2.4 for cardiac death) did not significantly decrease after adjustment for cardiovascular risk factors. Our findings indicate that PP is a strong independent prognostic factor of MACEs and cardiac death in surviving patients with AMI. Low PP is a more significant independent predictor of MACEs and cardiac death than high PP in surviving patients after AMI.
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Affiliation(s)
- Hyun Woong Park
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Min Gyu Kang
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Kyehwan Kim
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Jin-Sin Koh
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Jeong Rang Park
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Seok-Jae Hwang
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Hye Ree Kim
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Young-Hoon Jeong
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Jong Hwa Ahn
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Jeong Yoon Jang
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Choong Hwan Kwak
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Yongwhi Park
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Jin-Yong Hwang
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Myung Ho Jeong
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Hyo-Soo Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Chang-Hwan Yoon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Doo-Il Kim
- Department of Internal Medicine, Haeundae Paik hospital, InJe University College of Medicine, Busan, Republic of Korea
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Rueda-Ochoa OL, Smiderle-Gelain MA, Rizopoulos D, Dhana K, van den Berge JK, Echeverria LE, Ikram MA, Deckers JW, Franco OH, Kavousi M. Risk factors for longitudinal changes in left ventricular diastolic function among women and men. Heart 2019; 105:1414-1422. [PMID: 30936410 PMCID: PMC6820149 DOI: 10.1136/heartjnl-2018-314487] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 02/22/2019] [Accepted: 03/01/2019] [Indexed: 12/13/2022] Open
Abstract
Objective To evaluate changes in left ventricular diastolic function (LVDF) parameters and their associated risk factors over a period of 11 years among community-dwelling women and men. Methods Echocardiography was performed three times among 870 women and 630 men (age 67±3 years) from the prospective population-based Rotterdam Study during a period of 11-year follow-up. Changes in six continuous LVDF parameters were correlated with cardiovascular risk factors using a linear-mixed effect model (LMM). Results In women, smoking was associated with deleterious longitudinal changes in deceleration time (DT) (Beta (β): 7.73; 95% CI 2.56 to 12.9) and high-density lipoprotein cholesterol was associated with improvement of septal e′ (β: 0.37; 95% CI 0.13 to 0.62) and E/e′ ratio (β: −0.46; 95% CI −0.84 to –0.08) trajectories. Among men, diabetes was associated with deleterious longitudinal changes in A wave (β: 3.83; 95% CI 0.06 to 7.60), septal e′ (β: −0.40; 95% CI −0.70 to –0.09) and E/e′ ratio (β: 0.60; 95% CI 0.14 to 1.06) and body mass index was associated with deleterious longitudinal changes in A wave (β: 1.25; 95% CI 0.84 to 1.66), E/A ratio (β: −0.007; 95% CI −0.01 to –0.003), DT (β: 0.86; 95% CI 0.017 to 1.71) and E/e′ ratio (β: 0.12; 95% CI 0.06 to 0.19). Conclusions Smoking among women and metabolic factors (diabetes mellitus and body mass index) among men showed larger deleterious associations with longitudinal changes in LVDF parameters. The favourable association of HDL was mainly observed among women. This study, for the first time, evaluates risk factors associated with changes over time in continuous LVDF parameters among women and men and generates new hypothesis for further medical research.
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Affiliation(s)
- Oscar L Rueda-Ochoa
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands.,Department of Basic Sciences, Universidad Industrial de Santander, Bucaramanga, Colombia
| | - Marco A Smiderle-Gelain
- Department of Cardiology, Federal University of Health Sciences UFCSPA, Porto Alegre, Porto Alegre, Brazil
| | | | - Klodian Dhana
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
| | | | - Luis E Echeverria
- Heart Failure and Heart Transplant Clinic, Fundacion Cardiovascular de Colombia, Floridablanca, Colombia
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
| | - Jaap W Deckers
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Oscar H Franco
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
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26
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Li J, Cui R, Eshak ES, Yamagishi K, Imano H, Muraki I, Hayama-Terada M, Kiyama M, Okada T, Iso H. Association of cigarette smoking with radial augmentation index: the Circulatory Risk in Communities Study (CIRCS). Hypertens Res 2018; 41:1054-1062. [DOI: 10.1038/s41440-018-0106-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 04/29/2018] [Accepted: 05/02/2018] [Indexed: 01/12/2023]
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Hashemi A, Nourbakhsh S, Asgari S, Mirbolouk M, Azizi F, Hadaegh F. Blood pressure components and incident cardiovascular disease and mortality events among Iranian adults with chronic kidney disease during over a decade long follow-up: a prospective cohort study. J Transl Med 2018; 16:230. [PMID: 30111315 PMCID: PMC6094925 DOI: 10.1186/s12967-018-1603-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Accepted: 08/10/2018] [Indexed: 11/10/2022] Open
Abstract
Background To explore the association between systolic and diastolic blood pressure (SBP and DBP respectively) and pulse pressure (PP) with cardiovascular disease (CVD) and mortality events among Iranian patients with prevalent CKD. Methods Patients [n = 1448, mean age: 60.9 (9.9) years] defined as those with estimated glomerular filtration rate < 60 ml/min/1.73 m2, were followed from 31 January 1999 to 20 March 2014. Multivariable Cox proportional hazard models were applied to examine the associations between different components of BP with outcomes. Results During a median follow-up of 13.9 years, 305 all-cause mortality and 317 (100 fatal) CVD events (among those free from CVD, n = 1232) occurred. For CVD and CV-mortality, SBP and PP showed a linear relationship, while a U-shaped relationship for DBP was observed with all outcomes. Considering 120 ≤ SBP < 130 as reference, SBP ≥ 140 mmHg was associated with the highest hazard ratio (HR) for CVD [1.68 (1.2–2.34)], all-cause [1.72 (1.19–2.48)], and CV-mortality events [2.21 (1.16–4.22)]. Regarding DBP, compared with 80 ≤ DBP < 85 as reference, the level of ≥ 85 mmHg increased risk of CVD and all-cause mortality events; furthermore, DBP < 80 mmHg was associated with significant HR for CVD events [1.55 (1.08–2.24)], all-cause [1.68 (1.13–2.5)] and CV-mortality events [3.0 (1.17–7.7)]. Considering PP, the highest HR was seen in participants in the 4th quartile for all outcomes of interest; HRs for CVD events [1.92 (1.33–2.78)], all-cause [1.71 (1.11–2.63)] and CV-mortality events [2.22 (1.06–4.64)]. Conclusions Among patients with CKD, the lowest risk of all-cause and CV-mortality as well as incident CVD was observed in those with SBP < 140, 80 ≤ DBP < 85 and PP < 64 mmHg.
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Affiliation(s)
- Ashkan Hashemi
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No. 24, Parvaneh Street, Velenjak, P.O. Box: 19395-4763, Tehran, Iran
| | - Sormeh Nourbakhsh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No. 24, Parvaneh Street, Velenjak, P.O. Box: 19395-4763, Tehran, Iran
| | - Samaneh Asgari
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No. 24, Parvaneh Street, Velenjak, P.O. Box: 19395-4763, Tehran, Iran
| | - Mohammadhassan Mirbolouk
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Hospital, Baltimore, USA
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No. 24, Parvaneh Street, Velenjak, P.O. Box: 19395-4763, Tehran, Iran.
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Hou D, Yan Y, Liu J, Zhao X, Cheng H, Mi J. Childhood pulse pressure predicts subclinical vascular damage in adulthood. J Hypertens 2018; 36:1663-1670. [DOI: 10.1097/hjh.0000000000001748] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Tadic M, Quarti-Trevano F, Bombelli M, Facchetti R, Cuspidi C, Mancia G, Grassi G. The importance of pulse pressure on cardiovascular risk and total mortality in the general population: Is sex relevant? J Clin Hypertens (Greenwich) 2018; 20:1001-1007. [PMID: 29701009 DOI: 10.1111/jch.13300] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 03/20/2018] [Accepted: 04/02/2018] [Indexed: 11/27/2022]
Abstract
The aim of the present study is to investigate the predictive value of pulse pressure (PP) on cardiovascular events in the general population and in both sexes, separately. The study involved 2045 participants from the PAMELA study who underwent 24-hour ambulatory blood pressure (BP) monitoring. The participants were followed from the initial medical visit for a time interval of 137 ± 23 months. It was found that office, home, and 24-hour blood pressures were significantly higher in the individuals who experienced cardiovascular (CV) events. Office, 24-hour, and daytime PP were independent predictors of CV events after adjustment for main demographic and clinical parameters in the whole study population. Nighttime PP was an additional independent predictor in men. In conclusion, PP represents an important predictor of cardiovascular events in the general population, particularly among men. Daytime and 24-hour PP have greater predictive importance than nighttime PP in the general population.
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Affiliation(s)
- Marijana Tadic
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Michele Bombelli
- Department of Medicine and Surgery, University of Milan-Bicocca, Meda, Italy
| | - Rita Facchetti
- Department of Medicine and Surgery, University of Milan-Bicocca, Meda, Italy
| | - Cesare Cuspidi
- Department of Medicine and Surgery, University of Milan-Bicocca, Meda, Italy.,Istituto Auxologico Italiano, Clinical Research Unit, Meda, Italy
| | - Giuseppe Mancia
- Department of Medicine and Surgery, University of Milan-Bicocca, Meda, Italy
| | - Guido Grassi
- Department of Medicine and Surgery, University of Milan-Bicocca, Meda, Italy
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30
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Mancusi C, Losi MA, Izzo R, Canciello G, Carlino MV, Albano G, De Luca N, Trimarco B, de Simone G. Higher pulse pressure and risk for cardiovascular events in patients with essential hypertension: The Campania Salute Network. Eur J Prev Cardiol 2018; 25:235-243. [DOI: 10.1177/2047487317747498] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Background Increased pulse pressure is associated with structural target organ damage, especially in elderly patients, increasing cardiovascular risk. Design In this analysis, we investigated whether high pulse pressure retains a prognostic effect also when common markers of target organ damage are taken into account. Methods We analysed an unselected cohort of treated hypertensive patients from the Campania Salute Network registry ( n = 7336). Participants with available cardiac and carotid ultrasound were required to be free of prevalent cardiovascular disease, with ejection fraction ≥50%, and no more than stage III Chronic Kidney Disease. The median follow-up was 41 months and end-point was occurrence of major cardiovascular events (i.e. fatal and non-fatal stroke or myocardial infarction and sudden death). Based on current guidelines, pulse pressure ≥60 mm Hg was classified as high pulse pressure ( n = 2356), at the time of the initial visit, whereas pulse pressure <60 mm Hg was considered normal ( n = 4980). Results High pulse pressure patients were older, more likely to be women and diabetic, while receiving more antihypertensive medications than normal pulse pressure (all p < 0.0001). High pulse pressure exhibited greater prevalence of left ventricular hypertrophy, and carotid plaque than normal pulse pressure (all p < 0.0001). In Cox regression, high pulse pressure patients had 57% increased hazard of major cardiovascular events, compared to normal pulse pressure (hazard ratio = 1.57; 95% confidence interval: 1.12–2.22, p = 0.01), an effect that was independent of significant prognostic impact of older age, male sex, diabetes, left ventricular hypertrophy, carotid plaque and less prescription of anti-renin–angiotensin system therapy. Conclusions High pulse pressure is a functional marker of target organ damage, predicting cardiovascular events in hypertensive patients, even independently of well-known structural markers of target organ damage.
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Affiliation(s)
- Costantino Mancusi
- Hypertension Research Center, Federico II University Hospital, Italy
- Department of Advanced Biomedical Science, Federico II University Hospital, Italy
| | - Maria A Losi
- Hypertension Research Center, Federico II University Hospital, Italy
- Department of Advanced Biomedical Science, Federico II University Hospital, Italy
| | - Raffaele Izzo
- Hypertension Research Center, Federico II University Hospital, Italy
- Department of Translational Medical Science, Federico II University Hospital, Italy
| | - Grazia Canciello
- Hypertension Research Center, Federico II University Hospital, Italy
- Department of Advanced Biomedical Science, Federico II University Hospital, Italy
| | - Maria V Carlino
- Hypertension Research Center, Federico II University Hospital, Italy
- Department of Advanced Biomedical Science, Federico II University Hospital, Italy
| | - Giovanni Albano
- Hypertension Research Center, Federico II University Hospital, Italy
- Department of Advanced Biomedical Science, Federico II University Hospital, Italy
| | - Nicola De Luca
- Hypertension Research Center, Federico II University Hospital, Italy
- Department of Translational Medical Science, Federico II University Hospital, Italy
| | - Bruno Trimarco
- Hypertension Research Center, Federico II University Hospital, Italy
- Department of Advanced Biomedical Science, Federico II University Hospital, Italy
| | - Giovanni de Simone
- Hypertension Research Center, Federico II University Hospital, Italy
- Department of Advanced Biomedical Science, Federico II University Hospital, Italy
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Diaz A, Tringler M, Wray S, Ramirez AJ, Cabrera Fischer EI. The effects of age on pulse wave velocity in untreated hypertension. J Clin Hypertens (Greenwich) 2017; 20:258-265. [PMID: 29267992 DOI: 10.1111/jch.13167] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 09/14/2017] [Accepted: 09/22/2017] [Indexed: 01/18/2023]
Abstract
Increased arterial stiffness is an important determinant of cardiovascular risk, able to predict morbidity and mortality, and closely associated with ageing and blood pressure. The aims of this study were: (1) To determine the age-dependent reference pulse wave velocity (PWV), and compare it with values from hypertensive patients, and (2) to evaluate the impact of isolated and untreated hypertension on arterial stiffness. A total of 1079 patients were enrolled and divided into a control group (NT) of asymptomatic normotensive patients and a group of asymptomatic hypertensive patients (HT). Blood pressure, carotid-femoral PWV, and body mass index were measured in each subject, whose blood was drawn for laboratory tests. Aortic mean PWV in the NT group was 6.85 ± 1.66 m/s, which increased linearly (R2 = 0.62; P < .05) with age. In patients over 50 years of age, PWV was significantly higher than in younger patients (8.35 vs 5.92 m/s, respectively, P < .001). This significant difference persisted when observing male and female patients separately. In the hypertensive group, mean PWV value was 8.04 ± 1.8 m/s (range 4.5-15.8 m/s) and increased (R2 = 0.243; P < .05) with age. The PWV increase in HT was significantly higher (0.93 m/s per decade, P < .001) than in NT (0.44 m/s per decade). Our study provides normal values of PVW per decade, and shows that these values increase with age, especially after 50 years of age, particularly in HT patients. This stiffness growth rate may be responsible for increased cardiovascular risk in both groups.
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Affiliation(s)
- Alejandro Diaz
- CONICET School of Health Sciences IICS National University of the Center of Buenos Aires Province, Tandil, Argentina
| | - Matías Tringler
- CONICET School of Health Sciences IICS National University of the Center of Buenos Aires Province, Tandil, Argentina
| | - Sandra Wray
- Instituto de Medicina Traslacional, Trasplante, y Bioingeniería (IMeTTyB), Universidad Favaloro, CONICET, Buenos Aires, Argentina
| | - Agustín J Ramirez
- Instituto de Medicina Traslacional, Trasplante, y Bioingeniería (IMeTTyB), Universidad Favaloro, CONICET, Buenos Aires, Argentina.,Arterial Hypertension and Metabolic Unit, University Hospital Favaloro Foundation Buenos Aires, Argentina
| | - Edmundo I Cabrera Fischer
- Instituto de Medicina Traslacional, Trasplante, y Bioingeniería (IMeTTyB), Universidad Favaloro, CONICET, Buenos Aires, Argentina
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Yu CK, Xu T, Assoian RK, Rader DJ. Mining the Stiffness-Sensitive Transcriptome in Human Vascular Smooth Muscle Cells Identifies Long Noncoding RNA Stiffness Regulators. Arterioscler Thromb Vasc Biol 2017; 38:164-173. [PMID: 29051139 DOI: 10.1161/atvbaha.117.310237] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 09/26/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Vascular extracellular matrix stiffening is a risk factor for aortic and coronary artery disease. How matrix stiffening regulates the transcriptome profile of human aortic and coronary vascular smooth muscle cells (VSMCs) is not well understood. Furthermore, the role of long noncoding RNAs (lncRNAs) in the cellular response to stiffening has never been explored. This study characterizes the stiffness-sensitive (SS) transcriptome of human aortic and coronary VSMCs and identifies potential key lncRNA regulators of stiffness-dependent VSMC functions. APPROACH AND RESULTS Aortic and coronary VSMCs were cultured on hydrogel substrates mimicking physiological and pathological extracellular matrix stiffness. Total RNAseq was performed to compare the SS transcriptome profiles of aortic and coronary VSMCs. We identified 3098 genes (2842 protein coding and 157 lncRNA) that were stiffness sensitive in both aortic and coronary VSMCs (false discovery rate <1%). Hierarchical clustering revealed that aortic and coronary VSMCs grouped by stiffness rather than cell origin. Conservation analyses also revealed that SS genes were more conserved than stiffness-insensitive genes. These VSMC SS genes were less tissue-type specific and expressed in more tissues than stiffness-insensitive genes. Using unbiased systems analyses, we identified MALAT1 as an SS lncRNA that regulates stiffness-dependent VSMC proliferation and migration in vitro and in vivo. CONCLUSIONS This study provides the transcriptomic landscape of human aortic and coronary VSMCs in response to extracellular matrix stiffness and identifies novel SS human lncRNAs. Our data suggest that the SS transcriptome is evolutionarily important to VSMCs function and that SS lncRNAs can act as regulators of stiffness-dependent phenotypes.
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MESH Headings
- Aorta/metabolism
- Aorta/pathology
- Cell Movement
- Cell Proliferation
- Cells, Cultured
- Cluster Analysis
- Computational Biology/methods
- Coronary Vessels/metabolism
- Coronary Vessels/pathology
- Data Mining/methods
- Extracellular Matrix/genetics
- Extracellular Matrix/metabolism
- Extracellular Matrix/pathology
- Gene Expression Profiling/methods
- Gene Expression Regulation
- Humans
- Hydrogels
- Mechanotransduction, Cellular
- Muscle, Smooth, Vascular/metabolism
- Muscle, Smooth, Vascular/pathology
- Myocytes, Smooth Muscle/metabolism
- Myocytes, Smooth Muscle/pathology
- RNA, Long Noncoding/genetics
- RNA, Long Noncoding/metabolism
- Transcriptome
- Vascular Stiffness
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Affiliation(s)
- Christopher K Yu
- From the Perelman School of Medicine (C.K.Y.), Department of Systems Pharmacology and Translational Therapeutics (T.X., R.K.A.), Program in Translational Biomechanics, Institute of Translational Medicine and Therapeutics (T.X., R.K.A.), and Departments of Genetics, Medicine, and Pediatrics, Perelman School of Medicine (D.J.R.), University of Pennsylvania, Philadelphia
- This manuscript was sent to Zahi Fayad, Consulting Editor, for review by expert referees, editorial decision, and final disposition
| | - Tina Xu
- From the Perelman School of Medicine (C.K.Y.), Department of Systems Pharmacology and Translational Therapeutics (T.X., R.K.A.), Program in Translational Biomechanics, Institute of Translational Medicine and Therapeutics (T.X., R.K.A.), and Departments of Genetics, Medicine, and Pediatrics, Perelman School of Medicine (D.J.R.), University of Pennsylvania, Philadelphia
- This manuscript was sent to Zahi Fayad, Consulting Editor, for review by expert referees, editorial decision, and final disposition
| | - Richard K Assoian
- From the Perelman School of Medicine (C.K.Y.), Department of Systems Pharmacology and Translational Therapeutics (T.X., R.K.A.), Program in Translational Biomechanics, Institute of Translational Medicine and Therapeutics (T.X., R.K.A.), and Departments of Genetics, Medicine, and Pediatrics, Perelman School of Medicine (D.J.R.), University of Pennsylvania, Philadelphia
- This manuscript was sent to Zahi Fayad, Consulting Editor, for review by expert referees, editorial decision, and final disposition
| | - Daniel J Rader
- From the Perelman School of Medicine (C.K.Y.), Department of Systems Pharmacology and Translational Therapeutics (T.X., R.K.A.), Program in Translational Biomechanics, Institute of Translational Medicine and Therapeutics (T.X., R.K.A.), and Departments of Genetics, Medicine, and Pediatrics, Perelman School of Medicine (D.J.R.), University of Pennsylvania, Philadelphia.
- This manuscript was sent to Zahi Fayad, Consulting Editor, for review by expert referees, editorial decision, and final disposition.
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Hahn LA, Mackinnon A, Foley DL, Morgan VA, Waterreus A, Watts GF, Castle DJ, Liu D, Galletly CA. The role of arterial elasticity and cardiovascular peripheral resistance as clinically relevant indices of health status in people with psychosis. Schizophr Res 2017; 184:88-95. [PMID: 27939827 DOI: 10.1016/j.schres.2016.11.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 10/09/2016] [Accepted: 11/29/2016] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Hypertension is one of the most important risk factors for cardiovascular disease (CVD). Systolic and diastolic blood pressure (BP) are higher in people with psychosis compared to the general population, but there is little research into measures of the elasticity of the arterial wall (pulse pressure; PP) and peripheral resistance (mean arterial pressure; MAP). PP and MAP can provide an additional perspective on the functioning of the circulatory system. This study investigated PP and MAP in people with psychosis, using factors known to be related to PP and MAP in the general population. METHOD Participants included 1421 people aged 18-64years, from the second Australian national survey of psychosis, untreated with antihypertensive medication. We tested the interaction and main effects between age and gender on PP, MAP, systolic BP and diastolic BP. Odds ratios were calculated in people exceeding the at-risk thresholds for PP and MAP. Multiple linear regression was used to test whether factors associated with at-risk PP and MAP in the general population were similarly associated in the psychosis population. RESULTS The interaction effect between age and gender on PP, MAP, systolic BP and diastolic BP was not statistically significant. Variables that retained significance in the regression model in explaining higher PP and MAP were: male gender, higher age, and having a family history of hypertension. CONCLUSION Clinicians monitoring and treating CV risk in this population need to ensure that they have recorded whether there is a family history of hypertension, and should be especially, more vigilant in men and in older patients.
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Affiliation(s)
- Lisa A Hahn
- Level 4, Eleanor Harrald Building, Royal Adelaide Hospital, University of Adelaide, Discipline of Psychiatry, Adelaide, SA 5000, Australia.
| | - Andrew Mackinnon
- Black Dog Institute and University of New South Wales, Sydney, NSW, Australia; Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia.
| | - Debra L Foley
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, VIC, Australia.
| | - Vera A Morgan
- Neuropsychiatric Epidemiology Research Unit, School of Psychiatry & Clinical Neurosciences, The University of Western Australia, Crawley, WA, Australia.
| | - Anna Waterreus
- Neuropsychiatric Epidemiology Research Unit, School of Psychiatry & Clinical Neurosciences, The University of Western Australia, Crawley, WA, Australia.
| | - Gerald F Watts
- Cardiometabolic Clinic, Department of Cardiology, Royal Perth Hospital, School of Medicine and Pharmacology, The University of Western Australia, Crawley, WA, Australia.
| | - David J Castle
- St Vincent's Hospital, Melbourne and Department of Psychiatry, The University of Melbourne, VIC, Australia.
| | - Dennis Liu
- Discipline of Psychiatry, School of Medicine, University of Adelaide, Northern Adelaide Local Area Health Network, Adelaide, SA, Australia.
| | - Cherrie A Galletly
- Discipline of Psychiatry, School of Medicine, University of Adelaide Ramsay Health Care, Mental Health Services, Northern Adelaide Local Health Network, Adelaide, SA, Australia.
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Kang MG, Kim KH, Koh JS, Park JR, Hwang SJ, Hwang JY, Ahn JH, Jang JY, Jeong YH, Kwak CH, Park HW. Association between pulse pressure and body mass index in hypertensive and normotensive populations in the Korea National Health and Nutrition Examination Survey V, 2010-2012. J Clin Hypertens (Greenwich) 2016; 19:395-401. [PMID: 27804237 DOI: 10.1111/jch.12935] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 08/24/2016] [Accepted: 09/02/2016] [Indexed: 02/02/2023]
Abstract
The authors conducted a national cross-sectional cohort study to evaluate the associations between pulse pressure (PP) and body mass index (BMI) and sex, according to blood pressure (BP) status. A total of 18 812 patients without a history of antihypertensive medication and cardiovascular disease were selected. There was good concordance between PP and the selected cardiovascular risk factors. PP increased with high BMI among patients with normal BP, but decreased with high BMI among patients with hypertension (HTN). BMI (ß, -0.260; SE, 0.039 [P<.001]) and male sex (ß, -4.727; SE, 1.100 [P<.001]) were negatively correlated with PP in a multivariate model adjusted for several risk factors in patients with HTN. In conclusion, PP was negatively correlated with BMI in patients with HTN, which may explain the higher cardiovascular risk in lean persons and women with HTN.
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Affiliation(s)
- Min Gyu Kang
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Korea
| | - Kye-Hwan Kim
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Korea
| | - Jin-Sin Koh
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Korea
| | - Jeong Rang Park
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Korea
| | - Seok-Jae Hwang
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Korea
| | - Jin-Yong Hwang
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Korea
| | - Jong Hwa Ahn
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Jeong Yoon Jang
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Young-Hoon Jeong
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Choong Hwan Kwak
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Hyun Woong Park
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Korea
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Rehwald R, Petersen J, Gratl A, Zoller H, Mader A, Loizides A, Grams AE, Klocker J, Glodny B. Retrospective angiographic study to determine the effect of atherosclerotic stenoses of upstream arteries on the degree of atherosclerosis in distal vascular territories. BMJ Open 2016; 6:e010704. [PMID: 27256089 PMCID: PMC4893845 DOI: 10.1136/bmjopen-2015-010704] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 04/07/2016] [Accepted: 04/29/2016] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Experimental coarctation of the aorta prevents the development of downstream atherosclerosis. The aim of this study was to find out whether or not atherosclerotic stenoses protect distal vascular territories from developing atherosclerosis in humans. DESIGN AND SETTING A total of 2125 vascular segments from angiographies of 101 patients were evaluated by calculating the maximum degree of stenosis (NASCET criteria), the degree of calcification, the degree of collaterals and the Friesinger score. RESULTS Stenosis ≥30-49% was found in 685 vascular segments (32.2%), ≥50-69% in 490 (23.1%), ≥70-89% in 373 (17.6%) and ≥90% in 265 (12.5%). If a stenosis of at least ≥70-89% was present in the common iliac, the external iliac or the common femoral artery, the degrees of stenosis distal to it were lower than those on the contralateral side (19.8±22.3% (CI 11.7 to 28.0) vs 25.2±20.7% (CI 21.2 to 29.1); Friesinger scores 1.1±1.2 (CI 0.6 to 1.5) vs 1.4±1.1 (CI 1.2 to 1.6); degrees of calcification 0.8±1.0 (CI 0.4 to 1.1) vs 1.2±1.1 (CI 1.2 to 1.6); p<0.05 each). This effect depended on the degree of proximal stenosis, but not on collaterals, and was most pronounced distal to stenoses of the common iliac, the superficial femoral and the popliteal artery. In regression models, stenoses of the pelvic arteries were shown to be an independent protective factor for the distal vascular territories. CONCLUSIONS Atherosclerotic stenoses seem to protect distal vascular territories from developing atherosclerosis. The underlying pathophysiological mechanism of this phenomenon remains to be determined. It could be based on pulse pressure reduction.
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Affiliation(s)
- Rafael Rehwald
- Department of Radiology, University Hospital for Radiology, Medical University of Innsbruck, Innsbruck, Tyrol, Austria
| | - Johannes Petersen
- Department of Radiology, University Hospital for Radiology, Medical University of Innsbruck, Innsbruck, Tyrol, Austria
| | - Alexandra Gratl
- Department of Surgery, University Hospital for Vascular Surgery, Medical University of Innsbruck, Innsbruck, Tyrol, Austria
| | - Heinz Zoller
- Department of Internal Medicine, University Hospital for Internal Medicine II, Gastroenterology and Hepatology, Medical University of Innsbruck, Innsbruck, Tyrol, Austria
| | - Andreas Mader
- Department of Radiology, University Hospital for Radiology, Medical University of Innsbruck, Innsbruck, Tyrol, Austria
| | - Alexander Loizides
- Department of Radiology, University Hospital for Radiology, Medical University of Innsbruck, Innsbruck, Tyrol, Austria
| | - Astrid E Grams
- Department of Radiology, University Hospital for Neuroradiology, Medical University of Innsbruck, Innsbruck, Tyrol, Austria
| | - Josef Klocker
- Department of Internal Medicine, University Hospital for Internal Medicine II, Gastroenterology and Hepatology, Medical University of Innsbruck, Innsbruck, Tyrol, Austria
| | - Bernhard Glodny
- Department of Radiology, University Hospital for Radiology, Medical University of Innsbruck, Innsbruck, Tyrol, Austria
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Impact of pulse pressure on left ventricular global longitudinal strain in normotensive and newly diagnosed, untreated hypertensive patients. J Hypertens 2016; 34:1201-7. [DOI: 10.1097/hjh.0000000000000906] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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38
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Liu FD, Shen XL, Zhao R, Tao XX, Wang S, Zhou JJ, Zheng B, Zhang QT, Yao Q, Zhao Y, Zhang X, Wang XM, Liu HQ, Shu L, Liu JR. Pulse pressure as an independent predictor of stroke: a systematic review and a meta-analysis. Clin Res Cardiol 2016; 105:677-686. [DOI: 10.1007/s00392-016-0972-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 02/01/2016] [Indexed: 11/28/2022]
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Kozakova M, Palombo C. Diabetes Mellitus, Arterial Wall, and Cardiovascular Risk Assessment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:201. [PMID: 26861377 PMCID: PMC4772221 DOI: 10.3390/ijerph13020201] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 02/01/2016] [Indexed: 12/11/2022]
Abstract
Diabetes mellitus is an independent risk factor for atherothrombotic cardiovascular disease. Adults with diabetes are two to four times more likely to develop heart disease or stroke than adults without diabetes. The two major features of diabetes, i.e., hyperglycemia and insulin-resistance, trigger arterial stiffening and increase the susceptibility of the arterial wall to atherosclerosis at any given age. These pathological changes in the arterial wall may provide a functional and structural background for cardiovascular events. The present paper provides a critical overview of the clinical evidence linking diabetes-related metabolic abnormalities to cardiovascular risk, debates the pathophysiologic mechanisms through which insulin resistance and hyperglycemia may affect the arterial wall, and discusses the associations between vascular biomarkers, metabolic abnormalities and cardiovascular events.
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Affiliation(s)
- Michaela Kozakova
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa 56122, Italy.
| | - Carlo Palombo
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa 56122, Italy.
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40
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Lu DY, You LK, Sung SH, Cheng HM, Lin SJ, Chiang FT, Chen CH, Yu WC. Abnormal Pulsatile Hemodynamics in Hypertensive Patients With Normalized 24-Hour Ambulatory Blood Pressure by Combination Therapy of Three or More Antihypertensive Agents. J Clin Hypertens (Greenwich) 2015; 18:281-9. [DOI: 10.1111/jch.12751] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 09/14/2015] [Accepted: 09/22/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Dai-Yin Lu
- Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- Institute of Clinical Medicine; Faculty of Medicine; National Yang-Ming University; Taipei Taiwan
| | - Li-Kai You
- Department of Medical Education; Taipei Veterans General Hospital; Taipei Taiwan
| | - Shih-Hsien Sung
- Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- Cardiovascular Research Center; Faculty of Medicine; National Yang-Ming University; Taipei Taiwan
- Department of Medicine; Faculty of Medicine; National Yang-Ming University; Taipei Taiwan
| | - Hao-Min Cheng
- Department of Medical Education; Taipei Veterans General Hospital; Taipei Taiwan
- Cardiovascular Research Center; Faculty of Medicine; National Yang-Ming University; Taipei Taiwan
- Department of Medicine; Faculty of Medicine; National Yang-Ming University; Taipei Taiwan
- Department of Public Health; Faculty of Medicine; National Yang-Ming University; Taipei Taiwan
| | - Shing-Jong Lin
- Cardiovascular Research Center; Faculty of Medicine; National Yang-Ming University; Taipei Taiwan
- Department of Medicine; Faculty of Medicine; National Yang-Ming University; Taipei Taiwan
- Department of Medical Reserarch; Taipei Veterans General Hospital; Taipei Taiwan
| | - Fu-Tien Chiang
- Department of Laboratory Medicine; National Taiwan University Hospital; Taipei Taiwan
| | - Chen-Huan Chen
- Department of Medical Education; Taipei Veterans General Hospital; Taipei Taiwan
- Cardiovascular Research Center; Faculty of Medicine; National Yang-Ming University; Taipei Taiwan
- Department of Medicine; Faculty of Medicine; National Yang-Ming University; Taipei Taiwan
- Department of Public Health; Faculty of Medicine; National Yang-Ming University; Taipei Taiwan
| | - Wen-Chung Yu
- Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- Cardiovascular Research Center; Faculty of Medicine; National Yang-Ming University; Taipei Taiwan
- Department of Medicine; Faculty of Medicine; National Yang-Ming University; Taipei Taiwan
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41
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Determinants of pulse pressure and annual rates of change in the Atherosclerosis Risk in Communities study. J Hypertens 2015; 33:2463-70. [DOI: 10.1097/hjh.0000000000000731] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Takata M, Amiya E, Watanabe M, Yamada N, Watanabe A, Kawarasaki S, Ozeki A, Nakao T, Hosoya Y, Ando J, Komuro I. The association between orthostatic increase in pulse pressure and ischemic heart disease. Clin Exp Hypertens 2015; 38:23-9. [PMID: 26287795 DOI: 10.3109/10641963.2015.1047948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The clinical meaning of changes in PP with posture remains unclear. We performed treadmill exercise testing on 144 subjects to diagnose ischemic heart disease, and measured the PPs in the supine and standing positions. The differences in the two PPs ranged between -35 and 45 mmHg. Eleven subjects were diagnosed with significant coronary ischemia. The differences in the PPs were significantly increased, and PP in the standing position was significantly elevated in these subjects. A large difference in the PPs in the standing and supine positions was associated with significant coronary ischemia, independent of significant covariables.
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Affiliation(s)
- Munenori Takata
- a Department of Cardiovascular Medicine , Graduate School of Medicine, The University of Tokyo , Tokyo , Japan .,b Department of Clinical Research Support Center , The University of Tokyo Hospital , Tokyo , Japan
| | - Eisuke Amiya
- a Department of Cardiovascular Medicine , Graduate School of Medicine, The University of Tokyo , Tokyo , Japan
| | - Masafumi Watanabe
- a Department of Cardiovascular Medicine , Graduate School of Medicine, The University of Tokyo , Tokyo , Japan
| | - Namie Yamada
- c General Education Center, The University of Tokyo Hospital , Tokyo , Japan , and
| | - Aya Watanabe
- a Department of Cardiovascular Medicine , Graduate School of Medicine, The University of Tokyo , Tokyo , Japan
| | - Shuichi Kawarasaki
- a Department of Cardiovascular Medicine , Graduate School of Medicine, The University of Tokyo , Tokyo , Japan .,b Department of Clinical Research Support Center , The University of Tokyo Hospital , Tokyo , Japan
| | - Atsuko Ozeki
- a Department of Cardiovascular Medicine , Graduate School of Medicine, The University of Tokyo , Tokyo , Japan
| | - Tomoko Nakao
- d Department of Clinical Laboratory , The University of Tokyo Hospital , Tokyo , Japan
| | - Yumiko Hosoya
- a Department of Cardiovascular Medicine , Graduate School of Medicine, The University of Tokyo , Tokyo , Japan
| | - Jiro Ando
- a Department of Cardiovascular Medicine , Graduate School of Medicine, The University of Tokyo , Tokyo , Japan
| | - Issei Komuro
- a Department of Cardiovascular Medicine , Graduate School of Medicine, The University of Tokyo , Tokyo , Japan
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Santos IS, Alencar AP, Rundek T, Goulart AC, Barreto SM, Pereira AC, Benseñor IM, Lotufo PA. Low Impact of Traditional Risk Factors on Carotid Intima-Media Thickness: The ELSA-Brasil Cohort. Arterioscler Thromb Vasc Biol 2015; 35:2054-9. [PMID: 26183615 DOI: 10.1161/atvbaha.115.305765] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 07/07/2015] [Indexed: 01/13/2023]
Abstract
OBJECTIVE There is little information about how much traditional cardiovascular risk factors explain common carotid artery intima-media thickness (CCA-IMT) variance. We aimed to study to which extent CCA-IMT values are determined by traditional risk factors and which commonly used measurements of blood pressure, glucose metabolism, lipid profile, and adiposity contribute the most to this determination in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort baseline. APPROACH AND RESULTS We analyzed 9792 individuals with complete data and CCA-IMT measurements. We built multiple linear regression models using mean left and right CCA-IMT as the dependent variable. All models were stratified by sex. We also analyzed individuals stratified by 10-year coronary heart disease risk and, in separate, those with no traditional risk factors. Main models' R(2) varied between 0.141 and 0.373. The major part of the explained variance in CCA-IMT was because of age and race. Indicators of blood pressure, lipid profile, and adiposity that most frequently composed the best models were pulse pressure, low-density lipoprotein/high-density lipoprotein ratio, and neck circumference. The association between neck circumference and CCA-IMT persisted significant even after further adjustment for vessel sizes and body mass index. Indicators of glucose metabolism had smaller contribution. CONCLUSIONS We found that >60% of CCA-IMT were not explained by demographic and traditional cardiovascular risk factors, which highlights the need to study novel risk factors. Pulse pressure, low-density lipoprotein/high-density lipoprotein ratio, and neck circumference were the most consistent contributors.
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Affiliation(s)
- Itamar S Santos
- From the Centro de Pesquisa Clínica e Epidemiológica do Hospital Universitário (I.S.S., A.C.G., I.M.B., P.A.L.), Instituto de Matemática e Estatística (A.P.A.), and Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina (A.C.P.), Universidade de São Paulo, São Paulo, Brazil; Department of Neurology, University of Miami Miller School of Medicine, FL (T.R.); and Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (S.M.B.).
| | - Airlane P Alencar
- From the Centro de Pesquisa Clínica e Epidemiológica do Hospital Universitário (I.S.S., A.C.G., I.M.B., P.A.L.), Instituto de Matemática e Estatística (A.P.A.), and Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina (A.C.P.), Universidade de São Paulo, São Paulo, Brazil; Department of Neurology, University of Miami Miller School of Medicine, FL (T.R.); and Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (S.M.B.)
| | - Tatjana Rundek
- From the Centro de Pesquisa Clínica e Epidemiológica do Hospital Universitário (I.S.S., A.C.G., I.M.B., P.A.L.), Instituto de Matemática e Estatística (A.P.A.), and Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina (A.C.P.), Universidade de São Paulo, São Paulo, Brazil; Department of Neurology, University of Miami Miller School of Medicine, FL (T.R.); and Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (S.M.B.)
| | - Alessandra C Goulart
- From the Centro de Pesquisa Clínica e Epidemiológica do Hospital Universitário (I.S.S., A.C.G., I.M.B., P.A.L.), Instituto de Matemática e Estatística (A.P.A.), and Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina (A.C.P.), Universidade de São Paulo, São Paulo, Brazil; Department of Neurology, University of Miami Miller School of Medicine, FL (T.R.); and Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (S.M.B.)
| | - Sandhi M Barreto
- From the Centro de Pesquisa Clínica e Epidemiológica do Hospital Universitário (I.S.S., A.C.G., I.M.B., P.A.L.), Instituto de Matemática e Estatística (A.P.A.), and Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina (A.C.P.), Universidade de São Paulo, São Paulo, Brazil; Department of Neurology, University of Miami Miller School of Medicine, FL (T.R.); and Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (S.M.B.)
| | - Alexandre C Pereira
- From the Centro de Pesquisa Clínica e Epidemiológica do Hospital Universitário (I.S.S., A.C.G., I.M.B., P.A.L.), Instituto de Matemática e Estatística (A.P.A.), and Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina (A.C.P.), Universidade de São Paulo, São Paulo, Brazil; Department of Neurology, University of Miami Miller School of Medicine, FL (T.R.); and Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (S.M.B.)
| | - Isabela M Benseñor
- From the Centro de Pesquisa Clínica e Epidemiológica do Hospital Universitário (I.S.S., A.C.G., I.M.B., P.A.L.), Instituto de Matemática e Estatística (A.P.A.), and Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina (A.C.P.), Universidade de São Paulo, São Paulo, Brazil; Department of Neurology, University of Miami Miller School of Medicine, FL (T.R.); and Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (S.M.B.)
| | - Paulo A Lotufo
- From the Centro de Pesquisa Clínica e Epidemiológica do Hospital Universitário (I.S.S., A.C.G., I.M.B., P.A.L.), Instituto de Matemática e Estatística (A.P.A.), and Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina (A.C.P.), Universidade de São Paulo, São Paulo, Brazil; Department of Neurology, University of Miami Miller School of Medicine, FL (T.R.); and Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (S.M.B.)
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Palit S, Chonchol M, Cheung AK, Kaufman J, Smits G, Kendrick J. Association of BP with Death, Cardiovascular Events, and Progression to Chronic Dialysis in Patients with Advanced Kidney Disease. Clin J Am Soc Nephrol 2015; 10:934-40. [PMID: 25979975 DOI: 10.2215/cjn.08620814] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 02/24/2015] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND OBJECTIVE The optimal BP target to reduce adverse clinical outcomes in patients with CKD is unclear. This study examined the relationship between BP and death, cardiovascular events (CVEs), and kidney disease progression in patients with advanced kidney disease. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS The relationship of systolic BP (SBP), diastolic BP (DBP), and pulse pressure (PP) with death, CVE, and progression to long-term dialysis was examined in 1099 patients with advanced CKD (eGFR≤30 ml/min per 1.7 3m(2); not receiving dialysis) who participated in the Homocysteine in Kidney and ESRD study. That study enrolled participants from 2001 to 2003. Cox proportional hazard models were used to examine the association between BP and adverse outcomes. RESULTS The mean±SD baseline eGFR was 18±7 ml/min per 1.73 m(2). During a median follow-up of 2.9 years, 453 patients died, 215 had a CVE, and 615 initiated long-term dialysis. After adjustment for demographic characteristics and confounders, SBP, DBP, and PP were not associated with a higher risk of death. SBP and DBP were also not associated with CVE. The highest quartile of PP was associated with a substantial higher risk of CVE compared with the lowest quartile (hazard ratio [HR], 1.67; 95% confidence interval [95% CI], 1.10 to 2.52). The highest quartiles of SBP (HR, 1.28; 95% CI, 1.01 to 1.61) and DBP (HR, 1.36; 95% CI, 1.07 to 1.73), but not PP, were associated with a higher risk of progression to long-term dialysis compared with the lowest quartile. CONCLUSIONS In patients with advanced kidney disease not undergoing dialysis, higher PP was strongly associated with CVE whereas higher SBP and DBP were associated with progression to long-term dialysis. These results suggest that SBP and DBP should not be the only factors considered in determining antihypertensive therapy; elevated PP should also be considered.
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Affiliation(s)
- Shyamal Palit
- Division of Renal Diseases and Hypertension, University of Colorado School of Medicine, Aurora, Colorado
| | - Michel Chonchol
- Division of Renal Diseases and Hypertension, University of Colorado School of Medicine, Aurora, Colorado
| | - Alfred K Cheung
- Division of Nephrology & Hypertension, University of Utah, Salt Lake City, Utah; Renal Section, Medical Service, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah; and
| | - James Kaufman
- Research Service, Veterans Affairs New York Harbor Healthcare System and Department of Medicine, New York University School of Medicine, New York, New York
| | - Gerard Smits
- Division of Renal Diseases and Hypertension, University of Colorado School of Medicine, Aurora, Colorado
| | - Jessica Kendrick
- Division of Renal Diseases and Hypertension, University of Colorado School of Medicine, Aurora, Colorado;
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Theilade S, Claggett B, Hansen TW, Skali H, Lewis EF, Solomon SD, Parving HH, Pfeffer M, McMurray JJ, Rossing P. Pulse pressure is not an independent predictor of outcome in type 2 diabetes patients with chronic kidney disease and anemia--the Trial to Reduce Cardiovascular Events with Aranesp Therapy (TREAT). J Hum Hypertens 2015; 30:46-52. [PMID: 25810068 DOI: 10.1038/jhh.2015.22] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 01/26/2015] [Accepted: 02/17/2015] [Indexed: 01/20/2023]
Abstract
Pulse pressure (PP) remains an elusive cardiovascular risk factor with inconsistent findings. We clarified the prognostic value in patients with type 2 diabetes, chronic kidney disease (CKD) and anemia in the Trial to Reduce cardiovascular Events with Aranesp (darbepoetin alfa) Therapy. In 4038 type 2 diabetes patients, darbepoetin alfa treatment did not affect the primary outcome. Risk related to PP at randomization was evaluated in a multivariable model including age, gender, kidney function, cardiovascular disease (CVD) and other conventional risk factors. End points were myocardial infarction (MI), stroke, end stage renal disease (ESRD) and the composite of cardiovascular death, MI or hospitalization for myocardial ischemia, heart failure or stroke (CVD composite). Median (interquartile range) age, gender, eGFR and PP was 68 (60-75) years, 57.3% women, 33 (27-42) ml min(-1) per 1.73 m2 and 60 (50-74) mm Hg. During 29.1 months (median) follow-up, the number of events for composite CVD, MI, stroke and ESRD was 1010, 253, 154 and 668. In unadjusted analyses, higher quartiles of PP were associated with higher rates per 100 years of follow-up of all end points (P⩽0.04), except stroke (P=0.52). Adjusted hazard ratios (95% confidence interval) per one quartile increase in PP were 1.06 (0.99-1.26) for MI, 0.96 (0.83-1.11) for stroke, 1.01 (0.94-1.09) for ESRD and 1.01 (0.96-1.07) for CVD composite. Results were similar in continuous analyses of PP (per 10 mm Hg). In patients with type 2 diabetes, CKD and anemia, PP did not independently predict cardiovascular events or ESRD. This may reflect confounding by aggressive antihypertensive treatment, or PP may be too rough a risk marker in these high-risk patients.
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Affiliation(s)
- S Theilade
- Steno Diabetes Center, Gentofte, Denmark
| | - B Claggett
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Division of Cardiovascular Medicine, Brigham Women's Hospital, Boston, MA, USA
| | - T W Hansen
- Steno Diabetes Center, Gentofte, Denmark
| | - H Skali
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Division of Cardiovascular Medicine, Brigham Women's Hospital, Boston, MA, USA
| | - E F Lewis
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Division of Cardiovascular Medicine, Brigham Women's Hospital, Boston, MA, USA
| | - S D Solomon
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Division of Cardiovascular Medicine, Brigham Women's Hospital, Boston, MA, USA
| | - H-H Parving
- Department of Medical Endocrinology, Rigshospitalet, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Faculty of Health Sciences, Aarhus University, Aarhus, Denmark
| | - M Pfeffer
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Division of Cardiovascular Medicine, Brigham Women's Hospital, Boston, MA, USA
| | - J J McMurray
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - P Rossing
- Steno Diabetes Center, Gentofte, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Faculty of Health Sciences, Aarhus University, Aarhus, Denmark
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Relationship between sum of the four limbs' pulse pressure and brachial-ankle pulse wave velocity and atherosclerosis risk factors in Chinese adults. BIOMED RESEARCH INTERNATIONAL 2015; 2015:434516. [PMID: 25695080 PMCID: PMC4324739 DOI: 10.1155/2015/434516] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Accepted: 10/14/2014] [Indexed: 11/18/2022]
Abstract
The aim of the present study was to analyze the relationship between the sum of the four limbs' pulse pressure (Sum-PP) and brachial-ankle pulse wave velocity (baPWV) and atherosclerosis risk factors and evaluate the feasibility of Sum-PP in diagnosing atherosclerosis systemically. For the purpose, a cross-sectional study was conducted on the basis of medical information of 20748 adults who had a health examination in our hospital. Both Sum-PP and baPWV exhibited significant variations among different human populations grouped by gender, smoking, drinking, and age. Interestingly, Sum-PP had similar varying tendency with baPWV in different populations. And further study in different populations showed that Sum-PP was significantly positively related to baPWV. We also investigated the relationship between Sum-PP, baPWV, and cardiovascular risk factors, respectively. We found that both Sum-PP and baPWV had significant positive correlation with atherosclerosis risk factors while both of them were negatively related to HDL-c. In addition, there was a significant close correlation between Sum-PP and baPWV in the whole population (r = 0.4616, P < 0.0001). Thus, Sum-PP is closely related to baPWV and is of important value for clinical diagnosis of atherosclerosis.
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Miedel C, Leander K, de Faire U, Gigante B. Pulse pressure is not an independent predictor of incident atrial fibrillation in 60-year-old men and women. Ann Med 2015; 47:679-86. [PMID: 26555440 DOI: 10.3109/07853890.2015.1100321] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIM To evaluate if pulse pressure (PP) is a risk predictor for atrial fibrillation (AF) in a longitudinal study of 60-year-old men and women from Stockholm (n = 4,232), free from AF at baseline, with primary end-point incident AF. METHODS AF diagnoses were obtained from the national hospital discharge register. The estimated risk of AF associated with increasing PP values was calculated according to PP values above median (>52.5 mmHg) and according to 1-SD increase (14 mmHg) in PP, using a crude and an adjusted Cox proportional hazard regression model. RESULTS During a mean follow-up of 13.6 years, 286 incident AF cases were recorded. The number of AF cases increased significantly with increasing PP quartile in men but not in women. PP values above median were associated with increased AF risk (crude HR 1.63, 95% CI 1.28-2.06; p < 0.001), but risk estimates were attenuated after adjustment for common AF risk factors. When PP was entered in the Cox regression model as a continuous variable, the risk of AF did not change by 1-SD PP increase (adjusted HR 1.04, 95% CI 0.91-1.20; p = 0.560). CONCLUSIONS PP seems not to be associated with incident AF in a Swedish population of 60-year-old men and women.
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Affiliation(s)
- Charlotte Miedel
- a Unit of Cardiovascular Epidemiology , Institute of Environmental Medicine, Karolinska Institutet , Stockholm , Sweden
| | - Karin Leander
- a Unit of Cardiovascular Epidemiology , Institute of Environmental Medicine, Karolinska Institutet , Stockholm , Sweden
| | - Ulf de Faire
- a Unit of Cardiovascular Epidemiology , Institute of Environmental Medicine, Karolinska Institutet , Stockholm , Sweden.,b Department of Cardiology , Karolinska University Hospital , Stockholm , Sweden
| | - Bruna Gigante
- a Unit of Cardiovascular Epidemiology , Institute of Environmental Medicine, Karolinska Institutet , Stockholm , Sweden.,c Division of Cardiovascular Medicine, Department of Clinical Sciences , Danderyd's Hospital Karolinska Institutet , Stockholm , Sweden
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Ayyagari R, Vekeman F, Lefebvre P, Ong SH, Faust E, Trahey A, Machnicki G, Duh MS. Pulse pressure and stroke risk: development and validation of a new stroke risk model. Curr Med Res Opin 2014; 30:2453-60. [PMID: 25265131 DOI: 10.1185/03007995.2014.971357] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This study aims to develop and validate a stroke risk model incorporating pulse pressure (PP) as a potential risk factor. Recent evidence suggests that PP, defined as the difference between systolic blood pressure (SBP) and diastolic blood pressure (DBP), could be an incremental risk factor beyond SBP. METHODS Electronic health records (EHRs) of hypertensive patients from a US integrated health delivery system were analyzed (January 2004 to May 2012). Patients with ≥ 1 PP reading and ≥ 6 months of observation prior to the first diagnosis of hypertension were randomly split into development (two-thirds of sample) and validation (one-third of sample) datasets. Stroke events were identified using ICD-9-CM 433.xx-436.xx. Cox proportional hazards models assessed time to first stroke event within 3 years of first hypertension diagnosis based on baseline risk factors, including PP, age, gender, diabetes, and cardiac comorbidities. The optimal model was selected using the least absolute shrinkage and selection operator (LASSO); performance was evaluated by the c-statistic. RESULTS Among 34,797 patients selected (mean age 59.3 years, 48% male), 4272 patients (12.3%) had a stroke. PP was higher among patients who developed stroke (mean [SD] PP, stroke: 02.0 [15.3] mmHg; non-stroke: 58.1 [14.0] mmHg, p < 0.001). The best performing risk model (c-statistic, development: 0.730; validation: 0.729) included PP (hazard ratio per mmHg increase: 1.0037, p < 0.001) as a significant risk factor. LIMITATIONS This study was subject to limitations similar to other studies using EHRs. Only patient encounters occurring within the single healthcare network were captured in the data source. Though the model was tested internally, external validation (using a separate data source) would help assess the model's generalizability and calibration. CONCLUSIONS This stroke risk model shows that greater PP is a significant predictive factor for increased stroke risk, even in the presence of known risk factors. PP should be considered by practitioners along with established risk factors in stroke treatment strategies.
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Värri M, Tuomainen TP, Honkanen R, Rikkonen T, Niskanen L, Kröger H, Tuppurainen MT. Carotid intima-media thickness and calcification in relation to bone mineral density in postmenopausal women—The OSTPRE-BBA study. Maturitas 2014; 78:304-9. [DOI: 10.1016/j.maturitas.2014.05.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Revised: 05/17/2014] [Accepted: 05/21/2014] [Indexed: 10/25/2022]
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Xu J, Zhou Y, Cao K, Li J, Tao X, Zhang Z, Liu X, Liu J, Su H. Excessive pulse pressure response to standing in community population with orthostatic systolic hypertension. ACTA ACUST UNITED AC 2013; 8:166-70. [PMID: 24629401 DOI: 10.1016/j.jash.2013.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 10/14/2013] [Accepted: 12/01/2013] [Indexed: 10/25/2022]
Abstract
The postural change of pulse pressure (PP) in the persons with orthostatic hypertension (OHT) is unclear. This study included 2849 (65.0 ± 9.3 years) community participants. Blood pressures (BPs) in supine and standing positions were measured. The differences between upright and supine BP and PP were recorded as ΔBP and ΔPP. The criteria for OHT was ΔBP ≥10 mm Hg, for orthostatic hypotension (OH) was ≤-10 mm Hg and for orthostatic normotension (ONT) was -9 to 9 mm Hg. Fasting blood lipids and glucose were measured. The supine SBP of the sOHT group were similar to that of sONT group (140.9 ± 20.2 mm Hg vs 138.2 ± 19.7 mm Hg), but significantly lower than that of sOH group (151.9 ± 19.2 mm Hg; P < .05). Their PPs were 65.3 ± 15.9, 62.8 ± 14.7, and 71.1 ± 15.1 mm Hg, respectively, and with the similar group difference like SBP. When the position changed from supine to standing, the sOHT group showed PP rise, while sOH and sONT groups showed PP reduction (3.8 ± 7.1 mm Hg vs -17.0 ± 8.5 mm Hg and -5.8 ± 6.6 mm Hg; both P < .05). Thus, the standing PP in the sOHT group was significantly higher than in the sONT (69.1 ± 18.0 mm Hg vs 57.0 ± 15.8 mm Hg; P < .05) and in the sOH (54.2 ± 15.2 mm Hg; P < .05) groups. The postural PP profile varies with the postural responses of SBP. The sOHT group has obviously increased PP and significantly higher standing PP compared with the sONT group.
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Affiliation(s)
- Jingsong Xu
- Research Institute of Cardiovascular Diseases and Department of Cardiology, Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Yueying Zhou
- Department of Medicine, Guizhou Hospital of Fushan city, Fushan, Guangdong, People's Republic of China
| | - Kaiwu Cao
- Research Institute of Cardiovascular Diseases and Department of Cardiology, Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Juxiang Li
- Research Institute of Cardiovascular Diseases and Department of Cardiology, Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Xuehua Tao
- Department of Medicine, Sixth Hospital of Nanchang city, Nanchang, Jiangxi, People's Republic of China
| | - Zhihong Zhang
- Research Institute of Cardiovascular Diseases and Department of Cardiology, Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China; Statistic Teaching Group, Fuzhou Medical College of Nanchang University, Fuzhou, Jiangxi, China
| | - Xin Liu
- Statistic Teaching Group, Fuzhou Medical College of Nanchang University, Fuzhou, Jiangxi, China
| | - Jiaqi Liu
- Department of Medicine, Guizhou Hospital of Fushan city, Fushan, Guangdong, People's Republic of China
| | - Hai Su
- Research Institute of Cardiovascular Diseases and Department of Cardiology, Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China.
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