The effects of age on pulse wave velocity in untreated hypertension

The positive association between the atherogenic index of plasma and the risk of new-onset hypertension: a nationwide cohort study in China

BACKGROUND

The atherogenic index of plasma (AIP) is a novel metabolic biomarker of atherosclerosis. Nevertheless, the association between the AIP and new-onset hypertension has not been elucidated in the Chinese population.

METHODS

Prospective data were obtained from 3150 participants aged ≥ 18 years in the China Health and Nutrition Survey from 2009 to 2015. The AIP is a logarithmically transformed ratio of triglycerides to high-density lipoprotein cholesterol in molar concentration. Cox regression analysis was used to determine the association of AIP index with new-onset hypertension.

RESULTS

After the six-year follow-up, 1054 (33.4%) participants developed new-onset hypertension. The participants were divided into AIP quartile groups (Q1-Q4). Compared with those in Q1, subjects in Q3-4 had nearly 1.35 times the risk of new-onset hypertension after full adjustment [Q3: hazard ratio (HR): 1.35, 95% confidence interval (CI): 1.13-1.62; Q4: HR: 1.35, 95% CI: 1.13-1.64]. The risks of new-onset hypertension were nearly 1.30 times higher in subjects in Q2-4 than in subjects in Q1 (p < .01) after the full adjustment when we excluded subjects with diabetes and/or chronic kidney diseases. There was a significant difference [HR (CI): 1.27 (1.04-1.54) vs. 0.90 (0.69-1.18)] when subjects were divided into two groups according to body mass index (BMI) level (<24 vs. ≥24 kg/m2).

CONCLUSIONS

The present study suggested that individuals with a higher AIP index are associated with new-onset hypertension, independent of kidney function and glucose levels. The association was stronger in subjects with normal BMI, which may provide early screening of metabolomics in hypertension prevention.

Arterial stiffness in subclinical atherosclerosis quantified with ultrafast pulse wave velocity measurements: a comparison with a healthy population using propensity score matching

PURPOSE

This study aimed to evaluate changes in ultrafast pulse wave velocity (ufPWV) in individuals with arterial stiffness and subclinical atherosclerosis (subAS), and to provide cutoff values.

METHODS

This retrospective study recruited 231 participants, including 67 patients with subAS. The pulse wave velocity was measured at the beginning and end of systole (PWV-BS and PWVES, respectively) using ultrafast ultrasonography to assess arterial stiffness. The right and left common carotid arteries were measured separately, and laboratory metabolic parameters were also collected. Participants were balanced between groups using propensity score matching (PSM) at a 1:1 ratio, adjusting for age, sex, and waist-to-hip ratio as potential confounders. Cutoff values of ufPWV for monitoring subAS were determined via receiver operating characteristic (ROC) curve analysis.

RESULTS

PWV-ES, unlike PWV-BS, was higher in the subAS subgroup than in the subAS-free group after PSM (all P<0.05). For each 1 m/s increase in left, right, and bilateral mean PWV-ES, the risk of subAS increased by 23% (95% confidence interval [CI], 1.04 to 1.46), 26% (95% CI, 1.07 to 1.52), and 38% (95% CI, 1.12 to 1.72), respectively. According to ROC analyses, predictive potential was found for left PWV-ES (cutoff value=7.910 m/s, P=0.002), right PWV-ES (cutoff value=6.615 m/s, P=0.003), and bilateral mean PWV-ES (cutoff value=7.415 m/s, P<0.001), but not for PWV-BS (all P>0.05).

CONCLUSION

PWV-ES measured using ultrafast ultrasonography was significantly higher in individuals with subAS than in those without. Specific PWV-ES cutoff values showed potential for predicting an increased risk of subAS.

Plasma Metabolome Predicts Aortic Stiffness and Future Risk of Coronary Artery Disease and Mortality After 23 Years of Follow-Up in the General Population

BACKGROUND

Increased aortic stiffness (arteriosclerosis) is associated with early vascular aging independent of age and sex. The underlying mechanisms of early vascular aging remain largely unexplored in the general population. We aimed to investigate the plasma metabolomic profile in aortic stiffness (vascular aging) and associated risk of incident cardiovascular disease and mortality.

METHODS AND RESULTS

We included 6865 individuals from 2 Swedish population-based cohorts. Untargeted plasma metabolomics was performed by liquid-chromatography mass spectrometry. Aortic stiffness was assessed directly by carotid-femoral pulse wave velocity (PWV) and indirectly by augmentation index (AIx@75). A least absolute shrinkage and selection operator (LASSO) regression model was created on plasma metabolites in order to predict aortic stiffness. Associations between metabolite-predicted aortic stiffness and risk of new-onset cardiovascular disease, cardiovascular mortality, and all-cause mortality were calculated. Metabolite-predicted aortic stiffness (PWV and AIx@75) was positively associated particularly with acylcarnitines, dimethylguanidino valeric acid, glutamate, and cystine. The plasma metabolome predicted aortic stiffness (PWV and AIx@75) with good accuracy (R2=0.27 and R2=0.39, respectively). Metabolite-predicted aortic stiffness (PWV and AIx@75) was significantly correlated with age, sex, systolic blood pressure, body mass index, and low-density lipoprotein. After 23 years of follow-up, metabolite-predicted aortic stiffness (PWV and AIx@75) was significantly associated with increased risk of new-onset coronary artery disease, cardiovascular mortality, and all-cause mortality.

CONCLUSIONS

Aortic stiffness is associated particularly with altered metabolism of acylcarnitines, cystine, and dimethylguanidino valeric acid. These metabolic disturbances predict increased risk of new-onset coronary artery disease, cardiovascular mortality, and all-cause mortality after more than 23 years of follow-up in the general population.

Update on the Use of Pulse Wave Velocity to Measure Age-Related Vascular Changes

PURPOSE OF REVIEW

Pulse wave velocity (PWV) is an important and well-established measure of arterial stiffness that is strongly associated with aging. Age-related alterations in the elastic properties and integrity of arterial walls can lead to cardiovascular disease. PWV measurements play an important role in the early detection of these changes, as well as other cardiovascular disease risk factors, such as hypertension. This review provides a comprehensive summary of the current knowledge of the effects of aging on arterial stiffness, as measured by PWV.

RECENT FINDINGS

This review highlights recent findings showing the applicability of PWV analysis for investigating heart failure, hypertension, and other cardiovascular diseases, as well as cerebrovascular diseases and Alzheimer's disease. It also discusses the clinical implications of utilizing PWV to monitor treatment outcomes, various challenges in implementing PWV assessment in clinical practice, and the development of new technologies, including machine learning and artificial intelligence, which may improve the usefulness of PWV measurements in the future. Measuring arterial stiffness through PWV remains an important technique to study aging, especially as the technology continues to evolve. There is a clear need to leverage PWV to identify interventions that mitigate age-related increases in PWV, potentially improving CVD outcomes and promoting healthy vascular aging.

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.

Physical activity has a stronger correlation with arterial stiffness than strength, balance, or BMI in an older population

Background: Arterial stiffness is associated with an array of debilitating health conditions. While exercise typically has beneficial effects on both arterial stiffness and overall health, more research is needed to understand the associations of different types of fitness indices with arterial stiffness. Aim: To investigate the relationship between balance, strength, cardiovascular fitness and physical activity with arterial stiffness (as measured by pulse wave velocity (PWV)) in older adults. Method: Eighty retirement-village residents (24 males, 56 females, age: 78.2 ± 6.4 years, weight: 69.4 ± 12.5 kg, height: 162.9 ± 8.5 cm) completed the Yale Physical Activity Survey, PWV measurement, 30-s sit-to-stand leg strength test, hand grip strength assessment, 4-stage balance test, and a 6-min walk fitness test. The number of exiting risk factors (smoking, previous heart incidents, previous stroke(s), having hypertension, or taking anti-hypertension medication) were tallied. Pearson's correlations were used to assess the relationship between PWV and health and fitness parameters. Results were interpreted using qualitative inference. Results: The number of risk factors (r = 0.57, p < 0.001), age (r = 0.51, p < 0.001) and systolic blood pressure (r = 0.50, p = 0.001) had strong, harmful associations with PWV. Total physical activity minutes/week (r = -0.31 p = 0.01), total energy expenditure Kcal/week (r = -0.30, p = 0.01), and the 6-min walk test (r = -0.29, p = 0.01) had a moderate, beneficial association with PWV, while sit-to-stand (r = -0.27, p = 0.02) and balance (r = -0.27, p = 0.01) had a weak, beneficial association with PWV. Hand grip strength (r = 0.02, p = 0.94) and body mass index (r = -0.04, p = 0.75) had no significant associations with PWV. Discussion: All measured fitness indices had beneficial associations with PWV. However, having more risk factors, increased age, and higher systolic blood pressure had significant (harmful) associations with PWV in our older population. Conclusion: Controlling cardiovascular risk factors, especially high systolic blood pressure, is likely to have the largest beneficial effect on PWV. Improving general physical activity, including walking capacity, may prove beneficial in improving PWV in an older population.

Brachial-ankle pulse wave velocity increasing with heart rate accelerates

Pulse wave velocity (PWV) indicates the degree of vascular stiffness. This study aimed to explore the association between heart rate (HR) and brachial-ankle (ba)-PWV in patients with pacemaker implantation. This retrospective observational study included patients who underwent permanent pacemaker implantation at the Second Hospital of Hebei Medical University between December 2018 and December 2021. All patients were pacemaker-dependent, and the ba-PWV values were collected during HR setted from 60 to 100 bpm. A total of 68 patients (34 males, aged 65.97 ± 9.90 years) were included in this study. There were significant difference of ba-PWV and diastolic blood pressure (DBP) among different HR (both P < 0.001). After adjusted systolic blood pressure (SBP), DBP, age, and sex, the generalized estimating equation showed ba-PWV was independently associated with HR, with increased HR showed higher coefficient: 70 bpm: β = 42.26 (95% CI: 15.34-69.18, P = 0.002), 80 bpm: β = 84.16 (95% CI: 52.48-115.84, P < 0.001), 90 bpm: β = 129.27 (95% CI: 52.48-115.84, P < 0.001), and 100 bpm: 186.31 (95% CI: 137.02-235.59, P < 0.001). The results demonstrate that changes in HR may affect the ba-PWV, the ba-PWV values tend to be higher when HR accelerates.

Vascular Aging: Assessment and Intervention

Vascular aging represents a collection of structural and functional changes in a blood vessel with advancing age, including increased stiffness, vascular wall remodeling, loss of angiogenic ability, and endothelium-dependent vasodilation dysfunction. These age-related alterations may occur earlier in those who are at risk for or have cardiovascular diseases, therefore, are defined as early or premature vascular aging. Vascular aging contributes independently to cardio-cerebral vascular diseases (CCVDs). Thus, early diagnosis and interventions targeting vascular aging are of paramount importance in the delay or prevention of CCVDs. Here, we review the direct assessment of vascular aging by examining parameters that reflect changes in structure, function, or their compliance with age including arterial wall thickness and lumen diameter, endothelium-dependent vasodilation, arterial stiffness as well as indirect assessment through pathological studies of biomarkers including endothelial progenitor cell, lymphocytic telomeres, advanced glycation end-products, and C-reactive protein. Further, we evaluate how different types of interventions including lifestyle mediation, such as caloric restriction and salt intake, and treatments for hypertension, diabetes, and hyperlipidemia affect age-related vascular changes. As a single parameter or intervention targets only a certain vascular physiological change, it is recommended to use multiple parameters to evaluate and design intervention approaches accordingly to prevent systemic vascular aging in clinical practices or population-based studies.

Using the photoplethysmography method to monitor age-related changes in the cardiovascular system

Introduction: Aging is a physiological process characterized by progressive changes in all organ systems. In the last few decades, the elderly population has been growing, so the scientific community is focusing on the investigation of the aging process, all in order to improve the quality of life in elderly. One of the biggest challenges in studying the impact of the aging on the human body represents the monitoring of the changes that inevitably occur in arterial blood vessels. Therefore, the medical community has invested a great deal of effort in studying and discovering new methods and tools that could be used to monitor the changes in arterial blood vessels caused by the aging process. The goal of our research was to develop a new diagnostic method using a photoplethysmographic sensor and to examine the impact of the aging process on the cardiovascular system in adults. Long-term recorded arterial blood flow waveforms were analyzed using detrended fluctuation analysis. Materials and Methods: The study included 117 respondents, aged 20-70 years. The waveform of the arterial blood flow was recorded for 5 min, with an optical sensor placed above the left common carotid artery, simultaneously with a single-channel ECG. For each cardiac cycle, the blood flow amplitude was determined, and a new time series was formed, which was analyzed non-linearly (DFA method). The values of the scalar coefficients α 1 and α 2, particularly their ratio (α 1/α 2) were obtained, which were then monitored in relation to the age of the subjects. Result: The values of the scalar ratio (α 1/α 2) were significantly different between the subjects older and younger than 50 years. The value of the α 1/α 2 decreased exponentially with the aging. In the population of middle-aged adults, this ratio had a value around 1, in young adults the value was exclusively higher than 1 and in older adults the value was exclusively lower than 1. Conclusion: The results of this study indicated that the aging led to a decrease in the α 1/α 2 in the population of healthy subjects. With this non-invasive method, changes in the cardiovascular system due to aging can be detected and monitored.

Vascular stiffness and healthy arterial aging in older patients with optimal blood pressure

INTRODUCTION

Pulse wave velocity is used to diagnose central arterial stiffness (CAS) and quantify healthy vascular aging (HVA).

OBJECTIVE

To evaluate the CAS and HVA in elderly patients with systemic blood pressure levels classified as optimal/normal.

METHODS

A total of 102 patients without comorbidities and with systolic pressure (SP) < 120 mmHg and diastolic pressure (DP) < 80 mmHg were selected from the EVOPIU database (Pulse Wave Velocity of Elderly Individuals in an Urban area of Brazil). The carotid-femoral pulse wave velocity (c-fPWV) and the central and peripheral pressures were evaluated in all patients. The patients were divided into four groups: G1: (n = 19, with c-fPWV < 7.6 m/s, without medication), G2 (n = 26, c-fPWV ≥ 7.6 m/s; without medication), G3 (n = 25, c-fPWV < 7.6 m/s with antihypertensive medication), and G4 (n = 32, c-fPWV ≥ 7.6 m/s with antihypertensive medication).

RESULTS

In our sample, 56.7% of patients had c-fPWV ≥ 7.6 m/s. The central systolic pressure in G1 [99 (10) mmHg] was lower than that found in the other three groups [vs. 112 (14) mmHg, 111 (15), 112 (20) mmHg; P < 0.05)].

CONCLUSION

Older people with optimal arterial blood pressure do not necessarily have HVA and could have c-fPWV values close to the limits established for CAS diagnosis.

Effect of TNF inhibitors on arterial stiffness and intima media thickness in rheumatoid arthritis: a systematic review and meta-analysis

Controlling inflammation with tumor necrosis factor (TNF) inhibitors in rheumatoid arthritis (RA) patients is hypothesized to reduce their cardiovascular risk. We performed a systematic review and meta-analysis on the effects of TNF inhibitors on arterial stiffness and carotid intima media thickness (IMT) in RA. MEDLINE, EMBASE, clinicaltrials.gov , and WHO Clinical Trials Registry were searched up to September 2021 for randomized controlled trials, prospective cohort studies, and nonrandomized clinical trials evaluating the effects of TNF inhibitors on pulse wave velocity (PWV), augmentation index (AIx), and IMT in RA. A meta-analysis was performed to assess changes of these measures after therapy during different follow-up periods. Risk of bias assessment was performed using an adjusted Downs and Black checklist (INPLASY: 2022-1-0131). Thirty studies were identified from 1436 records, of which 23 were included in the meta-analysis. PWV and AIx showed a decrease after treatment (PWV: mean difference (MD) -0.51 m/s (95% CI: -0.96, -0.06), p=0.027; AIx: MD -0.57% (95% CI: -2.11, 0.96), p=0.463, sensitivity analysis AIx: MD -1.21% (95% CI: -2.60, 0.19), p=0.089). For IMT, there was a slight increase in the first months of follow-up, but this disappeared on the long-term (overall timepoints MD -0.01 mm (95% CI: -0.04, 0.02), p=0.615). Heterogeneity was high in the overall analyses and subgroups with long follow-up periods (≥12 months). The included studies showed mixed results of the effects of TNF inhibitors on the surrogate markers. The pooled results suggest that PWV and AIx decrease over time, while IMT remains stable. This indicates a favorable effect of TNF inhibitors on the cardiovascular disease risk, all the more since these markers also increase with age.

Rigidez vascular e envelhecimento arterial saudável em pacientes idosos com pressão arterial ideal

RESUMO Introdução: A velocidade da onda de pulso é usada para diagnosticar a rigidez arterial central (RAC) e quantificar o envelhecimento vascular saudável (EVS). Objetivo: Avaliar a RAC e o EVS em pacientes idosos com níveis pressóricos sistêmicos classificados como ideais/normais. Métodos: Um total de 102 pacientes sem comorbidades e com pressão sistólica (PS) < 120 mmHg e pressão diastólica (PD) < 80 mmHg foram selecionados do banco de dados EVOPIU (Estudo da Velocidade de Onda de Pulso em Idosos em área Urbana no Brasil). Foram avaliadas a velocidade da onda de pulso carotídeo-femoral (VOPcf) e as pressões central e periférica em todos os pacientes. Os pacientes foram divididos em quatro grupos: G1: (n = 19; com VOPcf < 7,6 m/s; sem medicação), G2 (n = 26; VOPcf ≥ 7,6 m/s; sem medicação), G3 (n = 25; VOPcf < 7,6 m/s com medicação anti-hipertensiva), e G4 (n = 32; VOPcf ≥ 7,6 m/s com medicação anti-hipertensiva). Resultados: Em nossa amostra, 56,7% dos pacientes apresentaram VOPcf ≥ 7,6 m/s. A pressão sistólica central no G1 [99 (10) mmHg] foi inferior à encontrada nos outros três grupos [vs. 112 (14) mmHg, 111 (15), 112 (20) mmHg; P < 0,05)]. Conclusão: Pessoas idosas com pressão arterial ideal não necessariamente têm EVS e podem apresentar valores de VOPcf próximos aos limites estabelecidos para o diagnóstico de RAC.

Quantifying carotid stiffness in a pre-hypertensive population with ultrafast ultrasound imaging

PURPOSE

The aim of this study was to assess carotid stiffening in a pre-hypertensive (PHT) population using ultrafast pulse wave velocity (ufPWV).

METHODS

This study retrospectively enrolled 626 individuals who underwent clinical interviews, serum tests, and assessments of the systolic blood pressure (SBP), diastolic blood pressure (DBP), carotid intima-media thickness (cIMT), pulse wave velocity-beginning of systole (PWV-BS), and pulse wave velocity-end of systole (PWV-ES) between January 2017 and December 2021. The patients were divided into three groups according to their blood pressure (BP)-normal BP (NBP): SBP <130 mmHg and DBP <80 mmHg (n=215); PHT: 130 mmHg≤SBP<140 mmHg and/or 80 mmHg≤DBP<90 mmHg (n=119); hypertensive (HT): SBP ≥140 mmHg and/or DBP ≥90 mmHg (n=292). Correlation analyses and comparisons were performed among the groups and in the cIMT subgroups (cIMT ≥0.050 cm and <0.050 cm).

RESULTS

cIMT and PWV-ES significantly differed among the BP groups (P<0.05). The BP groups had similar PWV-BS when cIMT <0.050 cm or cIMT ≥0.050 cm (all P>0.05). However, the NBP group had a notably lower PWV-ES than the PHT (P<0.001 and P=0.024) and HT (all P<0.001) groups in both cIMT categories, while the PWV-ES in the PHT group were not significantly lower than in the HT group (all P>0.05).

CONCLUSION

Carotid morphological and biomechanical properties in the PHT group differed from those in the NBP group. ufPWV could be used for an early evaluation of carotid stiffening linked to pre-hypertension.

Daily consumption of cranberry improves endothelial function in healthy adults: a double blind randomized controlled trial

Background: Previous studies indicate cardiovascular health benefits of cranberry juice consumption. However, whether daily consumption of whole cranberries will have sustained vascular benefits in healthy individuals is currently unknown. Objective: To investigate the vascular effects of acute and daily consumption of freeze dried whole cranberry in healthy men and how effects relate to circulating cranberry (poly)phenol metabolites. Methods: A double-blind, parallel-group, randomized controlled trial was conducted in 45 healthy male adults randomly allocated to 1 month daily consumption of either cranberry (9 g powder solubilized in water equivalent to 100 g of fresh cranberries, 525 mg total (poly)phenols) or control (9 g powder, no (poly)phenols). Flow-mediated dilation (FMD, primary outcome), pulse wave velocity (PWV), aortic augmentation index (AIx), blood pressure, heart rate, blood lipids, and blood glucose were assessed at baseline and at 2 h on day 1 and after 1 month. Plasma and 24 h-urine were analyzed before and after treatment using targeted quantitative LC-MS methods including 137 (poly)phenol metabolites. Results: Cranberry consumption significantly increased FMD at 2 h and 1-month (1.1% (95% CI: 1.1%, 1.8%); p_treatment ≤ 0.001; p_{treatment × time} = 0.606) but not PWV, AIx, blood pressure, heart rate, blood lipids, and glucose. Of the 56 and 74 (poly)phenol metabolites quantified in plasma and urine, 13 plasma and 13 urinary metabolites significantly increased 2 h post-consumption and on day 1, respectively, while 4 plasma and 13 urinary metabolites were significantly higher after 1-month of cranberry consumption, in comparison with control. A multi-variable stepwise linear regression analysis showed that plasma cinnamic acid-4'-glucuronide, 4-hydroxybenzoic acid-3-sulfate, 2,5-dihydroxybenzoic acid, 3'-hydroxycinnamic acid, and 5-O-caffeoylquinic acid were significant independent predictors of 2 h FMD effects (R² = 0.71), while 3'-hydroxycinnamic acid, 4-methoxycinnamic acid-3'-glucuronide, 3-(4'-methoxyphenyl)propanoic acid 3'-sulfate, and 3-(4'-methoxyphenyl)propanoic acid 3'-glucuronide predicted the 1-month FMD effects (R² = 0.52). Conclusions: Acute and daily consumption of whole cranberry powder for 1 month improves vascular function in healthy men and this is linked with specific metabolite profiles in plasma. The National Institutes of Health (NIH)-randomized trial records held on the NIH ClinicalTrials.gov website (NCT02764749). https://clinicaltrials.gov/ct2/show/NCT02764749.

Effect of Amlodipine/Nebivolol combination therapy on central BP and PWV compared to Amlodipine/Valsartan combination therapy

Background

Pulse wave velocity (PWV) and central blood pressure (CBP) have been intoduced into managment of hypertensive patients. PWV is positively correlated with arterial wall stiffness while central aortic pressure becomes better predictor of cardiovascular outcome than peripheral pressure. Reduction in CBP provides protective properties against subclinical organ damage. This work aims to investigate the effect of a new combination therapy of Amlodipine/Nebivolol (A/N) on central BP, peripheral BP and PWV. The results of using this combination will be compared to the well-established fixed-dose combination of Amlodipine/Valsartan (A/V). The study conducted between October 2018 and August 2020. One hundred and two hypertensive patients were assigned for Amlodipine 10 mg/Valsartan 160 mg combination therapy (A/V, n = 52) or Amlodipine 10 mg/Nebivolol 5 mg combination therapy (A/N, n = 50) by simple 1:1 randomization. Office, central blood pressure and PWV were measured on first (0 week), second (4–8 weeks) and third visit (10–12). Difference in BP (in each arm and between arms) was calculated along all visits.

Results

No statistical significant difference was found between A/V and A/N regarding age, gender, BMI and CV history. OBP, CBP and PWV were significantly reduced in each arm, but no differences were found when comparing both arm results to each other. Recorded side effects were insignificant.

Conclusions

The new combination therapy Amlodipine/Nebivolol (A/N) affords a significant reduction in CBP, PBP and PWV with minor and tolerable side effects. It has provided comparable results to Amlodipine/Valsartan (A/V) combination therapy.

Subject-Specific Pressure Normalization of Local Pulse Wave Velocity: Separating Intrinsic From Acute Load-Dependent Stiffening in Hypertensive Patients

Pulse wave velocity (PWV) is a powerful predictor of cardiovascular events. However, its intrinsic blood pressure (BP)-dependency complicates distinguishing between acute and chronic effects of increased BP on arterial stiffness. Based on the assumption that arteries exhibit a nearly exponential pressure-area (P-A) relationship, this study proposes a method to assess intersubject differences in local PWV independently from BP. The method was then used to analyze differences in local carotid PWV (cPWV) between hypertensive and healthy normotensive people before and after BP-normalization. Pressure (P) and diameter (D) waveforms were simultaneously acquired via tonometer at the left and ultrasound scanning at right common carotid artery (CCA), respectively, in 22 patients with Grade 1 or 2 hypertension and 22 age- and sex-matched controls. cPWV was determined using the D²P-loop method. Then, the exponential modeling of the P-area (A = πD²/4) relationships allowed defining a mathematical formulation to compute subject-specific changes in cPWV associated with BP changes, thus enabling the normalization of cPWV against intersubject differences in BP at the time of measurement. Carotid systolic BP (SBP) and diastolic BP (DBP) were, on average, 17.7 (p < 0.001) and 8.9 mmHg (p < 0.01) higher in hypertensives than controls, respectively. cPWV was 5.56 ± 0.86 m/s in controls and 6.24 ± 1.22 m/s in hypertensives. BP alone accounted for 68% of the cPWV difference between the two groups: 5.80 ± 0.84 vs. 6.03 ± 1.07 m/s after BP-normalization (p = 0.47). The mechanistic normalization of cPWV was in agreement with that estimated by analysis of covariance (ANCOVA). In conclusion, the proposed method, which could be easily implemented in the clinical setting, allows to assess the intersubject differences in PWV independently of BP. Our results suggested that mild hypertension in middle-aged subjects without target organ damage does not significantly alter the stiffness of the CCA wall independently of acute differences in BP. The results warrant further clinical investigations to establish the potential clinical utility of the method.

Systemic Arterial Stiffness Is Associated With Structural Progression in Early Open-Angle Glaucoma

Purpose

The purpose was to identify association between systemic arterial stiffness predicted by brachial-ankle pulse wave velocity (PWV) and initial location of structural progression in early open-angle glaucoma.

Methods

Patients with early open-angle glaucoma who underwent PWV measurements were subjected to a retrospective review of medical records. A total of 160 eyes of 160 patients were subjected to analyses. Patients were categorized into three PWV groups. Structural progression was determined using event-based analysis of the Guided Progression Analysis software of Cirrus optical coherence tomography.

Results

Thirty-eight patients had a PWV of 1400 cm/s or less on both the left and right sides (low PWV, 39.5% females, 53.9 ± 8.8 years old), and 46 patients showed a PWV of 1800 cm/s or more on either side (high PWV; 54.3% females, 71.3 ± 5.8 years old). The rest of the patients had an intermediate PWV (n = 76, 50.0% females, 59.8 ± 8.6 years old). Among patients who showed progression in 69.3 ± 41.5 months, macular ganglion cell–inner plexiform layer (mGCIPL) loss preceded peripapillary retinal nerve fiber layer (ppRNFL) loss in 86.7% of high PWV group (n = 15, 60.0% females, 70.0 ± 6.0 years old) in comparison with 26.7% of the low PWV group (P = 0.002). The PWV was significantly higher in patients whose structural progression was first observed at mGCIPL (1744.1 ± 347.7 cm/s) than patients whose initial location was ppRNFL (1452.0 ± 201.0 cm/s; P = 0.012). A high PWV was associated with increased likelihood of structural progression at mGCIPL (odds ratio, 7.484; 95% confidence interval, 1.212–49.196; P = 0.030) among patients who showed progression.

Conclusions

PWV is a significant predictor of the location of structural progression in open-angle glaucoma. Vascular insufficiency may be an important aspect in the pathogenesis of glaucoma.

Arterial stiffness and cardiometabolic health in omnivores and vegetarians: a cross-sectional pilot study

Objective

Arterial stiffness is a strong predictor of cardiovascular mortality, and often precedes elevations in blood pressure. This cross-sectional pilot study examined differences in arterial stiffness, blood pressure, cardiometabolic markers, anthropometric outcomes, and inflammation in vegetarians and matched omnivores. Participants were healthy, non-smoking adults (18–65 years old) adhering to either a vegetarian/vegan or omnivore diet. Omnivores were matched to vegetarians using broad body mass index (BMI) categories.

Results

Arterial stiffness trended higher in omnivores versus vegetarians (7.0 ± 1.5 and 6.8 ± 1.1 m/s, respectively; p = 0.073). This trend was mainly driven by the male omnivores (p = 0.006 for gender effect and p = 0.294 for eating pattern effect). Omnivores displayed higher HDL concentrations compared to vegetarians, 63.8 ± 18.5 and 55.2 ± 16.9 mg/dL; however, total cholesterol/HDL ratio did not vary significantly between groups; p = 0.310. In men, a vegetarian eating pattern may reduce arterial stiffness; however, this benefit may be limited in women, particularly those who are premenopausal. Future research should examine arterial stiffness and cardiometabolic health outcomes in younger versus older female vegetarians, as these data can provide valuable insights on the role of plant-based eating patterns on arterial stiffness and cardiometabolic health.

Off-Target Effects of Antidepressants on Vascular Function and Structure

Depression emerges as a risk factor for cardiovascular disease, and it is thought that successful antidepressant treatment may reduce such a risk. Therefore, antidepressant treatment embodies a potential preventive measure to reduce cardiovascular events in patients with depression. Accumulating evidence indicates that antidepressants have off-target effects on vascular dysfunction and in the early stages of atherosclerosis, which form the basis for cardiovascular disease (CVD) pathogenesis. In this context, we performed a thorough review of the evidence pertaining to the effects of different classes of antidepressant medications on hemodynamic and early atherosclerosis markers. The preclinical and clinical evidence reviewed revealed a preponderance of studies assessing selective serotonin reuptake inhibitors (SSRI), whereas other classes of antidepressants are less well-studied. Sufficient evidence supports a beneficial effect of SSRIs on vascular inflammation, endothelial function, arterial stiffening, and possibly delaying carotid atherosclerosis. In clinical studies, dissecting the hypothesized direct beneficial antidepressant effect of SSRIs on endothelial health from the global improvement upon remission of depression has proven to be difficult. However, preclinical studies armed with appropriate control groups provide evidence of molecular mechanisms linked to endothelial function that are indeed modulated by antidepressants. This suggests at least a partial direct action on vascular integrity. Further research on endothelial markers should focus on the effect of antidepressants on treatment responders versus non-responders in order to better ascertain the possible beneficial vascular effects of antidepressants, irrespective of the underlying course of depression.

Does body mass index or waist-hip ratio correlate with arterial stiffness based on brachial-ankle pulse wave velocity in Chinese rural adults with hypertension?

Background

The relationship between obesity indices and arterial stiffness (AS) has not been fully discovered nor has it been studied in depth in large hypertensive patient populations. The aim of this study was to explore the association between body mass index (BMI) and waist-hip ratio (WHR) levels and AS based on brachial-ankle pulse wave velocity (baPWV) in Chinese rural adults with hypertension.

Methods

This cross-sectional study analyzed 5049 Chinese rural adults with essential hypertension. BMI was calculated as the body weight in kilograms divided by the square of the height in meters (kg/m²). Central obesity was defined as WHR ≥ 0.9 for males and ≥ 0.85 for females. Measurement of arterial stiffness was carried out via brachial-ankle pulse wave velocity (baPWV).

Results

The prevalence of overweight, general obesity, central obesity and increased AS were 26.88%, 3.39%, 63.85% and 44.01%, respectively. Multivariate logistic regression analysis indicated that BMI levels were negatively associated with the prevalence of increased AS (adjusted-OR per SD increase: 0.74, 95% CI 0.67–0.81, P < 0.001). When BMI was instead treated as a categorical variable divided into tertiles, the same relationship was observed (P for trend < 0.001). Inversely, WHR levels were positively associated with the prevalence of increased AS (adjusted-OR per SD increase: 1.25, 95% CI 1.14–1.36, P < 0.001). Compared to subjects without central obesity, those with central obesity had a higher prevalence of increased AS (adjusted-OR: 1.52, 95% CI 1.28–1.81, P < 0.001). Linear regression models indicated similar results in the correlation between BMI or WHR levels and baPWV levels (adjusted-β per SD increase: − 0.57, 95% CI − 0.68 to − 0.46, P < 0.001; adjusted-β per SD increase: 4.46, 95% CI 3.04–5.88, P < 0.001). There were no interactions in terms of age and blood pressure on the relationship between BMI or WHR levels and the prevalence of increased AS or baPWV levels.

Conclusion

There was an inverse relationship between BMI levels and increased AS or baPWV levels, whereas WHR levels and central obesity were positively associated with increased AS or baPWV levels in Chinese rural adults with hypertension.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12872-021-02390-y.

Association Between Blood Pressure Control and Arterial Stiffness in Middle-Aged and Elderly Chinese Patients with Hypertension

Background

The severity of arterial stiffness can be evaluated by pulse wave velocity (PWV). This study investigated the association between blood pressure (BP) control and arterial stiffness in middle-aged and elderly Chinese patients with hypertension.

Material/Methods

Three hundred and twelve hypertensive patients were divided according to whether their hypertension was well-controlled or uncontrolled and stratified according to age. Arterial stiffness was evaluated by brachial-ankle pulse wave velocity (baPWV). The effect of BP control on arterial stiffness and its severity was assessed by multivariate linear and logistic regression analyses.

Results

Moderate and severe arterial stiffness was detected significantly more often in patients with uncontrolled hypertension than in those with well-controlled hypertension, regardless of age. BaPWV increased by 8.467 cm/s in the study population overall for every 1-mmHg increment in systolic BP and by 8.584, 8.616, and 8.199 cm/s, respectively, in patients aged 45–65, 65–80, and ≥80 years. Regardless of age, the risk of arterial stiffness was 5.93 times higher (95% confidence interval 2.78–12.64) and the risk of a one-grade increase in the severity of arterial stiffness was 4.01 times higher (95% confidence interval 2.51–6.42) in patients with uncontrolled hypertension than in those with well-controlled hypertension.

Conclusions

This study found a positive relationship between baPWV and BP and identified uncontrolled BP as a risk factor for arterial stiffness and its severity. Management of BP within a reasonable range may help to ameliorate arterial stiffness.

Central blood pressure lowering effect of telmisartan-rosuvastatin single-pill combination in hypertensive patients combined with dyslipidemia: A pilot study

This multicenter, phase 4, Prospective Randomized Open, Blinded End‐point (PROBE) study aimed to evaluate safety and efficacy of telmisartan/rosuvastatin single‐pill combination (SPC) therapy on lowering central blood pressure (BP) compared with telmisartan monotherapy in hypertensive patients with dyslipidemia in Korea. Study was terminated earlier than planned due to COVID‐19 pandemic, thus should be considered as a pilot study. Among 125 patients who met the inclusion criteria of hypertension and dyslipidemia (defined as 10‐year Atherosclerotic Cardiovascular Disease risk score over 5%), 80 patients went through 4‐week single‐group run‐in period with telmisartan 40–80 mg, then randomized to telmisartan 80 mg + rosuvastatin (10 or 20 mg) SPC group or telmisartan 80 mg monotherapy group. The central/brachial BP, brachial‐ankle pulse wave velocity (baPWV), and augmentation index (AIx) were assessed at baseline and 16 weeks later. Mean brachial SBP changed from 135.80 ± 14.22 mmHg to 130.69 ± 13.23 mmHg in telmisartan/rosuvastatin group and from 134.37 ± 12.50 mmHg to 133.75 ± 12.30 mmHg in telmisartan monotherapy group without significant difference (between‐group difference p = .149). Mean central SBP were reduced significantly in the telmisartan/rosuvastatin group with change from 126.72 ± 14.44 mmHg to 121.56 ± 14.56 mmHg while telmisartan monotherapy group showed no significant change (between‐group difference p = .028). BaPWV changed from 1672.57 ± 371.72 m/s to 1591.75 ± 272.16 m/s in telmisartan/rosuvastatin group and from 1542.85 ± 263.70 m/s to 1586.12 ± 297.45 m/s in telmisartan group with no significance (between‐group difference p = .078). Change of AIx had no significant difference (between‐group difference p = .314). Both groups showed excellent compliance rate of 96.9 ± 4.5% with no significant difference in adverse rate. Telmisartan/rosuvastatin SPC therapy was more effective in lowering central BP compared with the telmisartan monotherapy. The results of this study showed benefit of additive statin therapy in hypertensive patients combined with dyslipidemia.

Long-Term Effects of Renal Artery Denervation

Background and Objectives: Renal artery denervation (RDN) procedure is a broadly discussed method in the treatment of resistant hypertension. Many studies report short-term (3-12 months) results for blood pressure and arterial stiffness. The primary endpoints were changes in 24 h mean systolic blood pressure (BP) and office systolic BP 48 months after RDN. The secondary endpoints were changes in aortic pulse wave velocity and impact of polypharmacy on these variables. Materials and Methods: Renal artery denervation was performed in 73 patients treated for resistant hypertension; 49 patients remained in final analysis. Patient examination was carried out before the procedure, and subsequently at 3, 6, 12, 24, and 48 months later. Patients' antihypertensive and overall medication regimens were carefully analysed. Results: Mean 24 h arterial blood pressure lowered and was sustained at lower levels for up to 48 months; median (interequartile range-IQR) from 158(23.5)/100(14.2) to 140(26.5)/86(16.2) mmHg. Mean reduction in 24 h ambulatory systolic BP was -11 ± 25 mmHg (95% CI, -20 to -2; p < 0.001), while office systolic BP reduced by -7 ± 23 mmHg (95%CI, -24 to -1; p < 0.02). A significant reduction in median aortic pulse wave velocity 12 months after the procedure (drop from baseline 11.2 [3.15] m/s (95%CI 6.1 to 16.2) to 9.8 [2.1] m/s (95%CI 6.1 to 13.7; p = 0.002)). After 48 months, there was no worsening compared to the baseline level of 10.3 [4.0] m/s (95% CI 6.9 to 17.8) (p > 0.05). The total mean number of antihypertensive drugs remained unchanged: 5.97(±1.1) vs. 5.24 (±1.45). A higher number of pills after 48 months was associated with higher aortic pulse wave velocity (1-5 pill group: 8.1 ± 1.6 m/s; 6-10 pill group: 10.9 ± 1.8 m/s; >11 pill group: 15.1 ± 2.6 m/s) (p = 0.003). Conclusions: Antihypertensive effect after renal denervation lasts up to 48 months with no worsening of arterial stiffness compared to baseline. In our study, polypharmacy was associated with increased arterial stiffness 48 months after the procedure.

Micro- and macrovascular function in patients suffering from primary adrenal insufficiency: a cross-sectional case-control study

BACKGROUND

Despite adequate glucocorticoid (GC) and mineralocorticoid (MC) replacement therapy, patients suffering from primary adrenal insufficiency (AI) have an increased mortality, mainly due to cardiovascular diseases. Only little knowledge exists on the contribution of MC substitution to the cardiovascular risk. Therefore, this study investigates the impact of plasma renin concentration on parameters of micro- and macrovascular function.

METHODS

26 patients with primary AI [female = 18, age: 51 (28; 78) years; BMI: 24 (18; 40) kg/m²; disease duration: 18 (5; 36) years] were included in this cross-sectional analysis. Intima media thickness (IMT) and pulse wave velocity (PWV) were investigated to assess macrovascular remodeling and arterial stiffness. Microvascular function was estimated by post-occlusive reactive hyperemia using laser Doppler fluxmetry. Baseline perfusion, biological zero, peak perfusion, time to peak and recovery time were recorded. Patients were grouped according to their median plasma renin concentration of previous visits (Renin_high vs Renin_low) and were compared to a group of healthy women [age: 44 (43; 46) years; BMI: 24.2 (21.8; 27.5)].

RESULTS

PWV was significantly higher in AI patients compared to controls [9.9 (5; 18.5) vs 7.3 (6.8; 7.7) m/s; p < .01], whereas no differences in microvascular function could be found. In Renin_low time to peak perfusion was significantly longer [6.0 (3; 15) vs 3.5 (1.5; 11) s; p < .05], whereas no differences in IMT and PWV were observed between Renin_high and Renin_low. No impact of GC dose was observed.

CONCLUSIONS

Microvascular function is not impaired in patients with primary AI under adequate replacement therapy, although higher renin concentrations are associated with subclinical improvements. No relation between RAAS activity and macrovascular function is observed, while arterial stiffness might be increased in primary AI.

Association of Brachial Ankle Pulse Wave Velocity With New Onset Stroke in Hypertensive Patients Aged Less Than 65 With Normal Fasting Glucose Among Chinese Community-Based Population

BACKGROUND

Previous studies have shown an association of stroke and brachial ankle pulse wave velocity (baPWV). However, due to limitations on total population size and small numbers of stroke cases, lack of power has prevented further detection among subgroups such as age and laboratory testing.

METHODS

A total of 19217 participants including 660 incident stroke patients were pooled in the present study. Participants were divided to 2 groups, aged less than 65 years [56.0 (50.0, 61.0)] and aged 65 years or more [70.0 (67.0, 74.0)].

RESULTS

After adjustment for demographic, anthropometric, and laboratory parameters, the incident stroke was positively associated to baPWV in the group aged less than 65 years (OR, 1.16; 95% CI, 1.05-1.28), but not in the older group aged 65 or more. When baPWV was assigned as quartiles, a significant, increased risk of new-onset stroke was found in quartiles 3-4 compared with quartile 1. In addition, the predictive value of baPWV for incident stroke was modified by fasting glucose in participants aged less than 65 years (P-interaction = 0.010). An increase in baPWV was strongly, positively associated to new-onset stroke in the subgroup of normal fasting glucose (< 5.6 mmol/L) (OR, 1.34; 95% CI, 1.15 - 1.57), but no effect was seen in the impaired fasting glucose (5.6-7.0 mmol/L) or diabetic fasting glucose (> 7.0 mmol/L) subgroups.

CONCLUSIONS

Increased baPWV was significantly associated with new-onset stroke in a hypertensive population aged less than 65 years. Particularly, it is of great importance to monitor baPWV for predicting incident stroke in "relatively healthy" hypertensive patients, i.e. aged less than 65 years with normal fasting glucose.

Characteristics and Determinants of Pulse Pressure-Age Relationship in Healthy and Non-treated Hypertensive Subjects of Argentinean Population

BACKGROUND

The relationship between the increases in pulse pressure (PP) and arterial stiffness determined by aging or systemic hypertension has been widely reported. These findings are supported by large-cohort analyzes conducted in well-known populations, such as Framingham Study. However, there is evidence that an age-PP curvilinear relationship may exist in hypertensive subjects. This study aimed to evaluate the age-related change in pulse pressure and arterial stiffness in a population-based study.

METHODS

Carotid-femoral Pulse Wave Velocity (cfPWV) were obtained in 2075 subjects.

RESULTS

Age-related changes of PP showed a curvilinear relationship (R=0.39, p<0.0001) in normotensive subjects, with a nadir at around 50 years of age. On the other hand, the age-cfPWV relationship showed a linear and positive correlation (R=0.72, p<0.0001). PP also showed a curvilinear relationship with age (R=0.36, p<0.0001) in hypertensive subjects, with a nadir around 50 years of age. The age-cfPWV relationship showed a linear and positive correlation (R=0.55, p<0.0001). Similar results were observed in the adult population (age≥16 years). Multivariate analysis showed that age, sex, cfPWV, and mean arterial pressure are determinants of PP values in the entire population; however, this result was not uniform when different subgroups were analyzed.

CONCLUSION

In conclusion, age-related changes in PP showed a curvilinear relationship and no parallelism with the age-cfPWV relationship for both normotensive and hypertensive subjects. The determinants of PP impact it differently depending on age and the pathological condition of the subject.

Prevalence and lifestyle-related risk factors of obesity and unrecognized hypertension among bus drivers in Ghana

Obesity and hypertension are public health problems associated with cardiovascular events worldwide. Bus drivers, whose lifestyle is primarily sedentary and characterized by poor eating habits are at increased risk. This study determined the prevalence and lifestyle-related risk factors of obesity and hypertension among Inter-Regional Metromass Bus Drivers (IRMBDs) in Ghana. This cross-sectional study recruited 527 professional drivers from Metromass Bus stations in Accra and Kumasi Metropolis, Ghana. Structured questionnaires were administered to obtain socio-demographic and lifestyle characteristics from all participants. Anthropometric measurements including body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR) and blood pressure (BP) were determined. The prevalence of unrecognized hypertension was 38.7%. The prevalence of obesity using BMI, WC, and WHR as obesity indices were 19.0%, 19.9%, and 19.4%, respectively. Use of sleep inhibitors, long-duration sitting and eating late at night were independent risk factors for obesity, regardless of the obesity index used (p < 0.05). Physical inactivity, high caloric intake and eating at stressful periods were independent risk factors for obesity based on WC and WHR measurements (p < 0.05). Ageing, smoking history, alcoholic beverage intake, sleep inhibitor drug use, high calorie intake, long-duration sitting, eating late and under stressful conditions were independent risk factors for hypertension (p < 0.05). There is a high prevalence of unrecognized hypertension and obesity among IRMBDs which were associated with individual lifestyle and behaviours. Increased awareness through educational and screening programs will trigger lifestyle modifications that will reduce cardio-metabolic disease onset and offer clues for better disease predictive, preventive and personalized medicine.

Percentile curves for left ventricle structural, functional and haemodynamic parameters obtained in healthy children and adolescents from echocardiography-derived data

BACKGROUND

Transthoracic echocardiography is the most common non-invasive technique for the study of the left ventricle (LV) and the proximal aorta. Despite the clinical value, there is scarcity of data about reference intervals (RIs) and percentiles for thoracic aorta dimension and LV structural and functional parameters, obtained from population-based studies in children and adolescents. The aim was to generate RIs for LV, haemodynamic and thoracic aorta parameters obtained from transthoracic echocardiography in healthy children, adolescents and young adults from a South-American population.

METHODS

One thousand ninety-five healthy subjects (5-24 years) were studied (M-mode, B-mode and Doppler echocardiography).

RESULTS

RIs for LV structural (diameters, volumes and wall thickness) and functional (stroke volume, cardiac output, cardiac index, transmitral E and A flow waves velocities) parameters; systemic vascular resistance and aortic root diameter were obtained using parametric regression analyzes based on fractional polynomials. Covariate analysis (i.e., adjusting for age, body surface) showed that specific sex-specific RIs were necessary. Then, age, body height (BH), body weight (BW), body surface area (BSA), and sex-specific 1st, 2.5th, 5th, 10th, 25th, 50th, 75th, 90th, 95th, 97.5th and 99th percentiles were obtained. Our results were in agreement with and complimentary to available international databases.

CONCLUSION

This study provides RIs for echocardiography-derived haemodynamic, LV (structural and functional) and aortic parameters in children, adolescents and young adults considering data obtained from the largest Argentinean database. In early stages of life an adequate interpretation of echocardiography-derived LV and aortic parameters requires considering age, BH, BW, BSA and/or sex-specific RIs.

Normal percentile curves for left atrial size in healthy children and adolescents

BACKGROUND

Despite the clinical utility of echocardiography to measure left atrial (LA) structure and function, there are scarcities of data about the percentiles of LA diameter (LA_D ), LA volume (LA_VOL ), and LA volume indexed by body surface area (LA_{VOL / BSA} ) from prospective population-based studies in healthy children and adolescents from the Southern Cone of Latin America.

METHODS

Echocardiographic studies were obtained in 1095 healthy subjects nonexposed to cardiovascular risk factors (5-24 years). Age- and sex-specific reference values of LA_D , LA_VOL , and LA_{VOL / BSA} were generated using parametric regression based on fractional polynomials.

RESULTS

After covariate analysis (ie, adjusting by age, body surface area), specific sex-specific percentiles were evidenced as necessaries. Age- and sex-specific 1st, 2.5th, 5th, 10th, 25th, 50th, 75th, 90th, 95th, 97.5th, and 99th percentile and curves were reported. Our percentiles showed high concordance and complementarity with what was previously reported for the population of North American, European, and Asiatic Populations.

CONCLUSIONS

In children and adolescents, the interpretation of the LA size requires sex-related percentiles. This study provides the largest Argentinean database concerning percentile curves of LA_D , LA_VOL , and LA_{VOL / BSA} obtained in healthy children and adolescents. These data are valuable in that they provide values with which data of populations of children, adolescents, and young adults can be compared.

Reference Intervals and Percentile Curves of Echocardiographic Left Ventricular Mass, Relative Wall Thickness and Ejection Fraction in Healthy Children and Adolescents

Despite the clinical utility of echocardiography to measure cardiac target organ injury (TOI) there are scarcities of data about the reference intervals (RIs) and percentiles of left ventricular (LV) mass (LVM) and derived indexes (LVMI and LVMI^2.7), relative wall thickness (LVRWT) and ejection fraction (LVEF) from population-based studies in children and adolescents. The aim of this study was to generate reference intervals RIs of LVM and derived indexes (LVMI and LVMI^2.7), LVRWT, and LVEF obtained in healthy children, adolescents, and young adults from a South-American population. Echocardiographic studies were obtained in 1096 healthy subjects (5-24 years). Age and sex-specific RIs of LVM, LVMI, LVMI^2.7, LVRWT, and LVEF were generated using parametric regression based on fractional polynomials. After covariate analysis (i.e., adjusting by age, body surface area) specific sex-specific RIs were evidenced as necessaries. Age and sex-specific 1st, 2.5th, 5th, 10th, 25th, 50th, 75th, 90th, 95th, 97.5th, and 99th percentile and curves were reported and compared with previously reported RIs. RIs showed high concordance and complementarity with what was previously reported for the population of North-American children (0-18 years old). In conclusion, in children and adolescents the interpretation of the LVM, LVMIs, LVRWT, and LVEF RIs requires sex-related RIs. This study provides the largest Argentinean database concerning RIs and percentile curves of LVM, LVMIs, LVRWT, and LVEF as markers of cardiac TOI obtained in healthy children and adolescents. These data are valuable in that they provide RIs values with which data of populations of children, adolescents can be compared.

Reference intervals and percentile curve for left ventricular outflow tract (LVOT), velocity time integral (VTI), and LVOT-VTI-derived hemodynamic parameters in healthy children and adolescents: Analysis of echocardiographic methods association and agreement

BACKGROUND

Echocardiographic reference intervals (RIs) for left ventricular outflow tract (LVOT) and velocity time integral (VTI) are scarce in pediatrics.

AIMS

(a) to generate RIs and percentiles for LVOT, VTI, and hemodynamic variables in healthy children and adolescents from Argentina; (b) to analyze the equivalence between stroke volume (SV), cardiac output (CO), and cardiac index (CI) obtained from two-dimensional echocardiography (2D) and LVOT-VTI analysis with pulsed wave Doppler (PWD); and (c) to analyze the association between subjects' characteristics and VTI and LVOT-VTI-derived parameters.

METHODS

Two-dimensional and PWD studies were done in 385 subjects (5-24 years). Mean and standard deviation age-related and body surface area (BSA)-related equations were obtained for VTI and LVOT-VTI-derived parameters (parametric regression methods based on fractional polynomials). BSA- and age-specific percentiles were determined.

RESULTS

Pulsed wave Doppler- and 2D-derived parameters were positively correlated. However, PWD values were always lower than those from 2D. Specific RIs for PWD and 2D data were necessary. Covariance analysis showed that sex-specific RIs were required for LVOT, but not for VTI, VTI-derived CO and CI. Age-related RIs were obtained for LVOT, LVOT-VTI, and VTI-derived CO and CI. BSA-related RIs for VTI-derived CO and CI were obtained.

CONCLUSIONS

Stroke volume, CO, and CI data from 2D and PWD are not equivalent. An accurate analysis of LVOT-VTI-derived parameters requires considering age and BSA. In this study, age- and BSA-related RIs and percentiles for LVOT, VTI, and hemodynamic parameters in healthy children and adolescents were determined, discriminating data according to the methodological approach (2D or PWD).

Glycated hemoglobin correlates with arterial stiffness and endothelial dysfunction in patients with resistant hypertension and uncontrolled diabetes mellitus

This study aimed to evaluate the effects of glycated hemoglobin (HbA_1c ) on flow-mediated dilation, intima-media thickness, pulse wave velocity, and left ventricular mass index in patients with resistant hypertension (RHTN) comparing RHTN-controlled diabetes mellitus and RHTN-uncontrolled type 2 diabetes mellitus. Two groups were formed: HbA_1c <7.0% (RHTN-controlled diabetes mellitus: n = 98) and HbA_1c ≥7.0% (RHTN-uncontrolled diabetes mellitus: n = 122). Intima-media thickness and flow-mediated dilation were measured by high-resolution ultrasound, left ventricular mass index by echocardiography, and arterial stiffness by carotid-femoral pulse wave velocity. No differences in blood pressure levels were found between the groups but body mass index was higher in patients with RHTN-uncontrolled diabetes mellitus. Endothelial dysfunction and arterial stiffness were worse in patients with RHTN-uncontrolled diabetes mellitus. Intima-media thickness and left ventricular mass index measurements were similar between the groups. After adjustments, multiple linear regression analyses showed that HbA_1c was an independent predictor of flow-mediated dilation and pulse wave velocity in all patients with RHTN. In conclusion, HbA_1c may predict the grade of arterial stiffness and endothelial dysfunction in patients with RHTN, and superimposed uncontrolled diabetes mellitus implicates further impairment of vascular function.

Carotid Intima Media Thickness Reference Intervals for a Healthy Argentinean Population Aged 11-81 Years

Reference intervals (RIs) of carotid intima media thickness (CIMT) from large healthy population are still lacking in Latin America. The aim of this study was to determine CIMT RIs in a cohort of 1012 healthy subjects from Argentina. We evaluated if RIs for males and females and for left and right carotids were necessary. Second, mean and standard deviation (SD) age-related equations were obtained for left, right, and average (left + right)/2) CIMT using parametric regression methods based on fractional polynomials, in order to obtain age-specific percentiles curves. Age-specific percentile curves were obtained. Males showed higher A-CIMT (0.577 ± 0.003 mm versus 0.566 ± 0.004 mm, P = 0.039) in comparison with females. For males, the equations were as follows: A-CIMT mean = 0.42 + 8.14 × 10^-5⁎Age²; A-CIMT SD = 5.9 × 10^-2 + 1.09 × 10^-5⁎Age². For females, they were as follows: A-CIMT mean = 0.40 + 8.20 × 10^-5⁎Age²; A-CIMT SD = 4.67 × 10^-2 + 1.63 × 10^-5⁎Age². Our study provides the largest database concerning RIs of CIMT in healthy people in Argentina. Specific RIs and percentiles of CIMT for children, adolescents, and adults are now available according to age and gender, for right and left common carotid arteries.