Total vascular resistance, augmentation index, and augmentation pressure increase in patients with peripheral artery disease

Ambulatory blood pressure parameters and their association with albuminuria in adolescents with type 1 diabetes mellitus

BACKGROUND

This study aimed to evaluate the blood pressure (BP) status, including arterial stiffness parameters, hemodynamic indicators, circadian profile, and its association with albuminuria in adolescents with type 1 diabetes mellitus (DM1).

METHODS

The analysis included 46 patients, with diabetes duration of 7.38 ± 3.48 years. Ambulatory blood pressure monitoring (ABPM) was conducted using an oscillometric device, the Mobil-O-Graph, which is a Pulse Wave Analysis Monitor.

RESULTS

Hypertension (HT) was diagnosed in 31 adolescents (67% of patients), primarily due to isolated nocturnal BP (21 cases, 68% of HT cases). The HT group exhibited significantly increased diastolic load (DL). Pulse wave velocity (PWV, a measure of arterial stiffness) values showed a strong correlation with both peripheral systolic BP (r = 0.954) and central systolic BP (r = 0.838). Additionally, non-dipping status was found in 61% of the HT group. Urinary albumin excretion (UAE) was positively correlated with diastolic BP (particularly nocturnal) peripheral and central BP, DL, heart rate, augmentation index (AIx@75), and nocturnal total vascular resistance (TVR). Diastolic non-dippers exhibited a significant increase in UAE.

CONCLUSIONS

Hypertension is a common complication in adolescents with type 1 diabetes mellitus, primarily caused by elevated nocturnal diastolic BP. Albuminuria is mainly associated with diastolic BP, especially during the nocturnal period and in cases of diastolic non-dipping status. The association of UAE with AIx@75 and nocturnal TVR suggests the presence of early-stage vascular disease in diabetic adolescents.

Arterial Stiffness and Ankle-Brachial Index - Cross-Sectional Study of 259 Primary Care Patients ≥50 Year-Old

BACKGROUND Lower-extremity arterial disease (LEAD) is the most common form of peripheral artery disease (PAD), and diagnosis relies on the ankle-brachial index (ABI). The objective of our study was to evaluate the correlation between ABI and arterial stiffness parameters, specifically focusing on PWV. Additionally, we aimed to assess the correlation between PWV and established LEAD risk factors. MATERIAL AND METHODS The study included primary care patients aged ≥50 years. Pulse wave velocity was measured with a Mobil-o-Graph Pulse Wave Analyzer (I.E.M. Germany). Two criteria defined abnormal PWV: 1) universal PWV threshold exceeding 10 m/s (uPWVt) and 2) surpassing an individualized threshold calculated by the device, accounting for sex, age, and blood pressure (iPWVt). RESULTS We assessed PWV in 266 individuals and both PWV and ABI in 259. Overall, 6/259 (2.3%) had a diagnosis of LEAD, 44/259(16.9%) had ABI <0.9, and 97/259 (37.5%) had PWV values above iPWVt. Among patients with Doppler ABI <0.9, 25/44 (56.8%) exhibited elevated iPWVt versus 72/215 (33.5%) in those with ABI ≥0.9 (P=0.003, r=0.18 Spearman's correlation). Among patients with ABI <0.9 19/44 (43.2%) had PWV >iPWVt (P=0.003, r=0.18). We observed significant correlation between elevated PWV (both cutoffs) and hypertension (in both P=0.009, r=0.16) and PWV >uPWVt correlated with the presence of diabetes (P=0.004, r=0.18). CONCLUSIONS Elevated PWV correlates with abnormal ABI and some cardiovascular risk factors in primary care patients aged 50 and above. Use of individualized PWV thresholds, factoring in age, appears to be a preferable approach for assessment of arterial stiffness and early diagnosis of LEAD.

Affected Microcirculation and Vascular Hemodynamics in Takayasu Arteritis

Introduction: Takayasu arteritis (TAK) is a rare inflammatory disease affecting aorta and its major branches. Ultrasound (US) can detect inflammatory features in the arterial wall, but less is known regarding skin microcirculation and vascular hemodynamics. The aim was to study if assessment of these variables could add valuable information regarding vascular affection in TAK.

Methods: 17 patients diagnosed with TAK and 17 age- and sex-matched healthy controls were included. Microcirculatory peak oxygen saturation (OxyP) in the skin after induced ischemia was evaluated with laser Doppler flowmetry/diffuse reflectance spectroscopy. Cerebrovascular reserve capacity (CVR) in the brain was assessed with transcranial Doppler (TCD). Pulse waves were recorded in the radial artery by the aid of applanation tonometry, for calculation of central augmentation index (AIx75). Intima-media thickness (IMT) and stenosis/occlusions were evaluated using US in carotid and central arteries.

Results: Reduced OxyP (79 ± 8% vs. 87 ± 4%, p &lt; 0.001) was seen in patients with TAK regardless of significant arterial stenosis/occlusion or not. Increased AIx75 (22.3 ± 13.6 vs. 9.2 ± 16.3, p = 0.01) was seen in TAK patients without significant stenosis/occlusions. No differences were found in CVR, regardless of proximal stenosis. However, signs of a more high-resistance flow profile were seen in arteria cerebri media.

Conclusion: Regardless of arterial stenosis or not, impaired microcirculation of the skin and preserved CVR in the brain were found in subjects with TAK. Signs of increased arterial stiffness in the brain and central arteries were observed. The value of these findings for prediction of future cardiovascular events needs to be clarified in further studies.