1
|
Huang QF, An DW, Aparicio LS, Cheng YB, Wei FF, Yu YL, Sheng CS, Yang WY, Niiranen TJ, Boggia J, Stolarz-Skrzypek K, Tikhonoff V, Gilis-Malinowska N, Wojciechowska W, Casiglia E, Narkiewicz K, Filipovský J, Kawecka-Jaszcz K, Nawrot TS, Wang JG, Li Y, Staessen JA. An outcome-driven threshold for pulse pressure amplification. Hypertens Res 2024; 47:2478-2488. [PMID: 39039284 PMCID: PMC11374666 DOI: 10.1038/s41440-024-01779-4] [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] [Received: 02/06/2024] [Revised: 05/20/2024] [Accepted: 06/08/2024] [Indexed: 07/24/2024]
Abstract
Pulse pressure amplification (PPA) is the brachial-to-aortic pulse pressure ratio and decreases with age and cardiovascular risk factors. This individual-participant meta-analysis of population studies aimed to define an outcome-driven threshold for PPA. Incidence rates and standardized multivariable-adjusted hazard ratios (HRs) of cardiovascular and coronary endpoints associated with PPA, as assessed by the SphygmoCor software, were evaluated in the International Database of Central Arterial Properties for Risk Stratification (n = 5608). Model refinement was assessed by the integrated discrimination (IDI) and net reclassification (NRI) improvement. Age ranged from 30 to 96 years (median 53.6). Over 4.1 years (median), 255 and 109 participants experienced a cardiovascular or coronary endpoint. In a randomly defined discovery subset of 3945 individuals, the rounded risk-carrying PPA thresholds converged at 1.3. The HRs for cardiovascular and coronary endpoints contrasting PPA < 1.3 vs ≥1.3 were 1.54 (95% confidence interval [CI]: 1.00-2.36) and 2.45 (CI: 1.20-5.01), respectively. Models were well calibrated, findings were replicated in the remaining 1663 individuals analyzed as test dataset, and NRI was significant for both endpoints. The HRs associating cardiovascular and coronary endpoints per PPA threshold in individuals <60 vs ≥60 years were 3.86 vs 1.19 and 6.21 vs 1.77, respectively. The proportion of high-risk women (PPA < 1.3) was higher at younger age (<60 vs ≥60 years: 67.7% vs 61.5%; P < 0.001). In conclusion, over and beyond common risk factors, a brachial-to-central PP ratio of <1.3 is a forerunner of cardiovascular coronary complications and is an underestimated risk factor in women aged 30-60 years. Our study supports pulse wave analysis for risk stratification.
Collapse
Affiliation(s)
- Qi-Fang Huang
- Department of Cardiovascular Medicine, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - De-Wei An
- Department of Cardiovascular Medicine, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Non-Profit Research Association Alliance for the Promotion of Preventive Medicine, Mechelen, Belgium
- Research Unit Environment and Health, Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium
| | - Lucas S Aparicio
- Servicio de Clínica Médica, Sección Hipertensión Arterial, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Yi-Bang Cheng
- Department of Cardiovascular Medicine, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Fang-Fei Wei
- Non-Profit Research Association Alliance for the Promotion of Preventive Medicine, Mechelen, Belgium
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Yu-Ling Yu
- Non-Profit Research Association Alliance for the Promotion of Preventive Medicine, Mechelen, Belgium
- Research Unit Environment and Health, Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium
| | - Chang-Sheng Sheng
- Department of Cardiovascular Medicine, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wen-Yi Yang
- Department of Cardiology, Shanghai General Hospital, Shanghai, China
| | - Teemu J Niiranen
- Department of Chronic Disease Prevention, Department of Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - José Boggia
- Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - Katarzyna Stolarz-Skrzypek
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | | | - Natasza Gilis-Malinowska
- Hypertension Unit, Department of Hypertension and Diabetology, Medical University of Gdańsk, Gdańsk, Poland
| | - Wiktoria Wojciechowska
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | | | - Krzysztof Narkiewicz
- Hypertension Unit, Department of Hypertension and Diabetology, Medical University of Gdańsk, Gdańsk, Poland
| | - Jan Filipovský
- Faculty of Medicine, Charles University, Pilsen, Czech Republic
| | - Kalina Kawecka-Jaszcz
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Tim S Nawrot
- Research Unit Environment and Health, Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium
| | - Ji-Guang Wang
- Department of Cardiovascular Medicine, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yan Li
- Department of Cardiovascular Medicine, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
| | - Jan A Staessen
- Department of Cardiovascular Medicine, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
- Non-Profit Research Association Alliance for the Promotion of Preventive Medicine, Mechelen, Belgium.
- Biomedical Sciences Group, Faculty of Medicine, University of Leuven, Leuven, Belgium.
| |
Collapse
|
2
|
Rajagopalan S, Dobre M, Dazard JE, Vergara-Martel A, Connelly K, Farkouh ME, Gaztanaga J, Conger H, Dever A, Razavi-Nematollahi L, Fares A, Pereira G, Edwards-Glenn J, Cameron M, Cameron C, Al-Kindi S, Brook RD, Pitt B, Weir M. Mineralocorticoid Receptor Antagonism Prevents Aortic Plaque Progression and Reduces Left Ventricular Mass and Fibrosis in Patients With Type 2 Diabetes and Chronic Kidney Disease: The MAGMA Trial. Circulation 2024; 150:663-676. [PMID: 39129649 DOI: 10.1161/circulationaha.123.067620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 06/12/2024] [Indexed: 08/13/2024]
Abstract
BACKGROUND Persistent mineralocorticoid receptor activation is a pathologic response in type 2 diabetes and chronic kidney disease. Whereas mineralocorticoid receptor antagonists are beneficial in reducing cardiovascular complications, direct mechanistic pathways for these effects in humans are lacking. METHODS The MAGMA trial (Mineralocorticoid Receptor Antagonism Clinical Evaluation in Atherosclerosis) was a randomized, double-blind, placebo-controlled trial in patients with high-risk type 2 diabetes with chronic kidney disease (not receiving dialysis) on maximum tolerated renin-angiotensin system blockade. The primary end point was change in thoracic aortic wall volume, expressed as absolute or percent value (ΔTWV or ΔPWV), using 3T magnetic resonance imaging at 12 months. Secondary end points were changes in left ventricle (LV) mass; LV fibrosis, measured as a change in myocardial native T1; and 24-hour ambulatory and central aortic blood pressures. Tertiary end points included plasma proteomic changes in 7596 plasma proteins using an aptamer-based assay. RESULTS A total of 79 patients were randomized to placebo (n=42) or 25 mg of spironolactone daily (n=37). After a modified intent-to-treat, including available baseline data of study end points, patients who completed the trial protocol were included in the final analyses. At the 12-month follow-up, the average change in PWV was 7.1±10.7% in the placebo group and 0.87±10.0% in the spironolactone group (P=0.028), and ΔTWV was 1.2±1.7 cm3 in the placebo group and 0.037±1.9 cm3 in the spironolactone group (P=0.022). Change in LV mass was 3.1±8.4 g in the placebo group and -5.8±8.4 g in the spironolactone group (P=0.001). Changes in LV T1 values were significantly different between the placebo and spironolactone groups (26.0±41.9 ms in the placebo group versus a decrease of -10.1±36.3 ms in the spironolactone group; P=6.33×10-4). Mediation analysis revealed that the spironolactone effect on thoracic aortic wall volume and myocardial mass remained significant after adjustment for ambulatory and central blood pressures. Proteomic analysis revealed a dominant effect of spironolactone on pathways involving oxidative stress, inflammation, and leukocyte activation. CONCLUSIONS Among patients with diabetes with moderate to severe chronic kidney disease at elevated cardiovascular risk, treatment with spironolactone prevented progression of aortic wall volume and resulted in regression of LV mass and favorable alterations in native T1, suggesting amelioration of left-ventricular fibrosis. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT02169089.
Collapse
Affiliation(s)
- Sanjay Rajagopalan
- University Hospitals (S.R., M.D., J.-E.D., A.V.-M., H.C., A.D., L.R.-N., A.F., G.P.), Cleveland, OH
- Case Western Reserve University (S.R., M.D., J.-E.D., A.V.-M., L.R.-N., J.E.-G., M.C., C.C.), Cleveland, OH
| | - Mirela Dobre
- University Hospitals (S.R., M.D., J.-E.D., A.V.-M., H.C., A.D., L.R.-N., A.F., G.P.), Cleveland, OH
- Case Western Reserve University (S.R., M.D., J.-E.D., A.V.-M., L.R.-N., J.E.-G., M.C., C.C.), Cleveland, OH
| | - Jean-Eudes Dazard
- University Hospitals (S.R., M.D., J.-E.D., A.V.-M., H.C., A.D., L.R.-N., A.F., G.P.), Cleveland, OH
| | - Armando Vergara-Martel
- University Hospitals (S.R., M.D., J.-E.D., A.V.-M., H.C., A.D., L.R.-N., A.F., G.P.), Cleveland, OH
- Case Western Reserve University (S.R., M.D., J.-E.D., A.V.-M., L.R.-N., J.E.-G., M.C., C.C.), Cleveland, OH
| | - Kim Connelly
- St Michael's Hospital, University of Toronto, Canada (K.C.)
| | | | - Juan Gaztanaga
- New York University Langone Health School of Medicine, Winthrop, Mineola (J.G.)
| | - Heather Conger
- University Hospitals (S.R., M.D., J.-E.D., A.V.-M., H.C., A.D., L.R.-N., A.F., G.P.), Cleveland, OH
| | - Ann Dever
- University Hospitals (S.R., M.D., J.-E.D., A.V.-M., H.C., A.D., L.R.-N., A.F., G.P.), Cleveland, OH
| | - Laleh Razavi-Nematollahi
- University Hospitals (S.R., M.D., J.-E.D., A.V.-M., H.C., A.D., L.R.-N., A.F., G.P.), Cleveland, OH
- Case Western Reserve University (S.R., M.D., J.-E.D., A.V.-M., L.R.-N., J.E.-G., M.C., C.C.), Cleveland, OH
| | - Anas Fares
- University Hospitals (S.R., M.D., J.-E.D., A.V.-M., H.C., A.D., L.R.-N., A.F., G.P.), Cleveland, OH
| | - Gabriel Pereira
- University Hospitals (S.R., M.D., J.-E.D., A.V.-M., H.C., A.D., L.R.-N., A.F., G.P.), Cleveland, OH
| | - Jonnelle Edwards-Glenn
- Case Western Reserve University (S.R., M.D., J.-E.D., A.V.-M., L.R.-N., J.E.-G., M.C., C.C.), Cleveland, OH
| | - Mark Cameron
- Case Western Reserve University (S.R., M.D., J.-E.D., A.V.-M., L.R.-N., J.E.-G., M.C., C.C.), Cleveland, OH
| | - Cheryl Cameron
- Case Western Reserve University (S.R., M.D., J.-E.D., A.V.-M., L.R.-N., J.E.-G., M.C., C.C.), Cleveland, OH
| | - Sadeer Al-Kindi
- Debakey Heart and Vascular Center Houston Methodist Hospital, TX (S.A.-K.)
| | - Robert D Brook
- University of Michigan Frankel Cardiovascular Center, Ann Arbor (R.D.B.)
| | | | - Matthew Weir
- Division of Nephrology, University of Maryland Medical Center, Baltimore (M.W.)
| |
Collapse
|
3
|
Chen C, Zhu Y, Liu L, Ke J, Yu W, Song Q, Li M, Tang Y, Wang C. Associations of 24-Hour Central Systolic Blood Pressure With Multiorgan Damage in Nondialysis Patients With Chronic Kidney Disease. J Am Heart Assoc 2024; 13:e034469. [PMID: 39158576 DOI: 10.1161/jaha.124.034469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 07/25/2024] [Indexed: 08/20/2024]
Abstract
BACKGROUND Multiple target-organ damages (TODs) in the same patient are common and further increase the risk of cardiovascular disease. However, the relationship between ambulatory central systolic blood pressure (SBP) and multiple TODs has yet to be explored. METHODS AND RESULTS MobilO-Graph PWA was used to monitor the participants' ambulatory blood pressure, and the presence of left ventricular hypertrophy, carotid hypertrophy, and kidney injury were used to define TOD. Logistic regression analyses and receiver operating characteristic analyses were used to explore the correlation between SBP and TOD. Overall, 2018 nondialysis patients with chronic kidney disease were included and 580 (28.74%) had multiple TODs. Twenty-four-hour central SBP with c2 calibration exhibited a stronger correlation with the increasing number of TOD compared with 24-hour brachial SBP in ordinal logistic regression analyses. In the multivariable analyses with the presence of multiple TODs, the odds ratios were 1.786 (95% CI, 1.474-2.165; P<0.001) for 24-hour brachial SBP and 1.949 (95% CI, 1.605-2.366; P<0.001) for 24-hour central SBP with c2 calibration. The receiver operating characteristic analyses also showed that 24-hour central SBP with c2 calibration had higher discrimination than 24-hour brachial SBP regarding multiple TODs (P<0.001). In addition, using 130/135 mm Hg as the threshold for 24-hour brachial SBP/central SBP with c2 calibration to cross-classify, the prevalence of multiple TODs was greater in cases of concordant hypertension compared with cases of isolated brachial hypertension and concordant normotension, with no difference between the latter 2 conditions. CONCLUSIONS Twenty-four-hour central SBP with c2 calibration was more associated with the presence of multiple TODs compared with 24-hour brachial SBP and was helpful in risk classification of multiple TODs among nondialysis patients with chronic kidney disease.
Collapse
Affiliation(s)
- Cheng Chen
- Division of Nephrology Department of Medicine The Fifth Affiliated Hospital Sun Yat-Sen University Guangdong China
| | - Ye Zhu
- Division of Nephrology Department of Medicine The Fifth Affiliated Hospital Sun Yat-Sen University Guangdong China
| | - Lingling Liu
- Division of Nephrology Department of Medicine The Fifth Affiliated Hospital Sun Yat-Sen University Guangdong China
| | - Jianting Ke
- Division of Nephrology Department of Medicine The Fifth Affiliated Hospital Sun Yat-Sen University Guangdong China
| | - Wenjuan Yu
- Division of Nephrology Department of Medicine The Third Affiliated Hospital of Southern Medical University Guangzhou Guangdong China
| | - Qirong Song
- Division of Nephrology Department of Medicine The Third Affiliated Hospital of Southern Medical University Guangzhou Guangdong China
| | - Man Li
- Guangdong Provincial Key Laboratory of Biomedical Imaging The Fifth Affiliated Hospital Sun Yat-Sen University Guangdong China
| | - Ying Tang
- Division of Nephrology Department of Medicine The Third Affiliated Hospital of Southern Medical University Guangzhou Guangdong China
| | - Cheng Wang
- Division of Nephrology Department of Medicine The Fifth Affiliated Hospital Sun Yat-Sen University Guangdong China
- Guangdong Provincial Key Laboratory of Biomedical Imaging The Fifth Affiliated Hospital Sun Yat-Sen University Guangdong China
| |
Collapse
|
4
|
Martin ZT, Fields ND, Erving CL, Udaipuria S, Moore RH, Blevins KM, Murden RJ, Booker B, Culler L, Swanson S, Goodson J, Barinas-Mitchell E, Quyyumi AA, Vaccarino V, Lewis TT. Central Hemodynamics in African American Women: Examining the Role of Superwoman Schema Endorsement. J Am Heart Assoc 2024:e033587. [PMID: 39149994 DOI: 10.1161/jaha.123.033587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 04/19/2024] [Indexed: 08/17/2024]
Abstract
BACKGROUND African American women bear a disproportionate burden of cardiovascular diseases, potentially due to altered central hemodynamics. Racism and sexism often lead to African American women taking on numerous caretaking roles and overall increases their use of the Strong Black Woman (ie, Superwoman) mindset, which may have negative health consequences. We hypothesized that endorsing the Superwoman role and its Obligation to Help Others dimension would be associated with a deleterious central hemodynamics profile in African American women. METHODS AND RESULTS Using cross-sectional data, we examined central systolic blood pressure (mm Hg; n=408), augmentation index (percentage, adjusted for height and heart rate; n=408), and pulse wave velocity (m/s; n=368) in African American women aged 30 to 46 years. The Giscombe Superwoman Schema (SWS) questionnaire assessed endorsement of Overall SWS (range, 0-105) and SWS-Obligation to Help Others (range, 0-3). Multiple linear regression modeled associations between Overall SWS (10-unit increments) and SWS-Obligation to Help Others (1-unit increments) and central hemodynamics while adjusting for pertinent sociodemographic, clinical, and psychosocial factors. In fully adjusted models, central systolic blood pressure was significantly associated with Overall SWS (β=0.83 [95% CI, 0.19-1.47]) and SWS-Obligation to Help Others (β=2.03 [95% CI, 0.39-3.67]). Augmentation index was associated with Overall SWS (β=0.66 [95% CI, 0.02-1.30]) and SWS-Obligation to Help Others (β=2.21 [95% CI, 0.58-3.84]). Significant associations were not observed between pulse wave velocity and SWS. CONCLUSIONS Greater endorsement of the Superwoman role and prioritizing caregiving over self-care were associated with higher central systolic blood pressure and augmentation index, which may contribute to adverse cardiovascular health among African American women.
Collapse
Affiliation(s)
- Zachary T Martin
- Department of Epidemiology, Rollins School of Public Health Emory University Atlanta GA USA
| | - Nicole D Fields
- Department of Epidemiology, Rollins School of Public Health Emory University Atlanta GA USA
- Hubert Department of Global Health, Rollins School of Public Health Emory University Atlanta GA USA
| | - Christy L Erving
- Department of Sociology, College of Liberal Arts The University of Texas at Austin Austin TX USA
| | - Shivika Udaipuria
- Department of Epidemiology, Rollins School of Public Health Emory University Atlanta GA USA
| | - Reneé H Moore
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health Drexel University Philadelphia PA USA
| | - Kennedy M Blevins
- Department of Psychological Science, School of Social Ecology University of California, Irvine Irvine CA USA
| | - Raphiel J Murden
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health Emory University Atlanta GA USA
| | - Bianca Booker
- Department of Epidemiology, Rollins School of Public Health Emory University Atlanta GA USA
| | - LaKeia Culler
- Department of Epidemiology, Rollins School of Public Health Emory University Atlanta GA USA
| | - Seegar Swanson
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health Emory University Atlanta GA USA
| | - Jaylah Goodson
- Department of Epidemiology, Rollins School of Public Health Emory University Atlanta GA USA
| | - Emma Barinas-Mitchell
- Department of Epidemiology, School of Public Health University of Pittsburgh Pittsburgh PA USA
| | - Arshed A Quyyumi
- Department of Medicine, School of Medicine Emory University Atlanta GA USA
| | - Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health Emory University Atlanta GA USA
- Department of Medicine, School of Medicine Emory University Atlanta GA USA
| | - Tené T Lewis
- Department of Epidemiology, Rollins School of Public Health Emory University Atlanta GA USA
| |
Collapse
|
5
|
Wu Z, Heffernan KS. Central blood pressure and peripheral augmentation index following acute submaximal arm versus leg exercise. Eur J Appl Physiol 2024:10.1007/s00421-024-05573-5. [PMID: 39133269 DOI: 10.1007/s00421-024-05573-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 08/06/2024] [Indexed: 08/13/2024]
Abstract
BACKGROUND Aerobic exercises like running and cycling may lower cardiovascular disease (CVD) risk through favorable effects on central blood pressure and vascular function. Arm ergometry is a popular exercise modality used in rehabilitation settings, but little is known regarding the central hemodynamic and vascular effects of this form of exercise. PURPOSE To compare the acute effects of leg versus arm exercise on central blood pressure and vascular function. METHODS Twenty-one participants (n = 11 female, Age 21 ± 3, BMI 24.5 ± 3.2 kg/m2) completed two visits to the Human Performance Laboratory. Central systolic blood pressure (cSBP), central diastolic blood pressure (cDBP), and peripheral augmentation index (pAIx) were measured using a brachial oscillometric blood pressure cuff with measures being taken before and after 20 min of acute moderate-intensity (submaximal) arm or leg cycling exercise. RESULTS There was a condition-by-time interaction for pAIx (p = 0.011). pAIx slightly increased following arm exercise but significantly decreased following leg exercise. There was a condition-by-time interaction for cDBP (p = 0.011). cDBP significantly decreased following arm exercise but increased immediately following leg exercise. There was no condition-by-time interaction for cSBP (p = 0.721). There were similar acute increases in cSBP immediately post-exercise for both conditions. CONCLUSION Arm exercise increased pAlx and decreased cDBP compared to leg exercise. As an increase in pAIx may increase left ventricular work and a reduction in cDBP may reduce coronary perfusion pressure, these findings suggest that a single bout of arm exercise may not have the same favorable acute effect on central hemodynamic load as a single bout of leg exercise.
Collapse
Affiliation(s)
- Zeyi Wu
- Department of Exercise Science, David B. Falk College of Sport and Human Dynamics, Syracuse University, Syracuse, NY, USA
| | - Kevin S Heffernan
- Department of Biobehavioral Sciences, Movement Science & Applied Physiology, Teachers College, Columbia University, 525 W 120th St, Building 528, New York, NY, USA.
| |
Collapse
|
6
|
Fields ND, Martin ZT, Hoggard LS, Erving CL, Udaipuria S, Blevins KM, Parker JE, Goodson J, Murden RJ, Moore RH, Parker R, Culler L, Booker B, Barinas-Mitchell E, Quyyumi A, Vaccarino V, Lewis TT. Does stress from incarceration of family and friends contribute to signs of early vascular ageing in African American women? J Epidemiol Community Health 2024:jech-2024-222227. [PMID: 39122410 DOI: 10.1136/jech-2024-222227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 07/26/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND Early vascular ageing (EVA) contributes to elevated risk of cardiovascular disease (CVD), which disproportionately affects African American women. Incarceration, an event disproportionately impacting African Americans, may be a stressor contributing to EVA in African American women. Further, the subjective perspective, commonly referred to as appraisal, of incarceration may also be important for health. We hypothesised that having family and/or friends incarcerated and appraising the incarceration as upsetting would be associated with indices of EVA. METHODS In a community-based cohort of African American women aged 30-46 living in Atlanta, Georgia (n=391), participants were asked, at baseline, about family and/or friend incarceration and to appraise how upsetting the incarceration was. Multivariable linear regression examined associations between: (1) family and/or friend incarceration and indices of EVA (pulse wave velocity, augmentation index, central systolic blood pressure (SBP) and pulse pressure amplification) and (2) appraisal of incarceration and EVA indices. RESULTS 45% of participants (n=174) reported having a loved one incarcerated, and 59% (n=102) reported the incarceration as upsetting. Having a loved one incarcerated was associated with a higher central SBP (b=4.30; 95% CI 1.61, 6.99) and augmentation index (b=2.29; 95% CI 0.26, 4.33). Appraisal of incarceration was only associated with central SBP. CONCLUSIONS Family or friend incarceration was highly prevalent in this cohort of African American women and associated with indices of EVA. Mass incarceration of others may affect the physical health of African American women which may contribute to CVD disparities.
Collapse
Affiliation(s)
- Nicole D Fields
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Zachary T Martin
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Lori S Hoggard
- Department of Psychology, College of Humanities and Social Sciences, North Carolina State University, Raleigh, NC, USA
| | - Christy L Erving
- Department of Sociology, College of Liberal Arts, The University of Texas at Austin, Austin, Texas, USA
| | - Shivika Udaipuria
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Kennedy M Blevins
- Department of Psychological Science, School of Social Ecology, UC Irvine, Irvine, California, USA
| | - Jordan E Parker
- Department of Psychology, University of California Los Angeles, Los Angeles, California, USA
| | - Jaylah Goodson
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Raphiel J Murden
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Renee H Moore
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Rachel Parker
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - LaKeia Culler
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Bianca Booker
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | | | - Arshed Quyyumi
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Tené T Lewis
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| |
Collapse
|
7
|
Li K, Gao L, Jiang Y, Jia J, Li J, Fan F, Zhang Y, Huo Y. Association of cardiovascular events with central systolic blood pressure: A systemic review and meta-analysis. J Clin Hypertens (Greenwich) 2024; 26:747-756. [PMID: 38884940 PMCID: PMC11232452 DOI: 10.1111/jch.14853] [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: 02/13/2024] [Revised: 05/12/2024] [Accepted: 05/21/2024] [Indexed: 06/18/2024]
Abstract
Central blood pressure confers cardiovascular risk prediction ability, but whether the association between central systolic blood pressure (cSBP) and cardiovascular endpoints is independent of peripheral systolic blood pressure (pSBP) remains controversial. This systematic review and meta-analysis aim to investigate the associations between cSBP and cardiovascular endpoints in models including and excluding pSBP, respectively. Observational studies assessing the risk of composite cardiovascular endpoints with baseline cSBP were searched in PubMed, Embase, Scopus, Web of Science, and Cochrane Library to May 31, 2022. Risk of bias was assessed by the Newcastle-Ottawa Quality Assessment Scale, and random-effects models were used to pool estimates. Finally, 48 200 participants from 19 studies with a mean age of 59.0 ± 6.9 years were included. Per 10 mmHg increase of cSBP was associated with higher risk of composite cardiovascular outcomes (risk ratio [RR]: 1.14 [95%CI 1.08-1.19]) and cardiovascular death (RR: 1.18 [95%CI 1.08-1.30]), and the associations still existed after adjusting for pSBP (RR: 1.13 [95%CI 1.05-1.21] for composite cardiovascular endpoints; RR: 1.25 [95%CI 1.09-1.43] for cardiovascular death). In pSBP-unadjusted studies, increased cSBP was also associated with higher risk of all-cause mortality and stroke, but not in the pSBP-adjusted studies. Both cSBP and pSBP were similarly significantly associated with composite cardiovascular endpoints in models containing them separately and simultaneously. cSBP was significantly associated with cardiovascular events, independently of pSBP. Central or peripheral SBP could supplement cardiovascular risk assessment besides each other.
Collapse
Affiliation(s)
- Kaiyin Li
- Department of CardiologyPeking University First HospitalBeijingChina
| | - Lan Gao
- Department of CardiologyPeking University First HospitalBeijingChina
| | - Yimeng Jiang
- Department of CardiologyPeking University First HospitalBeijingChina
| | - Jia Jia
- Department of CardiologyPeking University First HospitalBeijingChina
- Institute of Cardiovascular DiseasePeking University First HospitalBeijingChina
- Hypertension Precision Diagnosis and Treatment Research CenterPeking University First HospitalBeijingChina
| | - Jianping Li
- Department of CardiologyPeking University First HospitalBeijingChina
- Institute of Cardiovascular DiseasePeking University First HospitalBeijingChina
- Hypertension Precision Diagnosis and Treatment Research CenterPeking University First HospitalBeijingChina
| | - Fangfang Fan
- Department of CardiologyPeking University First HospitalBeijingChina
- Institute of Cardiovascular DiseasePeking University First HospitalBeijingChina
- Hypertension Precision Diagnosis and Treatment Research CenterPeking University First HospitalBeijingChina
| | - Yan Zhang
- Department of CardiologyPeking University First HospitalBeijingChina
- Institute of Cardiovascular DiseasePeking University First HospitalBeijingChina
- Hypertension Precision Diagnosis and Treatment Research CenterPeking University First HospitalBeijingChina
| | - Yong Huo
- Department of CardiologyPeking University First HospitalBeijingChina
| |
Collapse
|
8
|
Nyvad J, Christensen KL, Andersen G, Reinhard M, Maeng M, Nielsen S, Thomsen MB, Jensen JM, Nørgaard BL, Buus NH. Aortic Calcification is Associated With the Difference Between Invasive Central and Cuff-Measured Brachial Blood Pressure in Chronic Kidney Disease. Am J Hypertens 2024; 37:455-464. [PMID: 38477704 DOI: 10.1093/ajh/hpae029] [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: 01/22/2024] [Revised: 03/06/2024] [Accepted: 03/06/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is associated with accelerated vascular calcification and increased central systolic blood pressure when measured invasively (invCSBP) relative to cuff-based brachial systolic blood pressure (cuffSBP). The contribution of aortic wall calcification to this phenomenon has not been clarified. We, therefore, examined the effects of aortic calcification on cuffSBP and invCSBP in a cohort of patients representing all stages of CKD. METHODS During elective coronary angiography, invCSBP was measured in the ascending aorta with a fluid-filled catheter with simultaneous recording of cuffSBP using an oscillometric device. Furthermore, participants underwent a non-contrast computed tomography scan of the entire aorta with observer-blinded calcification scoring of the aortic wall ad modum Agatston. RESULTS We included 168 patients (mean age 67.0 ± 10.5, 38 females) of whom 38 had normal kidney function, while 30, 40, 28, and 32 had CKD stages 3a, 3b, 4, and 5, respectively. Agatston scores adjusted for body surface area ranged from 48 to 40,165. We found that invCSBP increased 3.6 (95% confidence interval 1.4-5.7) mm Hg relative to cuffSBP for every 10,000-increment in aortic Agatston score. This association remained significant after adjustment for age, diabetes, antihypertensive treatment, smoking, eGFR, and BP level. No such association was found for diastolic BP. CONCLUSIONS Patients with advanced aortic calcification have relatively higher invCSBP for the same cuffSBP as compared to patients with less calcification. Advanced aortic calcification in CKD may therefore result in hidden central hypertension despite apparently well-controlled cuffSBP. ClinicalTrials.gov identifier: NCT04114695.
Collapse
Affiliation(s)
- Jakob Nyvad
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Gratien Andersen
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Mark Reinhard
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Michael Maeng
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Sebastian Nielsen
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | | | | | - Niels Henrik Buus
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
9
|
Rocchi M, Papangelopoulou K, Ingram M, Bekhuis Y, Claessen G, Claus P, D'hooge J, Donker DW, Meyns B, Fresiello L. A patient-specific echogenic soft robotic left ventricle embedded into a closed-loop cardiovascular simulator for advanced device testing. APL Bioeng 2024; 8:026114. [PMID: 38812756 PMCID: PMC11136518 DOI: 10.1063/5.0203653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 04/29/2024] [Indexed: 05/31/2024] Open
Abstract
Cardiovascular medical devices undergo a large number of pre- and post-market tests before their approval for clinical practice use. Sophisticated cardiovascular simulators can significantly expedite the evaluation process by providing a safe and controlled environment and representing clinically relevant case scenarios. The complex nature of the cardiovascular system affected by severe pathologies and the inherently intricate patient-device interaction creates a need for high-fidelity test benches able to reproduce intra- and inter-patient variability of disease states. Therefore, we propose an innovative cardiovascular simulator that combines in silico and in vitro modeling techniques with a soft robotic left ventricle. The simulator leverages patient-specific and echogenic soft robotic phantoms used to recreate the intracardiac pressure and volume waveforms, combined with an in silico lumped parameter model of the remaining cardiovascular system. Three different patient-specific profiles were recreated, to assess the capability of the simulator to represent a variety of working conditions and mechanical properties of the left ventricle. The simulator is shown to provide a realistic physiological and anatomical representation thanks to the use of soft robotics combined with in silico modeling. This tool proves valuable for optimizing and validating medical devices and delineating specific indications and boundary conditions.
Collapse
Affiliation(s)
- Maria Rocchi
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | | | - Marcus Ingram
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | | | | | - Piet Claus
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Jan D'hooge
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | | | | | | |
Collapse
|
10
|
Vriend EM, Bouwmeester TA, Franco OH, Galenkamp H, Zwinderman AH, van den Born BJH, Collard D. Sex differences in blood pressure phenotypes over time - the HELIUS study. J Hypertens 2024; 42:977-983. [PMID: 38372386 PMCID: PMC11064915 DOI: 10.1097/hjh.0000000000003676] [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] [Received: 10/16/2023] [Accepted: 01/18/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Hypertension can be classified into different phenotypes according to systolic and diastolic blood pressure (BP). In younger adults, these phenotypical differences have different prognostic value for men and women. However, little is known about sex differences in the natural course of different BP phenotypes over time. METHODS We used baseline and follow-up data from the multiethnic, population-based HELIUS study to assess differences in BP phenotypes over time in men and women aged < 45 years stratified according to baseline office BP into normotension (<140/<90 mmHg), isolated systolic hypertension (ISH, ≥140/<90 mmHg), isolated diastolic hypertension (IDH, <140/≥90 mmHg) or systolic diastolic hypertension (SDH, ≥140/≥90 mmHg). Logistic regression adjusted for age, ethnicity, and follow-up time was used to assess the risk of hypertension at follow-up (BP ≥140/90 mmHg or use of antihypertensive medication), stratified by sex. RESULTS We included 4103 participants [mean age 33.5 years (SD 7.4), 43.4% men] with a median follow-up time of 6.2 years. Compared to normotensive individuals, the age-adjusted odds ratios (OR) for having hypertension at follow-up were 4.78 (95% CI 2.90; 7.76) for ISH, 6.02 (95% CI 3.70; 9.74) for IDH and 33.73 (95% CI 20.35; 58.38) for SDH in men, while in women, OR were 10.08 (95% CI 4.09; 25.56) for ISH, 27.59 (95% CI 14.68; 53.82) for IDH and 50.58 (95% CI 24.78; 114.84) for SDH. CONCLUSIONS The risk of hypertension at follow-up was higher among women for all phenotypes compared to men, particularly in those with IDH. Findings of this study emphasize the importance of close BP monitoring in the young, especially in women.
Collapse
Affiliation(s)
- Esther M.C. Vriend
- Amsterdam UMC, University of Amsterdam, Department of Internal Medicine, Section Vascular Medicine, Amsterdam Cardiovascular Sciences
- Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute
| | - Thomas A. Bouwmeester
- Amsterdam UMC, University of Amsterdam, Department of Internal Medicine, Section Vascular Medicine, Amsterdam Cardiovascular Sciences
| | - Oscar H. Franco
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht
| | - Henrike Galenkamp
- Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute
| | - Aeilko H. Zwinderman
- Amsterdam UMC, University of Amsterdam, Department of Epidemiology, Biostatistics & Bioinformatics, Amsterdam, The Netherlands
| | - Bert-Jan H. van den Born
- Amsterdam UMC, University of Amsterdam, Department of Internal Medicine, Section Vascular Medicine, Amsterdam Cardiovascular Sciences
- Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute
| | - Didier Collard
- Amsterdam UMC, University of Amsterdam, Department of Internal Medicine, Section Vascular Medicine, Amsterdam Cardiovascular Sciences
| |
Collapse
|
11
|
Guberti D, Ferrario M, Liu S, Jakob SM, Carrara M. Wave Separation Analysis to Assess Cardiovascular Alterations Induced by Sepsis. IEEE Trans Biomed Eng 2024; 71:1719-1731. [PMID: 38163302 DOI: 10.1109/tbme.2023.3349104] [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: 01/03/2024]
Abstract
OBJECTIVE Sepsis induces a severe decompensation of arterial and cardiac functional properties, leading to important modifications of arterial blood pressure (ABP) waveform, not resolved by recommended therapy, as shown by previous works. The aim of this study is to quantify the changes in ABP waveform morphology and wave reflections during a long-term swine experiment of polymicrobial sepsis and resuscitation, to deepen the understanding of the cardiovascular response to standard resuscitation therapy. METHODS We analyzed 14 pigs: polymicrobial sepsis was induced in 9 pigs followed by standard resuscitation and 5 pigs were treated as sham controls. Septic animals were studied at baseline (T1), after sepsis development (T2), and after 24 h (T3) and 48 h (T4) of therapy administration, and sham controls at the same time points. ABP and arterial blood flow were measured in the left and right carotid artery, respectively. Pulse wave analysis and wave separation techniques were used to estimate arterial input impedance, carotid characteristic impedance, forward and backward waves, indices of wave reflections such as reflection magnitude and reflection index, and augmentation index. RESULTS Sepsis led to an acute alteration of ABP waveform passing from type A to type B or C; consistently, the reflection phenomena were significantly reduced. The resuscitation was successful in reaching targeted hemodynamic stability, but it failed in restoring a physiological blood propagation and reflection. CONCLUSION Septic pigs persistently showed altered reflected waves even after 48 hours of successful therapy according to guidelines, suggesting a persistent hidden cardiovascular disorder. SIGNIFICANCE The proposed indices may be useful to unravel the complex cardiovascular response to therapy administration in septic patients and could potentially be used for risk stratification of patient deterioration. Whether alterations of blood propagation and reflection contribute to persisting organ dysfunction after hemodynamic stabilization should be further investigated.
Collapse
|
12
|
Chen C, Liu L, Liu S, Ju M, Yu W, Song Q, Li M, Tang Y, Wang C. 24-h central pressure is a valuable predictor for left ventricular hypertrophy in non-dialysis patients with chronic kidney disease. Hypertens Res 2024; 47:1697-1706. [PMID: 38553645 DOI: 10.1038/s41440-024-01654-2] [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] [Received: 09/01/2023] [Revised: 02/23/2024] [Accepted: 03/01/2024] [Indexed: 05/23/2024]
Abstract
The current research on the relationship between 24-h central pressure and 24-h brachial pressure with left ventricular hypertrophy (LVH) is characterised by limited sample size and inconsistent findings. Furthermore, the association has never been explored in chronic kidney disease (CKD). A multicentre, cross-sectional study among non-dialysis patients with CKD was conducted. All participants underwent brachial and central ambulatory blood pressure monitoring using MobilO-Graph PWA, while trained cardiologists performed echocardiography. In this study, 2117 non-dialysis patients with CKD were examined. 24-h central systolic blood pressure with c2 calibration (24-h c2SBP) demonstrated a stronger association with left ventricular mass index and LVH compared with 24-h brachial systolic blood pressure (24-h bSBP) in the univariate and multivariate regression analyses. The multivariate net reclassification index (NRI) analysis revealed that 24-h c2SBP exhibited greater discriminatory power over 24-h bSBP (NRI = 0.310, 95% CI [0.192-0.429], P < 0.001). Applying 130/135 mmHg as the threshold for 24-h bSBP/c2SBP to cross-classify, the patients were divided into concordant normotension (1509 individuals), isolated brachial hypertension (155 individuals), isolated central hypertension (11 individuals), and concordant hypertension (442 individuals). With concordant normotension as the reference, the multivariable-adjusted ORs were 0.954 (95% CI, 0.534-1.640; P = 0.870) for isolated brachial hypertension and 2.585 (95%CI, 1.841-3.633; P < 0.001) for concordant hypertension. Among non-dialysis patients with CKD, 24-h c2SBP exhibits greater efficacy in identifying the presence of LVH compared with 24-h bSBP. The presence of LVH was greater in cases of concordant hypertension compared with cases of isolated brachial hypertension and concordant normotension.
Collapse
Affiliation(s)
- Cheng Chen
- Division of Nephrology, Department of Medicine, The Fifth Affiliated Hospital Sun Yat-Sen University, Zhuhai, 519000, Guangdong, China
| | - Lingling Liu
- Division of Nephrology, Department of Medicine, The Fifth Affiliated Hospital Sun Yat-Sen University, Zhuhai, 519000, Guangdong, China
| | - Sirui Liu
- Division of Nephrology, Department of Medicine, The Fifth Affiliated Hospital Sun Yat-Sen University, Zhuhai, 519000, Guangdong, China
| | - Menglei Ju
- Division of Nephrology, Department of Medicine, The Fifth Affiliated Hospital Sun Yat-Sen University, Zhuhai, 519000, Guangdong, China
| | - Wenjuan Yu
- Division of Nephrology, Department of Medicine, The Third Affiliated Hospital of Southern Medical University, Guangzhou, 510630, Guangdong, China
| | - Qirong Song
- Division of Nephrology, Department of Medicine, The Third Affiliated Hospital of Southern Medical University, Guangzhou, 510630, Guangdong, China
| | - Man Li
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital Sun Yat-Sen University, Zhuhai, 519000, Guangdong, China
| | - Ying Tang
- Division of Nephrology, Department of Medicine, The Third Affiliated Hospital of Southern Medical University, Guangzhou, 510630, Guangdong, China.
| | - Cheng Wang
- Division of Nephrology, Department of Medicine, The Fifth Affiliated Hospital Sun Yat-Sen University, Zhuhai, 519000, Guangdong, China.
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital Sun Yat-Sen University, Zhuhai, 519000, Guangdong, China.
| |
Collapse
|
13
|
Tian S, Wang L, Zhu R. A flexible multimodal pulse sensor for wearable continuous blood pressure monitoring. MATERIALS HORIZONS 2024; 11:2428-2437. [PMID: 38441176 DOI: 10.1039/d3mh01999c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
Monitoring of arterial blood pressure via cuffless pulse waveform measurement at the wrist has an important clinical value for the early diagnosis and prevention of cardiovascular disease. However, accurate measurement of the radial pulse waveform is challenging owing to its subtle, wideband, and preload-dependent variation characteristics. Evidence shows that uncertainties or variations of wearing pressure and skin temperature can cause artifact signals in wrist pulse measurements, thus degrading blood pressure estimate accuracy and hindering precise clinical diagnosis. Herein, we report a flexible multisensory pulse sensor utilizing natural piezo-thermic transduction of human skin in conjunction with thin-film thermistors for the accurately measuring radial artery pulse waves with high fidelity and good anti-artifact performance. The flexible pulse sensor achieved a wide pressure measuring range (228.2 kPa), low detection limit (4 Pa), good linearity (R2 = 0.999), low hysteresis (2.45%), fast response (88 ms), and good durability and stability, thereby enabling accurate pulse measurement with high fidelity. The pulse sensor also monolithically integrated the simultaneous detections of skin temperature and wearing pressure for resisting artifact effects in pulse measurements. Through the fusion of multiple features extracted from the pulse waveform, wearing pressure, skin temperature and user's personal physical characteristics using an efficient multilayer perceptron, blood pressure is accurately estimated and good generalizability is achieved.
Collapse
Affiliation(s)
- Shuo Tian
- State Key Laboratory of Precision Measurement Technology and Instrument, Department of Precision Instrument, Tsinghua University, Beijing, 100084, China.
| | - Liangqi Wang
- State Key Laboratory of Precision Measurement Technology and Instrument, Department of Precision Instrument, Tsinghua University, Beijing, 100084, China.
| | - Rong Zhu
- State Key Laboratory of Precision Measurement Technology and Instrument, Department of Precision Instrument, Tsinghua University, Beijing, 100084, China.
| |
Collapse
|
14
|
Brown PA. Genes Differentially Expressed Across Major Arteries Are Enriched in Endothelial Dysfunction-Related Gene Sets: Implications for Relative Inter-artery Atherosclerosis Risk. Bioinform Biol Insights 2024; 18:11779322241251563. [PMID: 38765020 PMCID: PMC11100403 DOI: 10.1177/11779322241251563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 04/13/2024] [Indexed: 05/21/2024] Open
Abstract
Atherosclerosis differs across major arteries. Although the biological basis is not fully understood, limited evidence of genetic differences has been documented. This study, therefore, was aimed to identify differentially expressed genes between clinically relevant major arteries and investigate their enrichment in endothelial dysfunction-related gene sets. A bioinformatic analysis of publicly available gene-level read counts for coronary, aortic, and tibial arteries was performed. Differential gene expression was conducted with DeSeq2 at a false discovery rate of 0.05. Differentially expressed genes were then subjected to over-representation analysis and active-subnetwork-oriented enrichment analysis, both at a false discovery rate of 0.005. Enriched terms common to both analyses were categorized for each contrast into immunity/inflammation-, membrane biology-, lipid metabolism-, and coagulation-related terms, and the top differentially expressed genes validated against Swiss Institute of Bioinformatics' Bgee database. There was mostly upregulation of differentially expressed genes for the coronary/tibial and aorta/tibial contrasts, but milder changes for the coronary/aorta contrast. Transcriptomic differences between coronary or aortic versus tibial samples largely involved immunity/inflammation-, membrane biology-, lipid metabolism-, and coagulation-related genes, suggesting potential to modulate endothelial dysfunction and atherosclerosis. These results imply atheroprone coronary and aortic environments compared with tibial artery tissue, which may explain observed relative inter-artery atherosclerosis risk.
Collapse
Affiliation(s)
- Paul A Brown
- Department of Basic Medical Sciences, Faculty of Medical Sciences Teaching and Research Complex, The University of the West Indies, Kingston, Jamaica
| |
Collapse
|
15
|
Tasmin S, Aschebrook-Kilfoy B, Hedeker D, Gopalakrishnan R, Connellan E, Kibriya MG, Young MT, Kaufman JD, Ahsan H. Long-term exposure to ambient air pollution and measures of central hemodynamics and arterial stiffness among multiethnic Chicago residents. Environ Health 2024; 23:47. [PMID: 38715087 PMCID: PMC11075200 DOI: 10.1186/s12940-024-01077-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 04/02/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVES To examine whether long-term air pollution exposure is associated with central hemodynamic and brachial artery stiffness parameters. METHODS We assessed central hemodynamic parameters including central blood pressure, cardiac parameters, systemic vascular compliance and resistance, and brachial artery stiffness measures [including brachial artery distensibility (BAD), compliance (BAC), and resistance (BAR)] using waveform analysis of the arterial pressure signals obtained from a standard cuff sphygmomanometer (DynaPulse2000A, San Diego, CA). The long-term exposures to particles with an aerodynamic diameter < 2.5 μm (PM2.5) and nitrogen dioxide (NO2) for the 3-year periods prior to enrollment were estimated at residential addresses using fine-scale intra-urban spatiotemporal models. Linear mixed models adjusted for potential confounders were used to examine associations between air pollution exposures and health outcomes. RESULTS The cross-sectional study included 2,387 Chicago residents (76% African Americans) enrolled in the ChicagO Multiethnic Prevention And Surveillance Study (COMPASS) during 2013-2018 with validated address information, PM2.5 or NO2, key covariates, and hemodynamics measurements. We observed long-term concentrations of PM2.5 and NO2 to be positively associated with central systolic, pulse pressure and BAR, and negatively associated with BAD, and BAC after adjusting for relevant covariates. A 1-µg/m3 increment in preceding 3-year exposures to PM2.5 was associated with 1.8 mmHg higher central systolic (95% CI: 0.98, 4.16), 1.0 mmHg higher central pulse pressure (95% CI: 0.42, 2.87), a 0.56%mmHg lower BAD (95% CI: -0.81, -0.30), and a 0.009 mL/mmHg lower BAC (95% CI: -0.01, -0.01). CONCLUSION This population-based study provides evidence that long-term exposures to PM2.5 and NO2 is related to central BP and arterial stiffness parameters, especially among African Americans.
Collapse
Affiliation(s)
- Saira Tasmin
- Department of Public Health Sciences, University of Chicago, 5815 S. Maryland Ave, Rm TC-620A, MC2000, Chicago, IL, 60637, USA
- Institute for Population and Precision Health, University of Chicago, Chicago, IL, USA
| | - Briseis Aschebrook-Kilfoy
- Department of Public Health Sciences, University of Chicago, 5815 S. Maryland Ave, Rm TC-620A, MC2000, Chicago, IL, 60637, USA
- Institute for Population and Precision Health, University of Chicago, Chicago, IL, USA
| | - Donald Hedeker
- Department of Public Health Sciences, University of Chicago, 5815 S. Maryland Ave, Rm TC-620A, MC2000, Chicago, IL, 60637, USA
| | | | - Elizabeth Connellan
- Institute for Population and Precision Health, University of Chicago, Chicago, IL, USA
| | - Muhammad G Kibriya
- Department of Public Health Sciences, University of Chicago, 5815 S. Maryland Ave, Rm TC-620A, MC2000, Chicago, IL, 60637, USA
- Institute for Population and Precision Health, University of Chicago, Chicago, IL, USA
| | - Michael T Young
- Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Joel D Kaufman
- Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Habibul Ahsan
- Department of Public Health Sciences, University of Chicago, 5815 S. Maryland Ave, Rm TC-620A, MC2000, Chicago, IL, 60637, USA.
- Institute for Population and Precision Health, University of Chicago, Chicago, IL, USA.
| |
Collapse
|
16
|
Montino Pelagi G, Baggiano A, Regazzoni F, Fusini L, Alì M, Pontone G, Valbusa G, Vergara C. Personalized Pressure Conditions and Calibration for a Predictive Computational Model of Coronary and Myocardial Blood Flow. Ann Biomed Eng 2024; 52:1297-1312. [PMID: 38334838 PMCID: PMC10995040 DOI: 10.1007/s10439-024-03453-9] [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: 07/25/2023] [Accepted: 01/14/2024] [Indexed: 02/10/2024]
Abstract
Predictive modeling of hyperemic coronary and myocardial blood flow (MBF) greatly supports diagnosis and prognostic stratification of patients suffering from coronary artery disease (CAD). In this work, we propose a novel strategy, using only readily available clinical data, to build personalized inlet conditions for coronary and MBF models and to achieve an effective calibration for their predictive application to real clinical cases. Experimental data are used to build personalized pressure waveforms at the aortic root, representative of the hyperemic state and adapted to surrogate the systolic contraction, to be used in computational fluid-dynamics analyses. Model calibration to simulate hyperemic flow is performed in a "blinded" way, not requiring any additional exam. Coronary and myocardial flow simulations are performed in eight patients with different clinical conditions to predict FFR and MBF. Realistic pressure waveforms are recovered for all the patients. Consistent pressure distribution, blood velocities in the large arteries, and distribution of MBF in the healthy myocardium are obtained. FFR results show great accuracy with a per-vessel sensitivity and specificity of 100% according to clinical threshold values. Mean MBF shows good agreement with values from stress-CTP, with lower values in patients with diagnosed perfusion defects. The proposed methodology allows us to quantitatively predict FFR and MBF, by the exclusive use of standard measures easily obtainable in a clinical context. This represents a fundamental step to avoid catheter-based exams and stress tests in CAD diagnosis.
Collapse
Affiliation(s)
- Giovanni Montino Pelagi
- LABS, Dipartimento di Chimica, Materiali e Ingegneria Chimica, Politecnico di Milano, 20133, Milan, Italy.
| | - Andrea Baggiano
- Perioperative Cardiology and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Via Carlo Parea 4, 20138, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Francesco Regazzoni
- MOX, Dipartimento di Matematica, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milan, Italy
| | - Laura Fusini
- Perioperative Cardiology and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Via Carlo Parea 4, 20138, Milan, Italy
- Department of Electronics, Information and Biomedical Engineering, Politecnico di Milano, 20133, Milan, Italy
| | - Marco Alì
- Bracco Imaging S.p.A., Via Caduti di Marcinelle 13, 20134, Milan, Italy
- Department of Diagnostic Imaging and Stereotactic Radiosurgery, Centro Diagnostico Italiano S.p.A., Via Saint Bon 20, 20147, Milan, Italy
| | - Gianluca Pontone
- Perioperative Cardiology and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Via Carlo Parea 4, 20138, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20134, Milan, Italy
| | - Giovanni Valbusa
- Bracco Imaging S.p.A., Via Caduti di Marcinelle 13, 20134, Milan, Italy
| | - Christian Vergara
- LABS, Dipartimento di Chimica, Materiali e Ingegneria Chimica, Politecnico di Milano, 20133, Milan, Italy
| |
Collapse
|
17
|
Champeroux P, Thireau J, Le Guennec JY, Fares R. In silico modelling of stroke volume, cardiac output and systemic vascular resistance in cardiovascular safety pharmacology studies by telemetry. J Pharmacol Toxicol Methods 2024; 127:107512. [PMID: 38719163 DOI: 10.1016/j.vascn.2024.107512] [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] [Received: 12/18/2023] [Revised: 04/26/2024] [Accepted: 05/04/2024] [Indexed: 05/13/2024]
Abstract
The principle of proportionality of the systolic area of the central aortic pressure to stroke volume (SV) has been long known. The aim of the present work was to evaluate an in silico solution derived from this principle for modelling SV (iSV model) in cardiovascular safety pharmacology studies by telemetry. Blood pressure was measured in the abdominal aorta in accordance with standard practice. Central aortic pressure was modelled from the abdominal aortic pressure waveform using the N-point moving average (NPMA) method for beat-to-beat estimation of SV. First, the iSV was compared to the SV measured by ultrasonic flowmetry in the ascending aorta (uSV) after various pharmacological challenges in beagle dogs anaesthetised with etomidate/fentanyl. The iSV showed minimal bias (0.2 mL i.e. 2%) and excellent agreement with uSV. Then, previous telemetry studies including reference vasoactive and inotropic compounds were retrospectively reanalysed to model drug effects on stroke volume (iSV), cardiac output (iCO) and systemic vascular resistance (iSVR). Among them, the examples of nicardipine and isoprenaline highlight risks of erroneous or biased estimation of drug effects from the abdominal aortic pressure due to pulse pressure amplification. Furthermore, the examples of verapamil, quinidine and moxifloxacin show that iSV, iCO and iSVR are earlier biomarkers than blood pressure itself for predicting drug effect on blood pressure. This in silico modelling approach included in vivo telemetry safety pharmacology studies can be considered as a New Approach Methodology (NAM) that provides valuable additional information and contribute to improving non-clinical translational research to the clinic.
Collapse
Affiliation(s)
| | - Jérôme Thireau
- Laboratoire PHYMEDEXP, Université de Montpellier, INSERM, CNRS, 371 Avenue du doyen G. Giraud, 34295 Montpellier, Cedex 05, France
| | - Jean-Yves Le Guennec
- Laboratoire PHYMEDEXP, Université de Montpellier, INSERM, CNRS, 371 Avenue du doyen G. Giraud, 34295 Montpellier, Cedex 05, France
| | - Raafat Fares
- ERBC France, Chemin de Montifault, 18800 Baugy, France
| |
Collapse
|
18
|
Größer V, Weyh C, Böttrich T, Frech T, Nolte S, Sommer N, Huber M, Eder K, Dörr O, Hoelscher S, Weber R, Akdogan E, Nef H, Most A, Hamm CW, Krüger K, Bauer P. Association of cardiorespiratory fitness level with vascular function and subclinical atherosclerosis in the elderly. Eur J Appl Physiol 2024; 124:1487-1497. [PMID: 38133663 PMCID: PMC11055712 DOI: 10.1007/s00421-023-05375-1] [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: 08/22/2023] [Accepted: 11/19/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE Physical exercise is crucial for healthy aging and plays a decisive role in the prevention of atherosclerotic cardiovascular disease (ASCVD). A higher level of cardiorespiratory fitness (CRF) in the elderly is associated with lower cardiovascular and all-cause mortality. This study investigated the association of CRF level with vascular function and cardiovascular risk factors in the elderly. METHODS We examined 79 apparently healthy and physically active subjects aged > 55 years (64 ± 4 years). Cardiovascular functional parameters assessed included brachial and central blood pressure (BP), pulse wave velocity (PWV), augmentation index (Aix), and ankle-brachial index. Sonography of the common carotid artery was performed. CRF level was determined by a cardiopulmonary exercise test, and everyday activity was quantified with an accelerometer. RESULTS All participants had a higher CRF level than the reported age-specific normative values. Twenty-nine subjects had subclinical atherosclerosis of the common carotid artery. Compared with participants without atherosclerosis, they were older (p = 0.007), displayed higher brachial systolic BP (p = 0.006), and higher central systolic BP (p = 0.014). Lower brachial (p = 0.036) and central (p = 0.003) systolic BP, lower PWV (p = 0.004), lower Aix (p < 0.001), lower body fat percentage (< 0.001), and lower LDL cholesterol (p = 0.005) were associated with a higher CRF level. CONCLUSIONS In this cohort of healthy and physically active individuals, subjects with subclinical atherosclerosis displayed higher systolic brachial and central BP. A higher CRF level was associated with enhanced vascular function, consistent with an influence of CRF on both BP and vascular function in the elderly.
Collapse
Affiliation(s)
- Vincent Größer
- Department of Cardiology and Angiology, Justus- Liebig-University Giessen, 35390, Giessen, Germany
| | - Christopher Weyh
- Department of Exercise Physiology and Sports Therapy, Institute of Sports Science, Justus-Liebig-University, Giessen, Germany
| | - Tim Böttrich
- Department of Exercise Physiology and Sports Therapy, Institute of Sports Science, Justus-Liebig-University, Giessen, Germany
| | - Torsten Frech
- Department of Exercise Physiology and Sports Therapy, Institute of Sports Science, Justus-Liebig-University, Giessen, Germany
| | - Svenja Nolte
- Department of Exercise Physiology and Sports Therapy, Institute of Sports Science, Justus-Liebig-University, Giessen, Germany
| | - Natascha Sommer
- Department of Internal Medicine, Member of the German Center for Lung Research, Universities of Giessen and Marburg Lung Center, Justus-Liebig-University Giessen, Giessen, Germany
| | - Magdalena Huber
- Institute for Systems Immunology, Center for Tumor und Immunology, Marburg, Germany
| | - Klaus Eder
- Institute of Animal Nutrition and Nutrition Physiology, Justus-Liebig-University, Giessen, Germany
| | - Oliver Dörr
- Department of Cardiology and Angiology, Justus- Liebig-University Giessen, 35390, Giessen, Germany
| | - Sophie Hoelscher
- Department of Cardiology and Angiology, Justus- Liebig-University Giessen, 35390, Giessen, Germany
| | - Rebecca Weber
- Department of Cardiology and Angiology, Justus- Liebig-University Giessen, 35390, Giessen, Germany
| | - Ebru Akdogan
- Department of Cardiology and Angiology, Justus- Liebig-University Giessen, 35390, Giessen, Germany
| | - Holger Nef
- Department of Cardiology and Angiology, Justus- Liebig-University Giessen, 35390, Giessen, Germany
| | - Astrid Most
- Department of Cardiology and Angiology, Justus- Liebig-University Giessen, 35390, Giessen, Germany
| | - Christian W Hamm
- Department of Cardiology and Angiology, Justus- Liebig-University Giessen, 35390, Giessen, Germany
- Department of Cardiology, Kerckhoff Clinic GmbH, Bad Nauheim, Germany
| | - Karsten Krüger
- Department of Exercise Physiology and Sports Therapy, Institute of Sports Science, Justus-Liebig-University, Giessen, Germany
| | - Pascal Bauer
- Department of Cardiology and Angiology, Justus- Liebig-University Giessen, 35390, Giessen, Germany.
| |
Collapse
|
19
|
Rowland SN, James LJ, O'Donnell E, Bailey SJ. Influence of acute dietary nitrate supplementation timing on nitrate metabolism, central and peripheral blood pressure and exercise tolerance in young men. Eur J Appl Physiol 2024; 124:1381-1396. [PMID: 38040982 PMCID: PMC11055761 DOI: 10.1007/s00421-023-05369-z] [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: 09/09/2023] [Accepted: 11/08/2023] [Indexed: 12/03/2023]
Abstract
PURPOSE Dietary nitrate (NO3-) supplementation can lower systolic blood pressure (SBP) and improve exercise performance. Salivary flow rate (SFR) and pH are key determinants of oral NO3- reduction and purported to peak in the afternoon. We tested the hypotheses that NO3--rich beetroot juice (BR) would increase plasma [nitrite] ([NO2-]), lower SBP and improve exercise performance to a greater extent in the afternoon (AFT) compared to the morning (MORN) and evening (EVE). METHOD Twelve males completed six experimental visits in a repeated-measures, crossover design. NO3--depleted beetroot juice (PL) or BR (~ 13 mmol NO3-) were ingested in the MORN, AFT and EVE. SFR and pH, salivary and plasma [NO3-] and [NO2-], brachial SBP and central SBP were measured pre and post supplementation. A severe-intensity exercise tolerance test was completed to determine cycling time to exhaustion (TTE). RESULTS There were no between-condition differences in mean SFR or salivary pH. The elevation in plasma [NO2-] after BR ingestion was not different between BR-MORN, BR-AFT and BR-EVE. Brachial SBP was unchanged following BR supplementation in all conditions. Central SBP was reduced in BR-MORN (- 3 ± 4 mmHg), BR-AFT (- 4 ± 3 mmHg), and BR-EVE (- 2 ± 3 mmHg), with no differences between timepoints. TTE was not different between BR and PL at any timepoint. CONCLUSION Acute BR supplementation was ineffective at improving TTE and brachial SBP and similarly effective at increasing plasma [NO2-] and lowering central SBP across the day, which may have implications for informing NO3- supplementation strategies.
Collapse
Affiliation(s)
- Samantha N Rowland
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK
| | - Lewis J James
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK
| | - Emma O'Donnell
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK
| | - Stephen J Bailey
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK.
- Department of Cardiovascular Science, University of Leicester, Leicester, UK.
| |
Collapse
|
20
|
Wang S, Wong SY, Yip BH, Lee EK. Age-dependent association of central blood pressure with cardiovascular outcomes: a cohort study involving 34 289 participants using the UK biobank. J Hypertens 2024; 42:769-776. [PMID: 38372322 PMCID: PMC10990010 DOI: 10.1097/hjh.0000000000003675] [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] [Received: 07/31/2023] [Revised: 12/18/2023] [Accepted: 01/18/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND It remained unclear whether central blood pressures (BP) was more closely associated with cardiovascular disease (CVD) than brachial BP in different age groups. OBJECTIVES To investigate the age-stratified association of CVD with brachial and central BPs, and to evaluate corresponding improvement in model performance. METHODS This cohort study included 34 289 adults without baseline CVD from the UK Biobank dataset. Participants were categorized into middle-aged and older aged groups using the cut-off of age 65 years. The primary endpoint was a composite cardiovascular outcome consisting of cardiovascular mortality combined with nonfatal coronary events, heart failure and stroke. Multivariable-adjusted hazard ratios expressed CVD risks associated with BP increments of 10 mmHg. Akaike Information Criteria (AIC) was used for model comparisons. RESULTS In both groups, CVD events were associated with brachial or central SBP ( P ≤ 0.002). Model fit was better for central SBP in middle-aged adults (AIC 4427.2 vs. 4429.5), but model fit was better for brachial SBP in older adults (AIC 10 246.7 vs. 10 247.1). Central SBP remained significantly associated to CVD events [hazard ratio = 1.05; 95% confidence interval (CI) 1.0-1.1] and improved model fit (AIC = 4426.6) after adjustment of brachial SBP only in the middle-aged adults. These results were consistent for pulse pressure (PP). CONCLUSION In middle-aged adults, higher central BPs were associated with greater risks of CVD events, even after adjusting for brachial BP indexes. For older adults, the superiority of central BP was not observed. Additional trials with adequate follow-up time will confirm the role of central BP in estimating CVD risk for middle-aged individuals.
Collapse
|
21
|
Azukaitis K, Puteikis K, Kinciniene O, Mikucionyte D, Mameniskiene R, Jankauskiene A. Cognitive performance in children and adolescents with primary hypertension and the role of body mass. Front Pediatr 2024; 12:1369690. [PMID: 38745835 PMCID: PMC11091299 DOI: 10.3389/fped.2024.1369690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 04/17/2024] [Indexed: 05/16/2024] Open
Abstract
Objective Primary hypertension has been shown to affect cognitive functions in adults but evidence in the pediatric population remain scarce and equivocal. We aimed to compare cognitive functioning between children diagnosed with primary hypertension and normotensive controls, with a focus on the role of different blood pressure (BP) parameters and body mass. Methods We conducted a single-center, prospective, cross-sectional study of children and adolescents (6-17 years old) with primary hypertension and age- and sex-matched normotensive controls. All participants underwent office BP, ambulatory BP monitoring (ABPM), and central BP measurements using an oscillometric device. Neurocognitive assessment consisted of evaluation of (i) intelligence quotient (IQ), (ii) categorical and phonemic fluency, (iii) verbal memory (verbal-logical story recall), and (iv) non-verbal computerized cognitive assessment. Results The study included a total of 59 patients with primary hypertension (14 ± 3 years) and 37 normotensive controls (14 ± 3 years). Participants in the primary hypertension group had a significantly higher body mass index z-score (BMIz: 2.1 ± 1.4 vs. 0.7 ± 0.9, p < 0.001), and 85% received antihypertensive therapy. Participants with primary hypertension showed worse performance in the domains of reaction speed, attention and processing speed, visual memory, new learning, and phonemic fluency. After adjusting for BMIz, only the differences in the reaction speed tasks remained significant. None of the BP parameters was associated with cognitive outcomes after adjustment for age, sex, and BMIz. BMIz associated with tasks of visual memory, new learning, spatial planning, and working memory, independent of age and sex. Conclusion Children and adolescents diagnosed with primary hypertension exhibit worse performance in the cognitive domains of reaction speed, attention, processing speed, visual memory, and new learning. These differences to healthy controls can be partially attributed to accompanying increase of body mass.
Collapse
Affiliation(s)
- Karolis Azukaitis
- Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
- Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Kristijonas Puteikis
- Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
- Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Odeta Kinciniene
- Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
- Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | | | - Ruta Mameniskiene
- Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
- Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Augustina Jankauskiene
- Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
- Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| |
Collapse
|
22
|
Tamborini A, Gharib M. Validation of a Suprasystolic Cuff System for Static and Dynamic Representation of the Central Pressure Waveform. J Am Heart Assoc 2024; 13:e033290. [PMID: 38591330 PMCID: PMC11262511 DOI: 10.1161/jaha.123.033290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 03/14/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Noninvasive pulse waveform analysis is valuable for central cardiovascular assessment, yet controversies persist over its validity in peripheral measurements. Our objective was to compare waveform features from a cuff system with suprasystolic blood pressure hold with an invasive aortic measurement. METHODS AND RESULTS This study analyzed data from 88 subjects undergoing concurrent aortic catheterization and brachial pulse waveform acquisition using a suprasystolic blood pressure cuff system. Oscillometric blood pressure (BP) was compared with invasive aortic systolic BP and diastolic BP. Association between cuff and catheter waveform features was performed on a set of 15 parameters inclusive of magnitudes, time intervals, pressure-time integrals, and slopes of the pulsations. The evaluation covered both static (subject-averaged values) and dynamic (breathing-induced fluctuations) behaviors. Peripheral BP values from the cuff device were higher than catheter values (systolic BP-residual, 6.5 mm Hg; diastolic BP-residual, 12.4 mm Hg). Physiological correction for pressure amplification in the arterial system improved systolic BP prediction (r2=0.83). Dynamic calibration generated noninvasive BP fluctuations that reflect those invasively measured (systolic BP Pearson R=0.73, P<0.001; diastolic BP Pearson R=0.53, P<0.001). Static and dynamic analyses revealed a set of parameters with strong associations between catheter and cuff (Pearson R>0.5, P<0.001), encompassing magnitudes, timings, and pressure-time integrals but not slope-based parameters. CONCLUSIONS This study demonstrated that the device and methods for peripheral waveform measurements presented here can be used for noninvasive estimation of central BP and a subset of aortic waveform features. These results serve as a benchmark for central cardiovascular assessment using suprasystolic BP cuff-based devices and contribute to preserving system dynamics in noninvasive measurements.
Collapse
Affiliation(s)
- Alessio Tamborini
- Department of Medical EngineeringCalifornia Institute of TechnologyPasadenaCAUSA
| | - Morteza Gharib
- Department of Medical EngineeringCalifornia Institute of TechnologyPasadenaCAUSA
| |
Collapse
|
23
|
Tade G, Hsu HC, Robinson C, Dlongolo N, Teckie G, Solomon A, Dessein PH. The relative potential contribution of volume load and vascular mechanisms to hypertension in non-dialysis and dialysis chronic kidney disease patients. Front Cardiovasc Med 2024; 11:1377887. [PMID: 38689863 PMCID: PMC11060794 DOI: 10.3389/fcvm.2024.1377887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 03/28/2024] [Indexed: 05/02/2024] Open
Abstract
Background Hypertension is highly prevalent and particularly difficult to treat adequately in patients with chronic kidney disease (CKD). The relative contribution of volume overload and vascular mechanisms to blood pressure measures in CKD and whether these effects differ in non-dialysis compared to dialysis patients is unknown. Methods We determined the potential impact of volume load (stroke volume) and vascular mechanisms (inverse of total arterial compliance (inv TAC) and systemic vascular resistance (SVR)) on mean and brachial and aortic systolic blood pressures in 67 non-dialysis and 48 dialysis chronic kidney disease (CKD) patients. Relationships were determined in confounder adjusted regression models. Results Stroke volume (p value = 0.003) was more strongly associated with mean arterial pressure than SVR (p value = 0.9) (p value for difference = 0.03). When stroke volume and SVR were entered in the same regression model (model R2 = 0.324), they contributed equally to the variation in mean arterial pressure (p value for difference = 0.5). Stroke volume (p value ≤ 0.002) and inv TAC (p value ≤ 0.001) contributed equally to the variation in systolic pressures (p value for difference ≥ 0.9). When stroke volume and inv TAC were entered in the same regression model (model R2 = 0.752 to 0.765), they contributed equally to the variation in systolic blood pressures (p value for difference = 0.7). Stroke volume, TAC and SVR were similar (p value ≥ 0.5) and associated to the same extent with blood pressure measures in non-dialysis and dialysis CKD patients (p value for difference ≥ 0.1). In receiver operator characteristic curve analysis, elevated systolic blood pressure was determined by stroke volume (p value = 0.005) and inv TAC (p value = 0.03) but not SVR (p value = 0.8). The calculated power of the study was 0.999 based on α = 0.05. Conclusions The present investigation suggests that both volume load and vascular mechanisms should be considered in the management of hypertension among patients with CKD. The extent and relative potential impact of volume load and vascular mechanisms on blood pressure measures are as large in non-dialysis compared to dialysis CKD patients.
Collapse
Affiliation(s)
- Grace Tade
- Cardiovascular Pathophysiology and Genomics Research Unit, Faculty of Health Sciences, School of Physiology, University of the Witwatersrand, Johannesburg, South Africa
| | - Hon-Chun Hsu
- Cardiovascular Pathophysiology and Genomics Research Unit, Faculty of Health Sciences, School of Physiology, University of the Witwatersrand, Johannesburg, South Africa
- Nephrology Unit, Milpark Hospital, Johannesburg, South Africa
| | - Chanel Robinson
- Cardiovascular Pathophysiology and Genomics Research Unit, Faculty of Health Sciences, School of Physiology, University of the Witwatersrand, Johannesburg, South Africa
| | - Noluntu Dlongolo
- Rheumatology Unit, Rosebank Hospital, Johannesburg, South Africa
| | - Gloria Teckie
- Division of Nephrology, Department of Medicine, Chris Hani Baragwanath Hospital and Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Ahmed Solomon
- Internal Medicine Department, University of the Witwatersrand, Johannesburg, South Africa
| | - Patrick Hector Dessein
- Cardiovascular Pathophysiology and Genomics Research Unit, Faculty of Health Sciences, School of Physiology, University of the Witwatersrand, Johannesburg, South Africa
- Rheumatology Unit, Rosebank Hospital, Johannesburg, South Africa
- Internal Medicine Department, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
24
|
Gudigar A, Kadri NA, Raghavendra U, Samanth J, Maithri M, Inamdar MA, Prabhu MA, Hegde A, Salvi M, Yeong CH, Barua PD, Molinari F, Acharya UR. Automatic identification of hypertension and assessment of its secondary effects using artificial intelligence: A systematic review (2013-2023). Comput Biol Med 2024; 172:108207. [PMID: 38489986 DOI: 10.1016/j.compbiomed.2024.108207] [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] [Received: 12/27/2023] [Revised: 02/09/2024] [Accepted: 02/12/2024] [Indexed: 03/17/2024]
Abstract
Artificial Intelligence (AI) techniques are increasingly used in computer-aided diagnostic tools in medicine. These techniques can also help to identify Hypertension (HTN) in its early stage, as it is a global health issue. Automated HTN detection uses socio-demographic, clinical data, and physiological signals. Additionally, signs of secondary HTN can also be identified using various imaging modalities. This systematic review examines related work on automated HTN detection. We identify datasets, techniques, and classifiers used to develop AI models from clinical data, physiological signals, and fused data (a combination of both). Image-based models for assessing secondary HTN are also reviewed. The majority of the studies have primarily utilized single-modality approaches, such as biological signals (e.g., electrocardiography, photoplethysmography), and medical imaging (e.g., magnetic resonance angiography, ultrasound). Surprisingly, only a small portion of the studies (22 out of 122) utilized a multi-modal fusion approach combining data from different sources. Even fewer investigated integrating clinical data, physiological signals, and medical imaging to understand the intricate relationships between these factors. Future research directions are discussed that could build better healthcare systems for early HTN detection through more integrated modeling of multi-modal data sources.
Collapse
Affiliation(s)
- Anjan Gudigar
- Department of Instrumentation and Control Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Nahrizul Adib Kadri
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, 50603, Malaysia
| | - U Raghavendra
- Department of Instrumentation and Control Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, 576104, India.
| | - Jyothi Samanth
- Department of Cardiovascular Technology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, 576104, India
| | - M Maithri
- Department of Mechatronics, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Mahesh Anil Inamdar
- Department of Mechatronics, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Mukund A Prabhu
- Department of Cardiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Ajay Hegde
- Manipal Hospitals, Bengaluru, Karnataka, 560102, India
| | - Massimo Salvi
- Biolab, PolitoBIOMedLab, Department of Electronics and Telecommunications, Politecnicodi Torino, Turin, Italy
| | - Chai Hong Yeong
- School of Medicine, Faculty of Health and Medical Sciences, Taylor's University, 47500, Subang Jaya, Malaysia
| | - Prabal Datta Barua
- Cogninet Brain Team, Cogninet Australia, Sydney, NSW, 2010, Australia; School of Business (Information Systems), Faculty of Business, Education, Law & Arts, University of Southern Queensland, Toowoomba, QLD, 4350, Australia; Faculty of Engineering and Information Technology, University of Technology Sydney, Sydney, NSW, 2007, Australia
| | - Filippo Molinari
- Biolab, PolitoBIOMedLab, Department of Electronics and Telecommunications, Politecnicodi Torino, Turin, Italy
| | - U Rajendra Acharya
- School of Mathematics, Physics, and Computing, University of Southern Queensland, Springfield, QLD, 4300, Australia; Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, 4350, Australia
| |
Collapse
|
25
|
Noh SA, Kim HS, Kang SH, Yoon CH, Youn TJ, Chae IH. History and evolution of blood pressure measurement. Clin Hypertens 2024; 30:9. [PMID: 38556854 PMCID: PMC10983645 DOI: 10.1186/s40885-024-00268-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 02/27/2024] [Indexed: 04/02/2024] Open
Abstract
Hypertension is the leading cause of morbidity and mortality worldwide. Hypertension mostly accompanies no symptoms, and therefore blood pressure (BP) measurement is the only way for early recognition and timely treatment. Methods for BP measurement have a long history of development and improvement. Invasive method via arterial cannulation was first proven possible in the 1800's. Subsequent scientific progress led to the development of the auscultatory method, also known as Korotkoff' sound, and the oscillometric method, which enabled clinically available BP measurement. However, hypertension management status is still poor. Globally, less than half of adults are aware of their hypertension diagnosis, and only one-third of them being treated are under control. Novel methods are actively investigated thanks to technological advances such as sensors and machine learning in addition to the clinical needs for easier and more convenient BP measurement. Each method adopts different technologies with its own specific advantages and disadvantages. Promises of novel methods include comprehensive information on out-of-office BP capturing dynamic short-term and long-term fluctuations. However, there are still pitfalls such as the need for regular calibration since most novel methods capture relative BP changes rather than an absolute value. In addition, there is growing concern on their accuracy and precision as conventional validation protocols are inappropriate for cuffless continuous methods. In this article, we provide a comprehensive overview of the past and present of BP measurement methods. Novel and emerging technologies are also introduced with respect to their potential applications and limitations.
Collapse
Affiliation(s)
- Su A Noh
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-Ro 173 Beon-Gil, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 13620, South Korea
| | - Hwang-Soo Kim
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-Ro 173 Beon-Gil, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 13620, South Korea
| | - Si-Hyuck Kang
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-Ro 173 Beon-Gil, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 13620, South Korea.
- Department of Internal Medicine, Seoul National University, Seoul, South Korea.
| | - Chang-Hwan Yoon
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-Ro 173 Beon-Gil, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 13620, South Korea
- Department of Internal Medicine, Seoul National University, Seoul, South Korea
| | - Tae-Jin Youn
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-Ro 173 Beon-Gil, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 13620, South Korea
- Department of Internal Medicine, Seoul National University, Seoul, South Korea
| | - In-Ho Chae
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-Ro 173 Beon-Gil, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 13620, South Korea
- Department of Internal Medicine, Seoul National University, Seoul, South Korea
| |
Collapse
|
26
|
Zhang X, Wang Y, Yin Z, Liang F. Optimization and validation of a suprasystolic brachial cuff-based method for noninvasively estimating central aortic blood pressure. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2024; 40:e3806. [PMID: 38281742 DOI: 10.1002/cnm.3806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/12/2023] [Accepted: 01/14/2024] [Indexed: 01/30/2024]
Abstract
Clinical studies have extensively demonstrated that central aortic blood pressure (CABP) has greater clinical significance in comparison with peripheral blood pressure. Despite the existence of various techniques for noninvasively measuring CABP, the clinical applications of most techniques are hampered by the unsatisfactory accuracy or large variability in measurement errors. In this study, we proposed a new method for noninvasively estimating CABP with improved accuracy and reduced uncertain errors. The main idea was to optimize the estimation of the pulse wave transit time from the aorta to the occluded lumen of the brachial artery under a suprasystolic cuff by identifying and utilizing the characteristic information of the cuff oscillation wave, thereby improving the accuracy and stability of the CABP estimation algorithms under various physiological conditions. The method was firstly developed and verified based on large-scale virtual subject data (n = 800) generated by a computational model of the cardiovascular system coupled to a brachial cuff, and then validated with small-scale in vivo data (n = 34). The estimation errors for the aortic systolic pressure were -0.05 ± 0.63 mmHg in the test group of the virtual subjects and -1.09 ± 3.70 mmHg in the test group of the patients, both demonstrating a good performance. In particular, the estimation errors were found to be insensitive to variations in hemodynamic conditions and cardiovascular properties, manifesting the high robustness of the method. The method may have promising clinical applicability, although further validation studies with larger-scale clinical data remain necessary.
Collapse
Affiliation(s)
- Xujie Zhang
- Department of Engineering Mechanics, School of Naval Architecture, Ocean & Civil Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Yue Wang
- Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhaofang Yin
- Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fuyou Liang
- Department of Engineering Mechanics, School of Naval Architecture, Ocean & Civil Engineering, Shanghai Jiao Tong University, Shanghai, China
| |
Collapse
|
27
|
Shostak E, Yusuf F, Schabes N, Lora B, Churchill A, Farzansyed M, Makle S, White M, Greaves LM, Blum OE, DeBlauw JA, Ives SJ. Exploring the Bob Ross effect: A psychophysiological investigation. Complement Ther Med 2024; 80:103022. [PMID: 38191033 DOI: 10.1016/j.ctim.2024.103022] [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] [Received: 09/01/2023] [Revised: 12/11/2023] [Accepted: 01/04/2024] [Indexed: 01/10/2024] Open
Abstract
Watching news broadcasts is known to elicit psychological stress. Conversely, the iconic painter Bob Ross (BR) has risen to pop culture status and amassed a following, as many find the messages and sounds of BR to be soothing and relaxing. Though, it has yet to be directly tested if such exposure can confer psychological or physiological benefit. The purpose of this study was to compare the effects of watching BR versus streaming news on markers of cardiovascular health and profile of mood states (POMS). It was hypothesized that watching BR would increase POMS scores and heart rate variability (HRV). It was also hypothesized that watching the news would increase blood pressure (BP), vascular stiffness (VS), and heart rate (HR). METHODS In a randomized, controlled, crossover design, 18 young (21 ± 1 yrs, 9 female, 9 male) healthy participants (172.6 ± 9.9 cm, 69 ± 18 kg) were assessed for BP, VS, HR, HRV, and POMS before and after watching an episode of BR or the News matched for time (∼27 mins). RESULTS A significant interaction effect on POMS scores were observed for, anxiety (p = 0.01), anger (p = 0.008), depression (p = 0.003), fatigue (p = 0.001), and confusion (p = 0.01) domains after watching BR. The LF/HF ratio, an HRV marker of sympathovagal balance, was significantly lower after watching BR (p = 0.04). There were no significant time, condition, or interaction effects on systolic BP, mean arterial pressure, and diastolic BP. CONCLUSION The "Bob Ross Effect" reduces overall mood disturbance, though appears to exert little influence on the cardiovascular system in this acute paradigm.
Collapse
Affiliation(s)
- Elena Shostak
- Health and Human Physiological Sciences, Skidmore College, Saratoga Springs, NY, USA
| | - Farouq Yusuf
- Health and Human Physiological Sciences, Skidmore College, Saratoga Springs, NY, USA
| | - Noa Schabes
- Health and Human Physiological Sciences, Skidmore College, Saratoga Springs, NY, USA
| | - Brian Lora
- Health and Human Physiological Sciences, Skidmore College, Saratoga Springs, NY, USA
| | - Anna Churchill
- Health and Human Physiological Sciences, Skidmore College, Saratoga Springs, NY, USA
| | - Maleeha Farzansyed
- Health and Human Physiological Sciences, Skidmore College, Saratoga Springs, NY, USA
| | - Seraya Makle
- Health and Human Physiological Sciences, Skidmore College, Saratoga Springs, NY, USA
| | - Megan White
- Health and Human Physiological Sciences, Skidmore College, Saratoga Springs, NY, USA
| | - Lauren M Greaves
- Health and Human Physiological Sciences, Skidmore College, Saratoga Springs, NY, USA
| | - Oliver E Blum
- Health and Human Physiological Sciences, Skidmore College, Saratoga Springs, NY, USA
| | - Justin A DeBlauw
- Health and Human Physiological Sciences, Skidmore College, Saratoga Springs, NY, USA
| | - Stephen J Ives
- Health and Human Physiological Sciences, Skidmore College, Saratoga Springs, NY, USA.
| |
Collapse
|
28
|
Hundemer GL, Agharazii M, Madore F, Vaidya A, Brown JM, Leung AA, Kline GA, Larose E, Piché ME, Crean AM, Shaw JLV, Ramsay T, Hametner B, Wassertheurer S, Sood MM, Hiremath S, Ruzicka M, Goupil R. Subclinical Primary Aldosteronism and Cardiovascular Health: A Population-Based Cohort Study. Circulation 2024; 149:124-134. [PMID: 38031887 PMCID: PMC10841691 DOI: 10.1161/circulationaha.123.066389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Primary aldosteronism, characterized by overt renin-independent aldosterone production, is a common but underrecognized form of hypertension and cardiovascular disease. Growing evidence suggests that milder and subclinical forms of primary aldosteronism are highly prevalent, yet their contribution to cardiovascular disease is not well characterized. METHODS This prospective study included 1284 participants between the ages of 40 and 69 years from the randomly sampled population-based CARTaGENE cohort (Québec, Canada). Regression models were used to analyze associations of aldosterone, renin, and the aldosterone-to-renin ratio with the following measures of cardiovascular health: arterial stiffness, assessed by central blood pressure (BP) and pulse wave velocity; adverse cardiac remodeling, captured by cardiac magnetic resonance imaging, including indexed maximum left atrial volume, left ventricular mass index, left ventricular remodeling index, and left ventricular hypertrophy; and incident hypertension. RESULTS The mean (SD) age of participants was 54 (8) years and 51% were men. The mean (SD) systolic and diastolic BP were 123 (15) and 72 (10) mm Hg, respectively. At baseline, 736 participants (57%) had normal BP and 548 (43%) had hypertension. Higher aldosterone-to-renin ratio, indicative of renin-independent aldosteronism (ie, subclinical primary aldosteronism), was associated with increased arterial stiffness, including increased central BP and pulse wave velocity, along with adverse cardiac remodeling, including increased indexed maximum left atrial volume, left ventricular mass index, and left ventricular remodeling index (all P<0.05). Higher aldosterone-to-renin ratio was also associated with higher odds of left ventricular hypertrophy (odds ratio, 1.32 [95% CI, 1.002-1.73]) and higher odds of developing incident hypertension (odds ratio, 1.29 [95% CI, 1.03-1.62]). All the associations were consistent when assessing participants with normal BP in isolation and were independent of brachial BP. CONCLUSIONS Independent of brachial BP, a biochemical phenotype of subclinical primary aldosteronism is negatively associated with cardiovascular health, including greater arterial stiffness, adverse cardiac remodeling, and incident hypertension.
Collapse
Affiliation(s)
- Gregory L. Hundemer
- Department of Medicine, Division of Nephrology, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Mohsen Agharazii
- Department of Medicine, Division of Nephrology, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - François Madore
- Department of Medicine, Division of Nephrology, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montreal, QC, Canada
| | - Anand Vaidya
- Center for Adrenal Disorders, Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Jenifer M. Brown
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Alexander A. Leung
- Department of Medicine, Division of Endocrinology and Metabolism, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Gregory A. Kline
- Department of Medicine, Division of Endocrinology and Metabolism, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Eric Larose
- Department of Medicine, Division of Cardiology, Université Laval, Quebec City, QC, Canada
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Quebec City, QC, Canada
| | - Marie-Eve Piché
- Department of Medicine, Division of Cardiology, Université Laval, Quebec City, QC, Canada
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Quebec City, QC, Canada
| | - Andrew M. Crean
- Division of Cardiovascular Medicine, Ottawa Heart Institute, Ottawa, ON, Canada
| | - Julie L. V. Shaw
- Department of Pathology and Laboratory Medicine, Division of Biochemistry, Ottawa Hospital, Ottawa, ON, Canada
- Eastern Ontario Regional Laboratories Association, Ottawa, ON, Canada
| | - Tim Ramsay
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Bernhard Hametner
- Center for Health & Bioresources, AIT Austrian Institute of Technology, Vienna, Austria
| | | | - Manish M. Sood
- Department of Medicine, Division of Nephrology, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Swapnil Hiremath
- Department of Medicine, Division of Nephrology, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Marcel Ruzicka
- Department of Medicine, Division of Nephrology, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Rémi Goupil
- Department of Medicine, Division of Nephrology, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montreal, QC, Canada
| |
Collapse
|
29
|
Sun YH, Hu NQ, Huang XY, Liu ZX, Li QY, Li QL, Li LH. Central and peripheral blood pressures in relation to the triglyceride-glucose index in a Chinese population. Cardiovasc Diabetol 2024; 23:3. [PMID: 38172813 PMCID: PMC10765647 DOI: 10.1186/s12933-023-02068-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/15/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The triglyceride-glucose (TyG) index has been proposed as a surrogate marker of insulin resistance. However, the relationship between the TyG index and central blood pressure (BP), has not been well studied in adults. METHODS A total of 715 Chinese adult participants were enrolled in this study. Anthropometric and BP were assessed. The TyG index was calculated as ln[fasting triglycerides(mg/dL) × fasting glucose(mg/dL)/2]. Central BP was measured using SphygmoCor system. RESULTS The participants were stratified into three groups based on the TyG index, and significant differences were observed in metabolic and cardiovascular parameters and the prevalence of hypertension among the groups. Both brachial (β = 1.38, P = 0.0310; group highest vs. lowest, β = 2.66, P = 0.0084) and aortic (β = 2.38, P = 0.0002; group highest vs. lowest, β = 3.96, P = 0.0001) diastolic BP were significantly and independently associated with the TyG index and increasing TyG index tertile. However, there was no independent association between the TyG index and systolic BP. A one-unit increase in the TyG index was associated with a 46% higher risk of hypertension (P = 0.0121), and compared with the lowest group, participants in the highest group had a 95% higher risk of hypertension (P = 0.0057). CONCLUSIONS Our study demonstrates a significant and independent association between the TyG index and both brachial and aortic diastolic BP in Chinese adults. Furthermore, the TyG index was found to be an independent predictor of hypertension.
Collapse
Affiliation(s)
- Yin-Hua Sun
- Department of Gerontology, The First Affiliated Hospital of Dali University, Jiashibo Road 32, Dali, 671000, Yunnan Province, China
| | - Nai-Qing Hu
- Department of Gerontology, The First Affiliated Hospital of Dali University, Jiashibo Road 32, Dali, 671000, Yunnan Province, China
| | - Xian-Yi Huang
- Department of Gerontology, The First Affiliated Hospital of Dali University, Jiashibo Road 32, Dali, 671000, Yunnan Province, China
| | - Zheng-Xin Liu
- Department of Gerontology, The First Affiliated Hospital of Dali University, Jiashibo Road 32, Dali, 671000, Yunnan Province, China
| | - Qi-Yan Li
- Department of Gerontology, The First Affiliated Hospital of Dali University, Jiashibo Road 32, Dali, 671000, Yunnan Province, China
| | - Qing-Lu Li
- Department of Gerontology, The First Affiliated Hospital of Dali University, Jiashibo Road 32, Dali, 671000, Yunnan Province, China
| | - Li-Hua Li
- Department of Gerontology, The First Affiliated Hospital of Dali University, Jiashibo Road 32, Dali, 671000, Yunnan Province, China.
| |
Collapse
|
30
|
Liao C, Chuang S, Cheng H, Lin C, Chen C. Aortic Characteristic Impedance and Suspected Mild Cognitive Impairment in a Community-Based Healthy Population. J Am Heart Assoc 2024; 13:e032268. [PMID: 38156549 PMCID: PMC10863810 DOI: 10.1161/jaha.123.032268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 11/28/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Aging of the proximal aorta can lead to increased pressure and flow pulsatility in the cerebral microcirculation, which may cause cognitive impairment. This study investigated the association between aortic characteristic impedance (Zc), an indicator of regional stiffness of the proximal aorta, and suspected mild cognitive impairment (MCI), compared with carotid-femoral pulse wave velocity (CFPWV). METHODS AND RESULTS A total of 1461 healthy community residents (46.4% men; age range, 35-96 years [mean±SD, 59.9±11.8 years]) without a history of cardiovascular events or stroke were included in the study. Zc was estimated using applanation tonometry and echocardiography. Cognitive function was assessed using the Mini-Mental State Examination. Education-adjusted cut points were used to define suspected MCI. Subjects with suspected MCI (n=493 [33.7%]) had significantly higher Zc and CFPWV than those without. In multivariable analysis, both Zc and CFPWV were inversely associated with Mini-Mental State Examination score. Zc (odds ratio per 1 SD, 1.22 [95% CI, 1.09-1.37] and CFPWV (odds ratio per 1 SD, 1.18 [95% CI, 1.01-1.38]) was also significantly associated with suspected MCI, after adjusting for age, sex, education level, mean arterial pressure, hypertension, diabetes, low-density lipoprotein cholesterol, and smoking status. In joint analysis, Zc was significantly associated with suspected MCI, but CFPWV was not. In the age subgroups of <50 years and 50 to 70 years, only Zc was significantly associated with suspected MCI. CONCLUSIONS This study found that Zc was significantly associated with Mini-Mental State Examination score and suspected MCI, especially in younger and middle-aged adults. These findings suggest that Zc may be a useful biomarker for identifying individuals at risk for MCI.
Collapse
Affiliation(s)
- Chao‐Feng Liao
- Institute of Public Health, National Yang Ming Chiao Tung University College of MedicineTaipeiTaiwan, R.O.C.
| | - Shao‐Yuan Chuang
- Institute of Population Health Science, National Health Research InstituteMiaoliTaiwan, R.O.C.
| | - Hao‐Min Cheng
- Program of Interdisciplinary MedicineNational Yang Ming Chiao Tung University College of MedicineTaipeiTaiwan, R.O.C.
- Division of Faculty Development, Department of Medical EducationTaipei Veterans General HospitalTaipeiTaiwan, R.O.C.
| | - Chen‐Hua Lin
- Institute of Public Health, National Yang Ming Chiao Tung University College of MedicineTaipeiTaiwan, R.O.C.
| | - Chen‐Huan Chen
- Institute of Public Health, National Yang Ming Chiao Tung University College of MedicineTaipeiTaiwan, R.O.C.
- Department of MedicineNational Yang Ming Chiao Tung University College of MedicineTaipeiTaiwan, R.O.C.
| |
Collapse
|
31
|
Willinger L, Brudy L, Meyer M, Oberhoffer-Fritz R, Ewert P, Müller J. Longitudinal development of central SBP in children with congenital heart disease. J Cardiovasc Med (Hagerstown) 2024; 25:68-75. [PMID: 38079283 DOI: 10.2459/jcm.0000000000001576] [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: 12/18/2023]
Abstract
AIMS Central SBP (cSBP) was shown to be increased already in children with congenital heart disease (CHD). However, its development over time has not yet been investigated. The aim of this study was to evaluate the natural course of cSBP over time from longitudinal assessment in children with CHD. METHODS In this longitudinal study, 306 children and adolescents (11.3 ± 2.9 years, 34% girls) with various CHD were prospectively examined from July 2014 to May 2022. Over a mean follow-up length of 30.1 ± 18.9 months, 467 follow-up assessments have been conducted. cSBP was noninvasively assessed by oscillometric measurement via Mobil-O-Graph. A linear mixed effect model was performed to examine the course of cSBP. RESULTS cSBP increased significantly over time by 1.22 mmHg per year of age (P < 0.001). The longitudinal increase in cSBP over time remained significant when including sex (b = 0.68, P < 0.001), BMI (b = 1.12, P < 0.001), hypertensive medication (b = 1.13, P < 0.001), disease severity (b = 1.04, P < 0.001), and CHD type (b = 3.74, P = 0.03) in the model. Patients with transposition of the great arteries (TGA) after arterial switch had a significantly higher cSBP increase over time (b = 1.78, P < 0.001). The longitudinal cSBP increase was significantly higher in obese CHD children (b = 2.52, P = 0.005) and in boys (b = 0.85, P < 0.001). CONCLUSION This study shows a longitudinal increase in cSBP in children with CHD. Whether observed trajectories of cSBP are normal or abnormal needs to be investigated in further studies. Monitoring of the vascular function with a special focus on patients with TGA and obese CHD children seems indicated.
Collapse
Affiliation(s)
- Laura Willinger
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum München
- Institute of Preventive Pediatrics, Technische Universität München
| | - Leon Brudy
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum München
| | - Michael Meyer
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum München
| | - Renate Oberhoffer-Fritz
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum München
- Institute of Preventive Pediatrics, Technische Universität München
| | - Peter Ewert
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum München
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Jan Müller
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum München
- Institute of Preventive Pediatrics, Technische Universität München
| |
Collapse
|
32
|
Hanna SM, Rabea HM, Abdelrahim MEA, Mahmoud HB. Safety and efficacy of candesartan versus valsartan combined with amlodipine on peripheral and central blood pressure. HIPERTENSION Y RIESGO VASCULAR 2024; 41:17-25. [PMID: 38418298 DOI: 10.1016/j.hipert.2023.11.004] [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] [Received: 08/22/2023] [Revised: 10/12/2023] [Accepted: 11/29/2023] [Indexed: 03/01/2024]
Abstract
INTRODUCTION "Amlodipine/valsartan" or "amlodipine/candesartan" combinations represent two effective antihypertensive agents with complementary mechanisms of action. Nevertheless, a study has yet to be done to evaluate the effect of amlodipine/candesartan on central blood pressure and compare it with amlodipine/valsartan combination. To see how "amlodipine plus candesartan combination" reduces peripheral and central blood pressure compared to the most studied combination, "amlodipine plus valsartan". MATERIAL AND METHODS Eighty-six patients were randomized in an open-label, prospective study by 1:1 ratio to two groups. Group I (n=42) received the amlodipine and valsartan combination, and group II (n=44) received the amlodipine and candesartan combination. Peripheral and central blood pressure (CBP) was measured at baseline, at 6 and 12 weeks of follow-up. DISCUSSION Both treatment groups reduced peripheral systolic, diastolic, and mean blood pressure. There was no significant difference between and within both groups. The amlodipine/candesartan combination showed more reduction in peripheral systolic blood pressure (PSBP) after 12 weeks of treatment (p=<0.001). Both groups decreased CBP without significant differences between groups. The amlodipine/candesartan combination showed additional efficacy in decreasing CSBP after 12 weeks (p=<0.001). The two treatment groups did not exert significant efficacy in lowering heart rate (HR) and augmentation index% (AIx%). CONCLUSION To conclude, the amlodipine 10mg/candesartan 16mg combination was non-inferior to the amlodipine 10mg/valsartan 160mg combination in terms of reducing peripheral and CBP over time.
Collapse
Affiliation(s)
- S M Hanna
- Clinical Pharmacist, Cardiovascular Department, Beni-Suef University Hospital, Egypt.
| | - H M Rabea
- Clinical Pharmacy Department, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
| | - M E A Abdelrahim
- Clinical Pharmacy Department, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
| | - H B Mahmoud
- Prof. of Cardiology, Beni-Suef University Hospital, Beni-Suef, Egypt
| |
Collapse
|
33
|
Yaneva-Sirakova T, Zlatancheva G, Karamfiloff K, Traykov L, Petrov I, Vassilev D. The role of periprocedural hemodynamic variables during carotid stenting for the mid-term general mortality in advanced age patients. Folia Med (Plovdiv) 2023; 65:902-908. [PMID: 38351778 DOI: 10.3897/folmed.65.e100100] [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] [Received: 01/09/2023] [Accepted: 05/15/2023] [Indexed: 02/16/2024] Open
Abstract
INTRODUCTION Carotid stenting may produce significant bradycardia and/or hypotension. This may have negative short- and long-term effects for the elderly high-risk patients. Their cerebral hemodynamics is with exhausted adaptive capacity because of the multiple cardiovascular risk factors, advanced age, and significant stenosis.
Collapse
Affiliation(s)
| | - Galina Zlatancheva
- Acibadem City Clinic Cardiovascular Center, Sofia University, Sofia, Bulgaria
| | | | | | - Ivo Petrov
- Acibadem City Clinic Cardiovascular Center, Sofia University, Sofia, Bulgaria
| | - Dobrin Vassilev
- Medica Cor University Hospital, University of Ruse, Ruse, Bulgaria
| |
Collapse
|
34
|
Choudhary MK, Bouquin H, Hytönen J, Koskela JK, Niemelä O, Nevalainen PI, Mustonen J, Pörsti I. Blood Haemoglobin Concentration Is Directly and Independently Related with Pulse Wave Velocity, a Measure of Large Artery Stiffness. J Clin Med 2023; 12:7623. [PMID: 38137695 PMCID: PMC10743951 DOI: 10.3390/jcm12247623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/20/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023] Open
Abstract
High haemoglobin level has been associated with metabolic syndrome, elevated blood pressure (BP), and increased mortality risk. In this cross-sectional study, we investigated the association of blood haemoglobin with haemodynamics in 743 subjects, using whole-body impedance cardiography and pulse wave analysis. The participants were allocated to sex-stratified haemoglobin tertiles with mean values 135, 144, and 154 g/L, respectively. The mean age was similar in all tertiles, while body mass index was higher in the highest versus the lowest haemoglobin tertile. The highest haemoglobin tertile had the highest erythrocyte and leukocyte counts, plasma C-reactive protein, uric acid, renin activity, and aldosterone. The lipid profile was less favourable and insulin sensitivity lower in the highest versus the lowest haemoglobin tertile. Aortic BP, cardiac output, and systemic vascular resistance were similar in all tertiles, while the pulse wave velocity (PWV) was higher in the highest versus the lowest haemoglobin tertile. In linear regression analysis, age (Beta 0.478), mean aortic BP (Beta 0.178), uric acid (Beta 0.150), heart rate (Beta 0.148), and aldosterone-to-renin ratio (Beta 0.123) had the strongest associations with PWV (p < 0.001 for all). Additionally, haemoglobin concentration was an explanatory factory for PWV (Beta 0.070, p = 0.028). To conclude, blood haemoglobin concentration had a small direct and independent association with a measure of large artery stiffness.
Collapse
Affiliation(s)
- Manoj Kumar Choudhary
- Faculty of Medicine and Health Technology, Tampere University, 33014 Tampere, Finland; (M.K.C.); (H.B.); (J.K.K.); (J.M.)
| | - Heidi Bouquin
- Faculty of Medicine and Health Technology, Tampere University, 33014 Tampere, Finland; (M.K.C.); (H.B.); (J.K.K.); (J.M.)
| | - Jere Hytönen
- Faculty of Medicine and Health Technology, Tampere University, 33014 Tampere, Finland; (M.K.C.); (H.B.); (J.K.K.); (J.M.)
| | - Jenni K. Koskela
- Faculty of Medicine and Health Technology, Tampere University, 33014 Tampere, Finland; (M.K.C.); (H.B.); (J.K.K.); (J.M.)
- Department of Internal Medicine, Tampere University Hospital, 33520 Tampere, Finland;
| | - Onni Niemelä
- Department of Laboratory Medicine and Medical Research Unit, Seinäjoki Central Hospital, 60220 Seinäjoki, Finland;
| | - Pasi I. Nevalainen
- Department of Internal Medicine, Tampere University Hospital, 33520 Tampere, Finland;
| | - Jukka Mustonen
- Faculty of Medicine and Health Technology, Tampere University, 33014 Tampere, Finland; (M.K.C.); (H.B.); (J.K.K.); (J.M.)
- Department of Internal Medicine, Tampere University Hospital, 33520 Tampere, Finland;
| | - Ilkka Pörsti
- Faculty of Medicine and Health Technology, Tampere University, 33014 Tampere, Finland; (M.K.C.); (H.B.); (J.K.K.); (J.M.)
- Department of Internal Medicine, Tampere University Hospital, 33520 Tampere, Finland;
| |
Collapse
|
35
|
Yuan W, Zhang Y, Chen L, Liu J, Chen M, Guo T, Wang X, Ma T, Ma Q, Jiang J, Cui M, Dong Y, Song Y, Ma J. Lean body mass positively associate with blood pressure in Chinese adults: the roles of ages and body fat distribution. BMC Public Health 2023; 23:2453. [PMID: 38062411 PMCID: PMC10704775 DOI: 10.1186/s12889-023-17312-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 11/23/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND The relationship between lean body mass (LBM) and blood pressure (BP) is controversial and limited. This study investigated the associations between LBM indexes and BP in adults of different ages and with varying body fat distribution. METHODS The data for the present analysis was obtained from a cross-sectional survey of 1,465 adults (50.7% males) aged 18-70 years conducted in Beijing, China. Regional LBM and fat distribution, including fat mass (FM) and android to gynoid fat ratio (AOI), were assessed using a dual-energy X-ray bone densitometer. Generalized Liner Model (GLM) was employed. Confounders, including age, sex, height, weight, smoking, and alcohol use, were evaluated through questionnaires and physical examinations. RESULTS Males had higher rates of hypertension (11.19% vs. 4.92%) and prehypertension (21.57% vs. 14.59%) than females. The mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 122.04 mmHg and 76.68 mmHg. There were no significant associations between LBM and DBP (p > 0.05). However, arms LBM (β = 1.86, 95% CI: 0.77, 2.94) and trunk LBM (β = 0.37, 95% CI: 0.01, 0.73) were significantly associated with SBP. The association of LBM on DBP was stronger with increasing ages, and stronger in females than in males (p < 0.001). The association between adults' arms LBM and SBP was stronger in the high level FM group (β = 2.74 vs. β = 1.30) and high level AOI group (β = 1.80 vs. β = 2.08). CONCLUSION The influence of LBM on SBP increases with age, particularly after the age twenty years in females. For adults with high FM or high AOI, LBM in the arms, showed a stronger positive predictive association with SBP. This suggests that, in addition to controlling fat content, future efforts to improve cardiovascular health in adults should include the management of LBM (especially in the upper body).
Collapse
Affiliation(s)
- Wen Yuan
- Institute of Child and Adolescent Health, School of Public Health, National Health Commission Key Laboratory of Reproductive Health, Peking University, 38 Xueyuan Rd, Haidian District, Beijing, 100191, China
| | - Yi Zhang
- Institute of Child and Adolescent Health, School of Public Health, National Health Commission Key Laboratory of Reproductive Health, Peking University, 38 Xueyuan Rd, Haidian District, Beijing, 100191, China
| | - Li Chen
- Institute of Child and Adolescent Health, School of Public Health, National Health Commission Key Laboratory of Reproductive Health, Peking University, 38 Xueyuan Rd, Haidian District, Beijing, 100191, China
| | - Jieyu Liu
- Institute of Child and Adolescent Health, School of Public Health, National Health Commission Key Laboratory of Reproductive Health, Peking University, 38 Xueyuan Rd, Haidian District, Beijing, 100191, China
| | - Manman Chen
- Institute of Child and Adolescent Health, School of Public Health, National Health Commission Key Laboratory of Reproductive Health, Peking University, 38 Xueyuan Rd, Haidian District, Beijing, 100191, China
| | - Tongjun Guo
- Institute of Child and Adolescent Health, School of Public Health, National Health Commission Key Laboratory of Reproductive Health, Peking University, 38 Xueyuan Rd, Haidian District, Beijing, 100191, China
| | - Xinxin Wang
- School of Public Health and Management, Key Laboratory of Environmental Factors and Chronic Disease Control, Ningxia Medical University, No.1160, Shengli Street, Xingqing District, 750004, China
| | - Tao Ma
- Institute of Child and Adolescent Health, School of Public Health, National Health Commission Key Laboratory of Reproductive Health, Peking University, 38 Xueyuan Rd, Haidian District, Beijing, 100191, China
| | - Qi Ma
- Institute of Child and Adolescent Health, School of Public Health, National Health Commission Key Laboratory of Reproductive Health, Peking University, 38 Xueyuan Rd, Haidian District, Beijing, 100191, China
| | - Jianuo Jiang
- Institute of Child and Adolescent Health, School of Public Health, National Health Commission Key Laboratory of Reproductive Health, Peking University, 38 Xueyuan Rd, Haidian District, Beijing, 100191, China
| | - Mengjie Cui
- Institute of Child and Adolescent Health, School of Public Health, National Health Commission Key Laboratory of Reproductive Health, Peking University, 38 Xueyuan Rd, Haidian District, Beijing, 100191, China
| | - Yanhui Dong
- Institute of Child and Adolescent Health, School of Public Health, National Health Commission Key Laboratory of Reproductive Health, Peking University, 38 Xueyuan Rd, Haidian District, Beijing, 100191, China.
| | - Yi Song
- Institute of Child and Adolescent Health, School of Public Health, National Health Commission Key Laboratory of Reproductive Health, Peking University, 38 Xueyuan Rd, Haidian District, Beijing, 100191, China.
| | - Jun Ma
- Institute of Child and Adolescent Health, School of Public Health, National Health Commission Key Laboratory of Reproductive Health, Peking University, 38 Xueyuan Rd, Haidian District, Beijing, 100191, China
| |
Collapse
|
36
|
Tokioka S, Nakaya N, Nakaya K, Takase M, Kogure M, Hatanaka R, Chiba I, Kanno I, Nochioka K, Metoki H, Murakami T, Satoh M, Nakamura T, Obara T, Hamanaka Y, Kobayashi T, Uruno A, Sugawara J, N Kodama E, Ogishima S, Izumi Y, Fuse N, Kuriyama S, Tsuji I, Hozawa A. Association of Central Blood Pressure and Carotid Intima Media Thickness with New-Onset Hypertension in People with High Normal Blood Pressure. J Atheroscler Thromb 2023; 30:1905-1916. [PMID: 37407442 DOI: 10.5551/jat.64151] [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: 07/07/2023] Open
Abstract
AIM People with high normal blood pressure (BP) have a higher risk of cardiovascular events than those with normal BP; therefore, progression to hypertension (HT) should be prevented. We aimed to assess the HT risk using central BP and carotid intima media thickness (CIMT) in people with high normal BP. METHODS This prospective cohort study used the Tohoku Medical Megabank Community-Based Project Cohort Study (conducted from 2013 in Miyagi Prefecture in Japan). The participants had a high normal BP, defined as a systolic BP of 120-139 mmHg and diastolic BP <90 mmHg using brachial BP measurement during the baseline survey. The outcome was new-onset HT during the secondary survey, conducted four years after the baseline survey. RESULTS Overall, 4,021 participants with high normal BP during the baseline survey, with an average age of 58.7 years, were included; 1,030 (26%) were diagnosed with new-onset HT during the secondary survey, 3.5±0.7 years after the baseline survey. The multivariable odds ratio (95% confidence interval) for HT in the highest versus lowest quartile of central BP was 1.7 (1.2-2.4, p=0.0030), and that of CIMT was 1.8 (1.4-2.4, p<0.001). Subgroup analysis according to age (<60 and ≥ 60 years) and sex revealed that the central BP was influential in groups with younger age and female individuals; CIMT was influential in all groups. CONCLUSIONS Higher central BP and thicker CIMT at the baseline were correlated with new-onset HT in individuals with high normal BP, independent of brachial systolic BP and other cardiovascular risk factors.
Collapse
Affiliation(s)
| | - Naoki Nakaya
- Tohoku University Graduate School of Medicine
- Tohoku Medical Megabank Organization, Tohoku University
| | - Kumi Nakaya
- Tohoku University Graduate School of Medicine
- Tohoku Medical Megabank Organization, Tohoku University
| | | | - Mana Kogure
- Tohoku University Graduate School of Medicine
- Tohoku Medical Megabank Organization, Tohoku University
| | - Rieko Hatanaka
- Tohoku University Graduate School of Medicine
- Tohoku Medical Megabank Organization, Tohoku University
| | - Ippei Chiba
- Tohoku University Graduate School of Medicine
- Tohoku Medical Megabank Organization, Tohoku University
| | - Ikumi Kanno
- Tohoku University Graduate School of Medicine
- Tohoku Medical Megabank Organization, Tohoku University
| | - Kotaro Nochioka
- Tohoku University Graduate School of Medicine
- Tohoku Medical Megabank Organization, Tohoku University
- Tohoku University Hospital, Tohoku University
| | - Hirohito Metoki
- Tohoku Medical Megabank Organization, Tohoku University
- Tohoku Medical and Pharmaceutical University
| | - Takahisa Murakami
- Tohoku Medical Megabank Organization, Tohoku University
- Tohoku Medical and Pharmaceutical University
| | - Michihiro Satoh
- Tohoku Medical Megabank Organization, Tohoku University
- Tohoku Medical and Pharmaceutical University
| | - Tomohiro Nakamura
- Tohoku University Graduate School of Medicine
- Tohoku Medical Megabank Organization, Tohoku University
| | - Taku Obara
- Tohoku University Graduate School of Medicine
- Tohoku Medical Megabank Organization, Tohoku University
- Tohoku University Hospital, Tohoku University
| | - Yohei Hamanaka
- Tohoku University Graduate School of Medicine
- Tohoku Medical Megabank Organization, Tohoku University
| | - Tomoko Kobayashi
- Tohoku University Graduate School of Medicine
- Tohoku Medical Megabank Organization, Tohoku University
- Tohoku University Hospital, Tohoku University
| | - Akira Uruno
- Tohoku University Graduate School of Medicine
- Tohoku Medical Megabank Organization, Tohoku University
| | - Junichi Sugawara
- Tohoku University Graduate School of Medicine
- Tohoku Medical Megabank Organization, Tohoku University
- Tohoku University Hospital, Tohoku University
- Suzuki Memorial Hospital
| | - Eiichi N Kodama
- Tohoku University Graduate School of Medicine
- Tohoku Medical Megabank Organization, Tohoku University
- Tohoku University Hospital, Tohoku University
| | - Soichi Ogishima
- Tohoku University Graduate School of Medicine
- Tohoku Medical Megabank Organization, Tohoku University
| | - Yoko Izumi
- Tohoku University Graduate School of Medicine
- Tohoku Medical Megabank Organization, Tohoku University
| | - Nobuo Fuse
- Tohoku University Graduate School of Medicine
- Tohoku Medical Megabank Organization, Tohoku University
- Tohoku University Hospital, Tohoku University
| | - Shinichi Kuriyama
- Tohoku University Graduate School of Medicine
- Tohoku Medical Megabank Organization, Tohoku University
- International Research Institute of Disaster Science, Tohoku University
| | - Ichiro Tsuji
- Tohoku University Graduate School of Medicine
- Tohoku Medical Megabank Organization, Tohoku University
| | - Atsushi Hozawa
- Tohoku University Graduate School of Medicine
- Tohoku Medical Megabank Organization, Tohoku University
| |
Collapse
|
37
|
Abdelmegid MAKF, Fouad DA, Beshay NWM, Mahran DG, Shams-Eddin H. Central blood pressure obtained by cuff-based oscillometry as a determinant of left ventricular hypertrophy in hypertensive patients. Blood Press Monit 2023; 28:322-329. [PMID: 37661727 DOI: 10.1097/mbp.0000000000000669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
OBJECTIVE Limited and conflicting data have been reported on the prognostic relevance of central blood pressure (CBP) compared with brachial blood pressure (BP) in the anticipation of hypertension-mediated organ damage and the majority of data derived using applanation tonometry with its known complexities. The objective of the present study was to investigate the diagnostic factors of left ventricular hypertrophy (LVH) with a special highlight on the utility of non-invasive oscillometric CBP measurement and derived hemodynamic indices compared to brachial BP as indicators of LVH. METHODS This cross-sectional study included 300 hypertensive patients (mean age 55.3 years, 61.3% female, 51.7% obese) with a mean duration of hypertension was 5.8 years. They underwent measurement of brachial BP, using a mercury sphygmomanometer, and CBP, using a Mobil-O-Graph, alongside the determination of left ventricular (LV) mass by two-dimensional transthoracic echocardiography. LVH and LV geometric patterns were defined by LV mass index/height 2.7 and relative wall thickness. RESULTS Bivariate then multivariate analysis showed that age, BMI, central systolic BP (SBP), and pulse wave velocity (PWV) were significant determinants of LVH and optimally controlled brachial BP was a significant negative determinant for LVH. Central SBP had an acceptable diagnostic performance to determine LVH in patients with hypertension (AUC = 0.722, 95% confidence interval: 0.618-0.824, SE = 0.21, P -value <0.001). Using one-way ANOVA, a comparison of means among age groups showed that the steady increase in central SBP and PWV with aging was greater among LVH patients than non-LVH patients. CONCLUSION Estimated central SBP using Mobil-O-Graph showed a significantly higher correlation to LVH than brachial SBP values. The consistent increase in central SBP and PWV with aging was greater among LVH patients than non-LVH patients.
Collapse
Affiliation(s)
| | - Doaa A Fouad
- Cardiovascular Medicine Department, Assiut University Heart Hospital, Assiut University
| | - Nardeen W M Beshay
- Cardiovascular Medicine Department, Assiut University Heart Hospital, Assiut University
| | - Dalia G Mahran
- Public health and community medicine department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Hamdy Shams-Eddin
- Cardiovascular Medicine Department, Assiut University Heart Hospital, Assiut University
| |
Collapse
|
38
|
Kim BK. The Efficacy of Single-pill Combination of Olmesartan Medoxomil and Amlodipine Besylate on Office Blood Pressure in Hypertensive Patients who did not Respond to Amlodipine Besylate Monotherapy. Electrolyte Blood Press 2023; 21:45-52. [PMID: 38152599 PMCID: PMC10751208 DOI: 10.5049/ebp.2023.21.2.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/10/2023] [Accepted: 09/28/2023] [Indexed: 12/29/2023] Open
Abstract
Background As combination therapy, switching to single-pill combination (SPC) medication after a short period of monotherapy is helpful because reducing pill numbers can improve patients' adherence to medications. This study was aimed to assess the effect of the single-pill combination (SPC) of olmesartan medoxomil 20 mg and amlodipine besylate 5mg (OLM 20 mg/AML 5 mg) on blood pressure (BP) reduction in hypertensive patients who did not respond to amlodipine besylate 5 mg (AML 5 mg) monotherapy for 4 weeks. Methods This study was a prospective, open-label, multi-center, non-comparative study. Patients whose BP was not got the target BP (≥140 mmHg and if diabetic patients ≥130 mmHg) after 4 weeks treatment with AML 5 mg, were enrolled. AML 5 mg was switched to the SPC (OLM 20 mg/AML 5 mg) treatment for 8 weeks. The primary effectiveness endpoint was the reduction of seated systolic blood pressure (SeSBP) after SPC (OLM 20 mg/AML 5 mg) treatment for 8 weeks. The changes of brachial-ankle pulse wave velocity (baPWV), central BP (CBP), and augmentation index (AIx@75) were evaluated also. Results Forty-seven patients were enrolled (mean age = 52±9 years, 36 men). After the SPC treatment for 8 weeks, SeSBP was reduced from 153±9 mmHg to 131±18 mmHg and seated diastolic BP (SeDBP) from 95±8 mmHg to 81±11 mmHg (p<0.001 and p<0.001, respectively). The reduction of SeSBP/SeDBP were 22 mmHg and 14 mmHg, respectively. The target goal BP achievement rate was 74.5%, and baPWV, CBP, and AIx@75 were improved. Conclusion SPC (OLM 20 mg/AML 5 mg) treatment for 8 weeks was effective in reducing BP, achieving target BP goal, and also improving arterial stiffness in uncontrolled hypertensive patients with AML 5 mg monotherapy.
Collapse
Affiliation(s)
- Byong-kyu Kim
- Division of Cardiology, Department of Internal Medicine, Dongguk University College of Medicine, Gyeongju Hospital, Gyeongju, Republic of Korea
| |
Collapse
|
39
|
Gogiberidze N, Suvorov A, Sultygova E, Sagirova Z, Kuznetsova N, Gognieva D, Chomakhidze P, Frolov V, Bykova A, Mesitskaya D, Novikova A, Kondakov D, Volovchenko A, Omboni S, Kopylov P. Practical Application of a New Cuffless Blood Pressure Measurement Method. PATHOPHYSIOLOGY 2023; 30:586-598. [PMID: 38133143 PMCID: PMC10748083 DOI: 10.3390/pathophysiology30040042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 11/06/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023] Open
Abstract
It would be useful to develop a reliable method for the cuffless measurement of blood pressure (BP), as such a method could be made available anytime and anywhere for the effective screening and monitoring of arterial hypertension. The purpose of this study is to evaluate blood pressure measurements through a CardioQVARK device in clinical practice in different patient groups. METHODS This study involved 167 patients aged 31 to 88 years (mean 64.2 ± 7.8 years) with normal blood pressure, high blood pressure, and compensated high blood pressure. During each session, three routine blood pressure measurements with intervals of 30 s were taken using a sphygmomanometer with an appropriate cuff size, and the mean value was selected for comparison. The measurements were carried out by two observers trained at the same time with a reference sphygmomanometer using a Y-shaped connector. In the minute following the last cuff-based measurements, an electrocardiogram (ECG) with an I-lead and a photoplethysmocardiogram were recorded simultaneously for 3 min with the CardioQVARK device. We compared the systolic and diastolic BP obtained from a cuff-based mercury sphygmomanometer and smartphone-case-based BP device: the CardioQVARK monitor. A statistical analysis plan was developed using the IEEE Standard for Wearable Cuffless Blood Pressure Devices. Bland-Altman plots were used to estimate the precision of cuffless measurements. RESULTS The mean difference between the values defined by CardioQVARK and the cuff-based sphygmomanometer for systolic blood pressure (SBP) was 0.31 ± 3.61, while that for diastolic blood pressure (DBP) was 0.44 ± 3.76. The mean absolute difference (MAD) for SBP was 3.44 ± 2.5 mm Hg, and that for DBP was 3.21 ± 2.82 mm Hg. In the subgroups, the smallest error (less than 3 mm Hg) was observed in the prehypertension group, with a slightly larger error (up to 4 mm Hg) found among patients with a normal blood pressure and stage 1 hypertension. The largest error was found in the stage 2 hypertension group (4-5.5 mm Hg). The largest error was 4.2 mm Hg in the high blood pressure group. We, therefore, did not record an error in excess of 7 mmHg, the upper boundary considered acceptable in the IEEE recommendations. We also did not reach a mean error of 5 mmHg, the upper boundary considered acceptable according to the very recent ESH recommendations. At the same time, in all groups of patients, the systolic blood pressure was determined with an error of less than 5 mm Hg in more than 80% of patients. While this study shows that the CardioQVARK device meets the standards of IEEE, the Bland-Altman analysis indicates that the cuffless measurement of diastolic blood pressure has significant bias. The difference was very small and unlikely to be of clinical relevance for the individual patient, but it may well have epidemiological relevance on a population level. Therefore, the CardioQVARK device, while being worthwhile for monitoring patients over time, may not be suitable for screening purposes. Cuffless blood pressure measurement devices are emerging as a convenient and tolerable alternative to cuff-based devices. However, there are several limitations to cuffless blood pressure measurement devices that should be considered. For instance, this study showed a high proportion of measurements with a measurement error of <5 mmHg, while detecting a small, although statistically significant, bias in the measurement of diastolic blood pressure. This suggests that this device may not be suitable for screening purposes. However, its value for monitoring BP over time is confirmed. Furthermore, and most importantly, the easy measurement method and the device portability (integrated in a smartphone) may increase the self-awareness of hypertensive patients and, potentially, lead to an improved adherence to their treatment. CONCLUSION The cuffless blood pressure technology developed in this study was tested in accordance with the IEEE protocol and showed great precision in patient groups with different blood pressure ranges. This approach, therefore, has the potential to be applied in clinical practice.
Collapse
Affiliation(s)
- Nana Gogiberidze
- Department of Cardiology, Functional and Ultrasound Diagnostics of N.V. Sklifosovsky Institute for Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (Z.S.); (D.G.); (P.C.); (A.B.); (D.M.); (A.N.); (D.K.); (A.V.); (S.O.); (P.K.)
| | - Aleksandr Suvorov
- World-Class Research Center “Digital Biodesign and Personalized Healthcare”, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (A.S.); (E.S.); (N.K.)
| | - Elizaveta Sultygova
- World-Class Research Center “Digital Biodesign and Personalized Healthcare”, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (A.S.); (E.S.); (N.K.)
| | - Zhanna Sagirova
- Department of Cardiology, Functional and Ultrasound Diagnostics of N.V. Sklifosovsky Institute for Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (Z.S.); (D.G.); (P.C.); (A.B.); (D.M.); (A.N.); (D.K.); (A.V.); (S.O.); (P.K.)
| | - Natalia Kuznetsova
- World-Class Research Center “Digital Biodesign and Personalized Healthcare”, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (A.S.); (E.S.); (N.K.)
| | - Daria Gognieva
- Department of Cardiology, Functional and Ultrasound Diagnostics of N.V. Sklifosovsky Institute for Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (Z.S.); (D.G.); (P.C.); (A.B.); (D.M.); (A.N.); (D.K.); (A.V.); (S.O.); (P.K.)
- World-Class Research Center “Digital Biodesign and Personalized Healthcare”, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (A.S.); (E.S.); (N.K.)
| | - Petr Chomakhidze
- Department of Cardiology, Functional and Ultrasound Diagnostics of N.V. Sklifosovsky Institute for Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (Z.S.); (D.G.); (P.C.); (A.B.); (D.M.); (A.N.); (D.K.); (A.V.); (S.O.); (P.K.)
- World-Class Research Center “Digital Biodesign and Personalized Healthcare”, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (A.S.); (E.S.); (N.K.)
| | - Victor Frolov
- Medical Center for Premorbid and Emergency Conditions, P.V. Mandryka Central Military Clinical Hospital, 121002 Moscow, Russia;
| | - Aleksandra Bykova
- Department of Cardiology, Functional and Ultrasound Diagnostics of N.V. Sklifosovsky Institute for Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (Z.S.); (D.G.); (P.C.); (A.B.); (D.M.); (A.N.); (D.K.); (A.V.); (S.O.); (P.K.)
| | - Dinara Mesitskaya
- Department of Cardiology, Functional and Ultrasound Diagnostics of N.V. Sklifosovsky Institute for Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (Z.S.); (D.G.); (P.C.); (A.B.); (D.M.); (A.N.); (D.K.); (A.V.); (S.O.); (P.K.)
| | - Alena Novikova
- Department of Cardiology, Functional and Ultrasound Diagnostics of N.V. Sklifosovsky Institute for Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (Z.S.); (D.G.); (P.C.); (A.B.); (D.M.); (A.N.); (D.K.); (A.V.); (S.O.); (P.K.)
| | - Danila Kondakov
- Department of Cardiology, Functional and Ultrasound Diagnostics of N.V. Sklifosovsky Institute for Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (Z.S.); (D.G.); (P.C.); (A.B.); (D.M.); (A.N.); (D.K.); (A.V.); (S.O.); (P.K.)
| | - Alexey Volovchenko
- Department of Cardiology, Functional and Ultrasound Diagnostics of N.V. Sklifosovsky Institute for Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (Z.S.); (D.G.); (P.C.); (A.B.); (D.M.); (A.N.); (D.K.); (A.V.); (S.O.); (P.K.)
| | - Stefano Omboni
- Department of Cardiology, Functional and Ultrasound Diagnostics of N.V. Sklifosovsky Institute for Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (Z.S.); (D.G.); (P.C.); (A.B.); (D.M.); (A.N.); (D.K.); (A.V.); (S.O.); (P.K.)
- Italian Institute of Telemedicine, Via Colombera 29, 21048 Solbiate Arno, Varese, Italy
| | - Philippe Kopylov
- Department of Cardiology, Functional and Ultrasound Diagnostics of N.V. Sklifosovsky Institute for Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (Z.S.); (D.G.); (P.C.); (A.B.); (D.M.); (A.N.); (D.K.); (A.V.); (S.O.); (P.K.)
- World-Class Research Center “Digital Biodesign and Personalized Healthcare”, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (A.S.); (E.S.); (N.K.)
| |
Collapse
|
40
|
Kim HL, Joh HS, Lim WH, Seo JB, Kim SH, Zo JH, Kim MA. Association between invasively measured central aortic pulse pressure and diameter of ascending aorta. Sci Rep 2023; 13:21152. [PMID: 38036600 PMCID: PMC10689808 DOI: 10.1038/s41598-023-48597-1] [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] [Received: 08/14/2023] [Accepted: 11/28/2023] [Indexed: 12/02/2023] Open
Abstract
Data on the relationship between arterial pulsatile hemodynamics and aortic root geometry, using invasive hemodynamic measurement, has been scarce. Thus, this study aimed to assess the relationship between invasively measured aortic pulse pressure (aPP) and the diameter of ascending aorta (AoD). We analyzed 665 subjects (64.3 ± 11.0 years; 34.6% female) who underwent elective invasive coronary angiography (ICA) for the evaluation of coronary artery disease. Transthoracic echocardiography was performed on the same day, and AoD was measured at the level of 1 cm above the sinotubular junction at the end-diastole. Body surface area (BSA)-adjusted AoD (AoD/BSA) was used for the analysis. A pig-tail catheter was used to measure aortic pressures at a level approximately 3 cm above the aortic valve just before ICA. aPP was calculated as the difference between systolic and diastolic pressures of the aorta. In multiple linear regression analyses, aPP (β = 0.259; P < 0.001) was found to be significantly correlated with AoD/BSA even after controlling for potential confounders. This correlation power was stronger than aortic systolic pressure (β = 0.189; P < 0.001) and brachial pulse pressure (β = 0.091; P = 0.018) at the same multivariable analyses. In conclusion, our study demonstrated a significant association between invasively measured aPP and AoD/BSA, providing stronger evidence for the link between central aortic pulsatile hemodynamics and aortic root geometry.
Collapse
Affiliation(s)
- Hack-Lyoung Kim
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, 5 Boramae-Ro, Dongjak-Gu, Seoul, 07061, Republic of Korea.
| | - Hyun Sung Joh
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, 5 Boramae-Ro, Dongjak-Gu, Seoul, 07061, Republic of Korea
| | - Woo-Hyun Lim
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, 5 Boramae-Ro, Dongjak-Gu, Seoul, 07061, Republic of Korea
| | - Jae-Bin Seo
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, 5 Boramae-Ro, Dongjak-Gu, Seoul, 07061, Republic of Korea
| | - Sang-Hyun Kim
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, 5 Boramae-Ro, Dongjak-Gu, Seoul, 07061, Republic of Korea
| | - Joo-Hee Zo
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, 5 Boramae-Ro, Dongjak-Gu, Seoul, 07061, Republic of Korea
| | - Myung-A Kim
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, 5 Boramae-Ro, Dongjak-Gu, Seoul, 07061, Republic of Korea
| |
Collapse
|
41
|
Gbaoui L, Hoeschen C, Kaniusas E, Khatib S, Gretschel S, Wellnhofer E. Estimation of central blood pressure waveform from femoral blood pressure waveform by blind sources separation. Front Cardiovasc Med 2023; 10:1280899. [PMID: 38045918 PMCID: PMC10690369 DOI: 10.3389/fcvm.2023.1280899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/24/2023] [Indexed: 12/05/2023] Open
Abstract
Background Central blood pressure (cBP) is a better indicator of cardiovascular morbidity and mortality than peripheral BP (pBP). However, direct cBP measurement requires invasive techniques and indirect cBP measurement is based on rigid and empirical transfer functions applied to pBP. Thus, development of a personalized and well-validated method for non-invasive derivation of cBP from pBP is necessary to facilitate the clinical routine. The purpose of the present study was to develop a novel blind source separation tool to separate a single recording of pBP into their pressure waveforms composing its dynamics, to identify the compounds that lead to pressure waveform distortion at the periphery, and to estimate the cBP. The approach is patient-specific and extracts the underlying blind pressure waveforms in pBP without additional brachial cuff calibration or any a priori assumption on the arterial model. Methods The intra-arterial femoral BPfe and intra-aortic pressure BPao were anonymized digital recordings from previous routine cardiac catheterizations of eight patients at the German Heart Centre Berlin. The underlying pressure waveforms in BPfe were extracted by the single-channel independent component analysis (SCICA). The accuracy of the SCICA model to estimate the whole cBP waveform was evaluated by the mean absolute error (MAE), the root mean square error (RMSE), the relative RMSE (RRMSE), and the intraclass correlation coefficient (ICC). The agreement between the intra-aortic and estimated parameters including systolic (SBP), diastolic (DBP), mean arterial pressure (MAP), and pulse pressure (PP) was evaluated by the regression and Bland-Altman analyses. Results The SCICA tool estimated the cBP waveform non-invasively from the intra-arterial BPfe with an MAE of 0.159 ± 1.629, an RMSE of 5.153 ± 0.957 mmHg, an RRMSE of 5.424 ± 1.304%, and an ICC of 0.94, as well as two waveforms contributing to morphological distortion at the femoral artery. The regression analysis showed a strong linear trend between the estimated and intra-aortic SBP, DBP, MAP, and PP with high coefficient of determination R2 of 0.98, 0.99, 0.99, and 0.97 respectively. The Bland-Altman plots demonstrated good agreement between estimated and intra-aortic parameters with a mean error and a standard deviation of difference of -0.54 ± 2.42 mmHg [95% confidence interval (CI): -5.28 to 4.20] for SBP, -1.97 ± 1.62 mmHg (95% CI: -5.14 to 1.20) for DBP, -1.49 ± 1.40 mmHg (95% CI: -4.25 to 1.26) for MAP, and 1.43 ± 2.79 mmHg (95% CI: -4.03 to 6.90) for PP. Conclusions The SCICA approach is a powerful tool that identifies sources contributing to morphological distortion at peripheral arteries and estimates cBP.
Collapse
Affiliation(s)
- Laila Gbaoui
- Chair of Medical System Technology, Institute for Medical Instrumentation, Otto von Guericke University, Magdeburg, Germany
| | - Christoph Hoeschen
- Chair of Medical System Technology, Institute for Medical Instrumentation, Otto von Guericke University, Magdeburg, Germany
| | - Eugenijus Kaniusas
- Institute of Biomedical Electronics, Vienna University of Technology (TU Wien), Vienna, Austria
| | - Saher Khatib
- Department of General, Visceral-, Thoracic and Vascular Surgery, University Hospital of Ruppin-Brandenburg, Neuruppin, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Fontane, Neuruppin, Germany
| | - Stephan Gretschel
- Department of General, Visceral-, Thoracic and Vascular Surgery, University Hospital of Ruppin-Brandenburg, Neuruppin, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Fontane, Neuruppin, Germany
| | - Ernst Wellnhofer
- Institute of Computer-Assisted Cardiovascular Medicine, Charité, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| |
Collapse
|
42
|
Xiao H, Song W, Liu C, Peng B, Zhu M, Jiang B, Liu Z. Reconstruction of central arterial pressure waveform based on CBi-SAN network from radial pressure waveform. Artif Intell Med 2023; 145:102683. [PMID: 37925212 DOI: 10.1016/j.artmed.2023.102683] [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] [Received: 06/12/2022] [Revised: 05/30/2023] [Accepted: 10/06/2023] [Indexed: 11/06/2023]
Abstract
The central arterial pressure (CAP) is an important physiological indicator of the human cardiovascular system which represents one of the greatest threats to human health. Accurate non-invasive detection and reconstruction of CAP waveforms are crucial for the reliable treatment of cardiovascular system diseases. However, the traditional methods are reconstructed with relatively low accuracy, and some deep learning neural network models also have difficulty in extracting features, as a result, these methods have potential for further advancement. In this study, we proposed a novel model (CBi-SAN) to implement an end-to-end relationship from radial artery pressure (RAP) waveform to CAP waveform, which consisted of the convolutional neural network (CNN), the bidirectional long-short-time memory network (BiLSTM), and the self-attention mechanism to improve the performance of CAP reconstruction. The data on invasive measurements of CAP and RAP waveform were used in 62 patients before and after medication to develop and validate the performance of CBi-SAN model for reconstructing CAP waveform. We compared it with traditional methods and deep learning models in mean absolute error (MAE), root mean square error (RMSE), and Spearman correlation coefficient (SCC). Study results indicated the CBi-SAN model performed great performance on CAP waveform reconstruction (MAE: 2.23 ± 0.11 mmHg, RMSE: 2.21 ± 0.07 mmHg), concurrently, the best reconstruction effect was obtained in the central artery systolic pressure (CASP) and the central artery diastolic pressure(CADP) (RMSECASP: 2.94 ± 0.48 mmHg, RMSECADP: 1.96 ± 0.06 mmHg). These results implied the performance of the CAP reconstruction based on CBi-SAN model was superior to the existing methods, hopped to be effectively applied to clinical practice in the future.
Collapse
Affiliation(s)
- Hanguang Xiao
- College of Artificial Intelligent, Chongqing University of Technology, Chongqing 401135, China.
| | - Wangwang Song
- College of Artificial Intelligent, Chongqing University of Technology, Chongqing 401135, China
| | - Chang Liu
- College of Artificial Intelligent, Chongqing University of Technology, Chongqing 401135, China
| | - Bo Peng
- College of Artificial Intelligent, Chongqing University of Technology, Chongqing 401135, China
| | - Mi Zhu
- College of Artificial Intelligent, Chongqing University of Technology, Chongqing 401135, China
| | - Bin Jiang
- College of Artificial Intelligent, Chongqing University of Technology, Chongqing 401135, China
| | - Zhi Liu
- College of Artificial Intelligent, Chongqing University of Technology, Chongqing 401135, China.
| |
Collapse
|
43
|
Hotek JC, Detwiler TJ, Chirinos JA, Regan CP. A generalized canine transfer function accurately reconstructs central aortic pressure waveforms to enable enhanced pulse wave analysis. J Pharmacol Toxicol Methods 2023; 124:107476. [PMID: 37931824 DOI: 10.1016/j.vascn.2023.107476] [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] [Received: 07/06/2023] [Revised: 09/20/2023] [Accepted: 11/02/2023] [Indexed: 11/08/2023]
Abstract
Routine preclinical blood pressure evaluation is an important risk assessment tool. Although proximal aortic pressure is most relevant for key target organs, abdominal aortic pressures are more commonly recorded. Pulse pressure amplification and waveform distortion in abdominal waveforms make it inappropriate for central hemodynamic analytical methods without the use of a mathematical transfer function. Clinical transfer functions have been developed to estimate ascending aortic waveforms from brachial or radial artery waveforms in humans, but no preclinical analogues exist. The aim of this study was to develop a canine-specific transfer function to reconstruct thoracic aortic pressure waveforms from abdominal aortic data to enable the application of central hemodynamic analytical methods. Simultaneous abdominal and thoracic blood pressures were recorded from seven conscious, male beagle dogs administered 3 well-characterized pharmacologic standards and animals were appointed to a training (n = 3) or validation (n = 4) group at baseline and during dosing. A generalized transfer function was developed from the training group data and evaluated for its ability to synthesize thoracic pressure waves in the training and validation groups. Select hemodynamic parameters were evaluated in measured and synthesized thoracic data. There was a high degree of correlation between measured and synthesized thoracic parameters (r2 = 0.74-0.99). There was no difference between indices computed from synthesized or actual thoracic waveforms at baseline or after administration of pharmacologic standards. This work demonstrates that a generalized preclinical transfer function can reproduce thoracic pressure waves across a range of hemodynamic responses thus enabling the application of central hemodynamic analytical methods.
Collapse
Affiliation(s)
- Julia C Hotek
- Safety & Exploratory Pharmacology (SEP), Merck & Co., Inc., Rahway, NJ, USA.
| | | | - Julio A Chirinos
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | |
Collapse
|
44
|
Brasil S, de Carvalho Nogueira R, Salinet ÂSM, Yoshikawa MH, Teixeira MJ, Paiva W, Malbouisson LMS, Bor-Seng-Shu E, Panerai RB. Critical Closing Pressure and Cerebrovascular Resistance Responses to Intracranial Pressure Variations in Neurocritical Patients. Neurocrit Care 2023; 39:399-410. [PMID: 36869208 PMCID: PMC10541829 DOI: 10.1007/s12028-023-01691-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 01/31/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND Critical closing pressure (CrCP) and resistance-area product (RAP) have been conceived as compasses to optimize cerebral perfusion pressure (CPP) and monitor cerebrovascular resistance, respectively. However, for patients with acute brain injury (ABI), the impact of intracranial pressure (ICP) variability on these variables is poorly understood. The present study evaluates the effects of a controlled ICP variation on CrCP and RAP among patients with ABI. METHODS Consecutive neurocritical patients with ICP monitoring were included along with transcranial Doppler and invasive arterial blood pressure monitoring. Internal jugular veins compression was performed for 60 s for the elevation of intracranial blood volume and ICP. Patients were separated in groups according to previous intracranial hypertension severity, with either no skull opening (Sk1), neurosurgical mass lesions evacuation, or decompressive craniectomy (DC) (patients with DC [Sk3]). RESULTS Among 98 included patients, the correlation between change (Δ) in ICP and the corresponding ΔCrCP was strong (group Sk1 r = 0.643 [p = 0.0007], group with neurosurgical mass lesions evacuation r = 0.732 [p < 0.0001], and group Sk3 r = 0.580 [p = 0.003], respectively). Patients from group Sk3 presented a significantly higher ΔRAP (p = 0.005); however, for this group, a higher response in mean arterial pressure (change in mean arterial pressure p = 0.034) was observed. Exclusively, group Sk1 disclosed reduction in ICP before internal jugular veins compression withholding. CONCLUSIONS This study elucidates that CrCP reliably changes in accordance with ICP, being useful to indicate ideal CPP in neurocritical settings. In the early days after DC, cerebrovascular resistance seems to remain elevated, despite exacerbated arterial blood pressure responses in efforts to maintain CPP stable. Patients with ABI with no need of surgical procedures appear to remain with more effective ICP compensatory mechanisms when compared with those who underwent neurosurgical interventions.
Collapse
Affiliation(s)
- Sérgio Brasil
- Division of Neurosurgery, Department of Neurology, School of Medicine, University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 255, São Paulo, Brazil.
| | - Ricardo de Carvalho Nogueira
- Division of Neurosurgery, Department of Neurology, School of Medicine, University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 255, São Paulo, Brazil
| | - Ângela Salomão Macedo Salinet
- Division of Neurosurgery, Department of Neurology, School of Medicine, University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 255, São Paulo, Brazil
| | - Márcia Harumy Yoshikawa
- Division of Neurosurgery, Department of Neurology, School of Medicine, University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 255, São Paulo, Brazil
| | - Manoel Jacobsen Teixeira
- Division of Neurosurgery, Department of Neurology, School of Medicine, University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 255, São Paulo, Brazil
| | - Wellingson Paiva
- Division of Neurosurgery, Department of Neurology, School of Medicine, University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 255, São Paulo, Brazil
| | | | - Edson Bor-Seng-Shu
- Division of Neurosurgery, Department of Neurology, School of Medicine, University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 255, São Paulo, Brazil
| | - Ronney B Panerai
- Department of Cardiovascular Sciences, School of Life Sciences, University of Leicester, Leicester, UK
- National Institute for Health and Care Research, Cardiovascular Research Centre, Glenfield Hospital, University of Leicester, Leicester, UK
| |
Collapse
|
45
|
Sturla F, Caimi A, Romarowski RM, Nano G, Glauber M, Redaelli A, Votta E, Marrocco-Trischitta MM. Fast Approximate Quantification of Endovascular Stent Graft Displacement Forces in the Bovine Aortic Arch Variant. J Endovasc Ther 2023; 30:756-768. [PMID: 35588222 PMCID: PMC10503258 DOI: 10.1177/15266028221095403] [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] [Indexed: 11/16/2022]
Abstract
PURPOSE Displacement forces (DFs) identify hostile landing zones for stent graft deployment in thoracic endovascular aortic repair (TEVAR). However, their use in TEVAR planning is hampered by the need for time-expensive computational fluid dynamics (CFD). We propose a novel fast-approximate computation of DFs merely exploiting aortic arch anatomy, as derived from the computed tomography (CT) and a measure of central aortic pressure. MATERIALS AND METHODS We tested the fast-approximate approach against CFD gold-standard in 34 subjects with the "bovine" aortic arch variant. For each dataset, a 3-dimensional (3D) model of the aortic arch lumen was reconstructed from computed tomography angiography and CFD then employed to compute DFs within the aortic proximal landing zones. To quantify fast-approximate DFs, the wall shear stress contribution to the DF was neglected and blood pressure space-distribution was averaged on the entire aortic wall to reliably approximate the patient-specific central blood pressure. Also, DF values were normalized on the corresponding proximal landing zone area to obtain the equivalent surface traction (EST). RESULTS Fast-approximate approach consistently reflected (r2=0.99, p<0.0001) the DF pattern obtained by CFD, with a -1.1% and 0.7° bias in DFs magnitude and orientation, respectively. The normalized EST progressively increased (p<0.0001) from zone 0 to zone 3 regardless of the type of arch, with proximal landing zone 3 showing significantly greater forces than zone 2 (p<0.0001). Upon DF normalization to the corresponding aortic surface, fast-approximate EST was decoupled in blood pressure and a dimensionless shape vector (S) reflecting aortic arch morphology. S showed a zone-specific pattern of orientation and proved a valid biomechanical blueprint of DF impact on the thoracic aortic wall. CONCLUSION Requiring only a few seconds and quantifying clinically relevant biomechanical parameters of proximal landing zones for arch TEVAR, our method suits the real preoperative decision-making process. It paves the way toward analyzing large population of patients and hence to define threshold values for a future patient-specific preoperative TEVAR planning.
Collapse
Affiliation(s)
- Francesco Sturla
- 3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Italy
- Department of Electronics Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Alessandro Caimi
- Department of Electronics Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Rodrigo M. Romarowski
- 3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Giovanni Nano
- Vascular Surgery Unit, Cardiovascular Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy
| | - Mattia Glauber
- Minimally Invasive Cardiac Surgery Unit, Istituto Clinico Sant’Ambrogio, Milano, Italy
| | - Alberto Redaelli
- Department of Electronics Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Emiliano Votta
- 3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Italy
- Department of Electronics Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Massimiliano M. Marrocco-Trischitta
- Vascular Surgery Unit, Cardiovascular Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
- Clinical Research Unit, Cardiovascular Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| |
Collapse
|
46
|
Tao Q, Liu S, Zhang J, Jiang J, Jin Z, Huang Y, Liu X, Lin S, Zeng X, Li X, Tao G, Chen H. Clinical applications of smart wearable sensors. iScience 2023; 26:107485. [PMID: 37636055 PMCID: PMC10448028 DOI: 10.1016/j.isci.2023.107485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
Abstract
Smart wearable sensors are electronic devices worn on the body that collect, process, and transmit various physiological data. Compared to traditional devices, their advantages in terms of portability and comfort have made them increasingly important in the medical field. This review takes a unique clinical physician's standpoint, diverging from conventional sensor-type-based classifications, and provides a comprehensive overview of the diverse clinical applications of wearable sensors in recent years. In this review, we categorize these applications according to different diseases, encompassing skin diseases and injuries, cardiovascular diseases, abnormal human motion, as well as endocrine and metabolic disorders. Additionally, we discuss the challenges and perspectives hindering the development of sensors for clinical use, emphasizing the critical need for interdisciplinary collaboration between medical and engineering professionals. Overall, this review would serve as an important reference for the future direction of sensor devices in clinical use.
Collapse
Affiliation(s)
- Qingxiao Tao
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Suwen Liu
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Jingyu Zhang
- Department of Dermatology, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen 518052, China
- Shenzhen University Medical School, Shenzhen 518060, China
| | - Jian Jiang
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Zilin Jin
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Yuqiong Huang
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Xin Liu
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Shiying Lin
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Xin Zeng
- Department of Dermatology, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen 518052, China
| | - Xuemei Li
- Department of Dermatology, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen 518052, China
| | - Guangming Tao
- Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan 430074, China
- State Key Laboratory of Material Processing and Die & Mould Technology, School of Materials Science and Engineering, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Hongxiang Chen
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Department of Dermatology, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen 518052, China
| |
Collapse
|
47
|
Guimarães Filho GC, de Oliveira Vitorino PV, Inuzuka S, Barroso AS, Pacífico Alves Filho RP, Melo VA, de Oliveira Urzeda LF, Lima Sousa AL, Coca A, Veiga Jardim PCB, Barroso WKS. Pharmacological treatment of hypertension guided by peripheral or central blood pressure: a comparison between the two strategies. Front Cardiovasc Med 2023; 10:1247146. [PMID: 37771662 PMCID: PMC10525392 DOI: 10.3389/fcvm.2023.1247146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 08/28/2023] [Indexed: 09/30/2023] Open
Abstract
Background Arterial hypertension treatment guided by central blood pressures (CPB) rather than peripheral blood pressures (PBP) measurement has the potential to show greater effectiveness in preventing or even regressing stiffness and target organ damage (TOD). Objective This study aimed to compare the parameters of CBP and PBP measurements, arterial stiffness, TOD and renal profile in patients with anti-hypertensive treatment guided by CBP or PBP targets. Methods A randomized clinical trial was conducted in central group (CG) and peripheral group (PG). Patients were randomized, evaluated every 3 months for BP and antihypertensive adjustments during a one-year follow up. The procedures in V1 and V5: anthropometric assessment; CBP/PBP measurements, carotid ultrasound; echocardiography; laboratory tests. Paired and unpaired t-tests and the χ2 were used (significance level: 5%). Results The study evaluated 59 participants (30CG/29PG). The augmentation index (AIx) was higher in the CG (27.3% vs. 20.3%, p = 0.041). Intergroup analysis has found central diastolic BP lower in the CG (78.9 vs. 84.3 mmHg, p = 0.024) and the Alx difference between groups ceased to exist after a one-year follow-up. Intragroup comparisons, after intervention, showed a lower frequency of changed PWV (p < 0.001) and LVMI (p = 0.018) in the CG. The PG showed a higher frequency of changed PWV (p < 0.001) and LVMI (p = 0.003). Conclusion The intervention guided by central BP reduced the central diastolic BP and AIx compared to the PG. There was a reduction in the frequency of changed PWV and LVMI in the CG.
Collapse
Affiliation(s)
- Gilberto Campos Guimarães Filho
- Hypertension League and Graduate Program, Department of Cardiology, Medicine School Federal University of Goiás, Goiânia, Brazil
| | | | - Sayuri Inuzuka
- Hypertension League and Graduate Program, Department of Cardiology, Medicine School Federal University of Goiás, Goiânia, Brazil
| | - Adriana Sebba Barroso
- Hypertension League and Graduate Program, Department of Cardiology, Medicine School Federal University of Goiás, Goiânia, Brazil
| | | | - Victoria Alves Melo
- Hypertension League and Graduate Program, Department of Cardiology, Medicine School Federal University of Goiás, Goiânia, Brazil
| | - Luiz Fernando de Oliveira Urzeda
- Hypertension League and Graduate Program, Department of Cardiology, Medicine School Federal University of Goiás, Goiânia, Brazil
| | - Ana Luiza Lima Sousa
- Hypertension League and Graduate Program, Department of Cardiology, Medicine School Federal University of Goiás, Goiânia, Brazil
| | - Antonio Coca
- Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clínic (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Paulo César Brandão Veiga Jardim
- Hypertension League and Graduate Program, Department of Cardiology, Medicine School Federal University of Goiás, Goiânia, Brazil
| | - Weimar Kunz Sebba Barroso
- Hypertension League and Graduate Program, Department of Cardiology, Medicine School Federal University of Goiás, Goiânia, Brazil
| |
Collapse
|
48
|
Khwaounjoo P, Dixon AW, HajiRassouliha A, Lam Po Tang EJ, Webster MWI, Taberner AJ, Nielsen PMF, Nash MP, Cakmak YO. Non-contact quantification of aortic stenosis and mitral regurgitation using carotid waveforms from skin displacements. Physiol Meas 2023; 44:095001. [PMID: 37478870 DOI: 10.1088/1361-6579/ace9ac] [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] [Received: 02/16/2023] [Accepted: 07/21/2023] [Indexed: 07/23/2023]
Abstract
Objective. Early diagnosis of heart problems is essential for improving patient prognosis.Approach. We created a non-contact imaging system that calculates the vessel-induced deformation of the skin to estimate the carotid artery pressure displacement waveforms. We present a clinical study of the system in patients (n= 27) with no underlying condition, aortic stenosis (AS), or mitral regurgitation (MR).Main results. Displacement waveforms were compared to aortic catheter pressures in the same patients. The morphologies of the pressure and displacement waveforms were found to be similar, and pulse wave analysis metrics, such as our modified reflection indices (RI) and waveform duration proportions, showed no significant differences. Compared with the control group, AS patients displayed a greater proportion of time to peak (p= 0.026 andp= 0.047 for catheter and displacement, respectively), whereas augmentation index (AIx)was greater for the displacement waveform only (p= 0.030). The modified RI for MR (p= 0.047 andp= 0.004 for catheter and displacement, respectively) was lower than in the controls. AS and MR were also significantly different for the proportion of time to peak (p= 0.018 for the catheter measurements), RI (p= 0.045 andp= 0.002 for the catheter and displacement, respectively), and AIx (p= 0.005 for the displacement waveform).Significance. These findings demonstrate the ability of our system to provide insights into cardiac conditions and support further development as a diagnostic/telehealth-based screening tool.
Collapse
Affiliation(s)
- Prashanna Khwaounjoo
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
- Department of Anatomy, University of Otago, Dunedin, New Zealand
| | - Alexander W Dixon
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Amir HajiRassouliha
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Emily J Lam Po Tang
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Mark W I Webster
- Cardiology, Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand
| | - Andrew J Taberner
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
- Department of Engineering Science, The University of Auckland, Auckland, New Zealand
| | - Poul M F Nielsen
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
- Department of Engineering Science, The University of Auckland, Auckland, New Zealand
| | - Martyn P Nash
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
- Department of Engineering Science, The University of Auckland, Auckland, New Zealand
| | - Yusuf O Cakmak
- Department of Anatomy, University of Otago, Dunedin, New Zealand
- Centre for Bioengineering and Nanotechnology, University of Otago, New Zealand
- Centre For Health Systems and Technology, University of Otago, Dunedin, New Zealand
- Brain Health Research Centre, University of Otago, New Zealand
| |
Collapse
|
49
|
Tunedal K, Viola F, Garcia BC, Bolger A, Nyström FH, Östgren CJ, Engvall J, Lundberg P, Dyverfeldt P, Carlhäll CJ, Cedersund G, Ebbers T. Haemodynamic effects of hypertension and type 2 diabetes: Insights from a 4D flow MRI-based personalized cardiovascular mathematical model. J Physiol 2023; 601:3765-3787. [PMID: 37485733 DOI: 10.1113/jp284652] [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] [Received: 04/14/2023] [Accepted: 06/29/2023] [Indexed: 07/25/2023] Open
Abstract
Type 2 diabetes (T2D) and hypertension increase the risk of cardiovascular diseases mediated by whole-body changes to metabolism, cardiovascular structure and haemodynamics. The haemodynamic changes related to hypertension and T2D are complex and subject-specific, however, and not fully understood. We aimed to investigate the haemodynamic mechanisms in T2D and hypertension by comparing the haemodynamics between healthy controls and subjects with T2D, hypertension, or both. For all subjects, we combined 4D flow magnetic resonance imaging data, brachial blood pressure and a cardiovascular mathematical model to create a comprehensive subject-specific analysis of central haemodynamics. When comparing the subject-specific haemodynamic parameters between the four groups, the predominant haemodynamic difference is impaired left ventricular relaxation in subjects with both T2D and hypertension compared to subjects with only T2D, only hypertension and controls. The impaired relaxation indicates that, in this cohort, the long-term changes in haemodynamic load of co-existing T2D and hypertension cause diastolic dysfunction demonstrable at rest, whereas either disease on its own does not. However, through subject-specific predictions of impaired relaxation, we show that altered relaxation alone is not enough to explain the subject-specific and group-related differences; instead, a combination of parameters is affected in T2D and hypertension. These results confirm previous studies that reported more adverse effects from the combination of T2D and hypertension compared to either disease on its own. Furthermore, this shows the potential of personalized cardiovascular models in providing haemodynamic mechanistic insights and subject-specific predictions that could aid in the understanding and treatment planning of patients with T2D and hypertension. KEY POINTS: The combination of 4D flow magnetic resonance imaging data and a cardiovascular mathematical model allows for a comprehensive analysis of subject-specific haemodynamic parameters that otherwise cannot be derived non-invasively. Using this combination, we show that diastolic dysfunction in subjects with both type 2 diabetes (T2D) and hypertension is the main group-level difference between controls, subjects with T2D, subjects with hypertension, and subjects with both T2D and hypertension. These results suggest that, in this relatively healthy population, the additional load of both hypertension and T2D affects the haemodynamic function of the left ventricle, whereas each disease on its own is not enough to cause significant effects under resting conditions. Finally, using the subject-specific model, we show that the haemodynamic effects of diastolic dysfunction alone are not sufficient to explain all the observed haemodynamic differences. Instead, additional subject-specific variations in cardiac and vascular function combine to explain the complex haemodynamics of subjects affected by hypertension and/or T2D.
Collapse
Affiliation(s)
- Kajsa Tunedal
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Federica Viola
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Belén Casas Garcia
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
| | - Ann Bolger
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Fredrik H Nyström
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Carl Johan Östgren
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Division of Prevention, Rehabilitation and Community Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Jan Engvall
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Clinical Physiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Peter Lundberg
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Department of Radiation Physics, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Petter Dyverfeldt
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Carl-Johan Carlhäll
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Clinical Physiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Gunnar Cedersund
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Tino Ebbers
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| |
Collapse
|
50
|
Climie RE, Alastruey J, Mayer CC, Schwarz A, Laucyte-Cibulskiene A, Voicehovska J, Bianchini E, Bruno RM, Charlton PH, Grillo A, Guala A, Hallab M, Hametner B, Jankowski P, Königstein K, Lebedeva A, Mozos I, Pucci G, Puzantian H, Terentes-Printzios D, Yetik-Anacak G, Park C, Nilsson PM, Weber T. Vascular ageing: moving from bench towards bedside. Eur J Prev Cardiol 2023; 30:1101-1117. [PMID: 36738307 PMCID: PMC7614971 DOI: 10.1093/eurjpc/zwad028] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/20/2022] [Accepted: 01/12/2023] [Indexed: 02/05/2023]
Abstract
Prevention of cardiovascular disease (CVD) remains one of the largest public health challenges of our time. Identifying individuals at increased cardiovascular risk at an asymptomatic, sub-clinical stage is of paramount importance for minimizing disease progression as well as the substantial health and economic burden associated with overt CVD. Vascular ageing (VA) involves the deterioration in vascular structure and function over time and ultimately leads to damage in the heart, brain, kidney, and other organs. Vascular ageing encompasses the cumulative effect of all cardiovascular risk factors on the arterial wall over the life course and thus may help identify those at elevated cardiovascular risk, early in disease development. Although the concept of VA is gaining interest clinically, it is seldom measured in routine clinical practice due to lack of consensus on how to characterize VA as physiological vs. pathological and various practical issues. In this state-of-the-art review and as a network of scientists, clinicians, engineers, and industry partners with expertise in VA, we address six questions related to VA in an attempt to increase knowledge among the broader medical community and move the routine measurement of VA a little closer from bench towards bedside.
Collapse
Affiliation(s)
- Rachel E. Climie
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, 7000 Hobart, Australia
- Sports Cardiology, Baker Heart and Diabetes Institute, 99 Commercial Rd, Melbourne 3000, Australia
- Integrative Epidemiology of Cardiovascular Disease, Université de Paris, INSERM, U970, Paris Cardiovascular Research Center (PARCC), 56 rue Leblanc, 75015 Paris, France
| | - Jordi Alastruey
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King’s College London, 249 Westminster Bridge Rd, London SE1 7EH, UK
| | - Christopher C. Mayer
- Medical Signal Analysis, Center for Health & Bioresources, AIT Austrian Institute of Technology, Giefinggasse 4, 1210 Vienna, Austria
| | - Achim Schwarz
- ALF Distribution GmbH, Stephanstrasse 19, 52064 Aachen, Germany
| | - Agne Laucyte-Cibulskiene
- Department of Clinical Sciences, Lund University, Skane University Hospital, Sölvegatan 19 - BMC F12, 221 84 Lund, Malmö, Sweden
- Faculty of Medicine, Vilnius University, M. K. C iurlionio g. 21, 03101 Vilnius, Lithuania
| | - Julija Voicehovska
- Department of Internal Diseases, Riga Stradins University, Dzirciema str. 16, Riga, L-1007, Latvia
- Nephrology and Renal Replacement Therapy Clinics, Riga East University Hospital, Hipokrata str. 2, Riga, LV-1079, Latvia
| | - Elisabetta Bianchini
- Institute of Clinical Physiology, Italian National Research Council (CNR), Via Moruzzi, 1, 56124 Pisa (PI), Italy
| | - Rosa-Maria Bruno
- Integrative Epidemiology of Cardiovascular Disease, Université de Paris, INSERM, U970, Paris Cardiovascular Research Center (PARCC), 56 rue Leblanc, 75015 Paris, France
| | - Peter H. Charlton
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, 2 Worts Causeway, Cambridge CB1 8RN, UK
| | - Andrea Grillo
- Medicina Clinica, Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy
| | - Andrea Guala
- Vall d’Hebron Institut de Recerca (VHIR), Paseo de la Vall d’Hebron, 129, 08035 Barcelona, Spain
| | - Magid Hallab
- Clinique Bizet, 23 Georges Bizet, 75116 Paris, France
| | - Bernhard Hametner
- Medical Signal Analysis, Center for Health & Bioresources, AIT Austrian Institute of Technology, Giefinggasse 4, 1210 Vienna, Austria
| | - Piotr Jankowski
- Department of Internal Medicine and Geriatric Cardiology, Centre of Postgraduate Medical Education, 231 Czerniakowska St., 00-416 Warsaw, Poland
| | - Karsten Königstein
- Department of Sport, Exercise and Health (DSBG) University of Basel, Grosse Allee 6, 4052 Basel, Switzerland
| | - Anna Lebedeva
- Department of Internal Medicine and Cardiology, Dresden Heart Centre, Dresden University of Technology, Fetscher str. 76, 01307 Dresden, Germany
| | - Ioana Mozos
- Department of Functional Sciences-Pathophysiology, Center for Translational Research and Systems Medicine, ‘Victor Babes’ University of Medicine and Pharmacy, T. Vladimirescu Street 14, 300173 Timisoara, Romania
| | - Giacomo Pucci
- Unit of Internal Medicine, Terni University Hospital - Department of Medicine and Surgery, University of Perugia, Terni, Italy
| | - Houry Puzantian
- Hariri School of Nursing, American University of Beirut, P.O. Box 11-0236, Riad El Solh 1107 2020, Beirut, Lebanon
| | - Dimitrios Terentes-Printzios
- First Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, 114 Vasilissis Sofias Avenue, 11527 Athens, Greece
| | - Gunay Yetik-Anacak
- Department of Pharmacology, Faculty of Pharmacy, Acibadem Mehmet Ali Aydinlar University, Kayisdagi Cad. No:32 Atasehir, 34752 Istanbul, Turkey
| | - Chloe Park
- MRC Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London WC1E 7HB, UK; and
| | - Peter M. Nilsson
- Department of Clinical Sciences, Lund University, Skane University Hospital, Sölvegatan 19 - BMC F12, 221 84 Lund, Malmö, Sweden
| | - Thomas Weber
- Cardiology Department, Klinikum Wels-Grieskirchen, Grieskirchnerstrasse 42, 4600 Wels, Austria
| |
Collapse
|