Arterial stiffness in elderly patients with normotension and hypertension in Brazil

Discriminative value of pulse wave velocity for arterial stiffness and cardiac injury in prediabetic patients

Background

Prediabetes (PD) is defined as impaired fasting glucose and/or impaired glucose tolerance (IGT) and may be associated with high risk of cardiovascular injury. It is recommended that PD patients be screened for signs of arterial stiffness and cardiovascular injury to reinforce therapeutic strategies.

Objectives

To identify pulse wave velocity values discriminative for arterial stiffness and cardiovascular injury in PD patients.

Methods

A cross-sectional study was conducted with PD (N=43) and normoglycemic (N=37) patients who underwent clinical evaluation, arterial stiffness assessment by carotid-femoral pulse wave velocity (cfPWV) using SphygmoCor, laboratory blood analysis, investigation of morphological and functional cardiac variables by transthoracic echocardiogram, and assessment of carotid intima-media-thickness (CIMT) by carotid ultrasonography. A statistical analysis was performed using SPSS software and values of p<0.05 were considered significant.

Results

A cfPWV cut-off value of 6.9 m/s was identified for IGT (Sensitivity [SE]: 74% and Specificity [SP]: 51%). Comparison of general data and risk factors between subsets with values above and below this cutoff value revealed higher rates of fasting glucose (p=0.02), obesity (p=0.03), dyslipidemia (p=0.004), early signs of left ventricle (p=0.017) and right ventricle (p=0.03) impaired diastolic function, and elevated CIMT in subjects with cfPWV ≥ 6.9m/s (p=0.04).

Conclusions

In PD patients, a cfPWV cutoff of 6.9 m/s was considered a discriminative value for arterial stiffness. These findings highlight the value of early investigation of cardiovascular injury and aggressive therapy strategies with good control of risk factors in PD.

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.

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.

Vascular Age, Metabolic Panel, Cardiovascular Risk and Inflammaging in Patients With Rheumatoid Arthritis Compared With Patients With Osteoarthritis

Introduction

The risk of cardiovascular disease (CVD) in patients with rheumatoid arthritis (RA) is 1.5–2 times higher than the general population. The fundamental risk factor for CVD is age, related to alterations at the arterial level. The aim of the study was to compare vascular age (VA) in RA patients under a strict treat-to-target (T2T) strategy with Osteoarthritis (OA) patients without strict follow up and to assess the influence of inflammaging (chronic, sterile, low-grade inflammation related to aging) and metabolic markers on VA.

Materials and Methods

This was an analytical cross-sectional study. Patients with RA (under a strict a T2T strategy) and OA patients without strict clinical follow-up were included. Patients with a history of uncontrolled hypertension, CVD, and/or current smoking were excluded. Sociodemographic, physical activity, and toxic exposure data were obtained. Waist-hip ratio and body mass index (BMI) were measured. DAS-28 (RA) and inflammatory markers, lipid profile, and glycaemia were analyzed. Pulse wave velocity (PWV) was measured (oscillometric method, Arteriograph-TensioMed®). VA was calculated based on PWV. Eleven components of inflammaging [six interleukins, three metalloproteinases (MMP), and two tissue inhibitors of metalloproteinases (TIMP)] were evaluated (Luminex® system). Univariate and bivariate analyzes (Mann Whitney U and chi-square) and correlations (Spearmans Rho) were done to compare the two groups.

Results

A total of 106 patients (74% women) were included, 52/RA and 54/OA. The mean age was 57 (Interquartile range - IQR 9 years). The BMI, waist circumference, and weight were higher in patients with OA (p &lt; 0.001). RA patients had low disease activity (DAS-28-CRP). There were no differences in VA, inflammaging nor in PWV between the two groups. VA had a positive, but weak correlation, with age and LDL. In group of RA, VA was higher in those who did not receive methotrexate (p = 0.013). LDL levels correlated with MMP1, TIMP1, and TIMP2.

Conclusions

When comparing RA patients with low levels of disease activity with OA patients with poor metabolic control, there are no differences in VA. Furthermore, methotrexate also influences VA in RA patients. This shows that implemented therapies may have an impact on not only the inflammatory state of the joint but also CVD risk.

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.

Arterial stiffness in type 2 diabetes: determinants and indication of a discriminative value

OBJECTIVES

To identify the clinical discriminative value and determinants of arterial stiffness in individuals with type 2 diabetes mellitus (T2DM).

METHODS

This prospective cohort study included 51 individuals (53.57±9.35 years) diagnosed with T2DM (stage glucose≥126 mg/dL; diagnostic time: 87.4±69.8 months). All participants underwent an initial evaluation of personal habits, medications, and history; arterial stiffness assessment by carotid-femoral pulse wave velocity (cfPWV) using SphygmoCor; and blood laboratory analysis. A statistical analysis was performed using SPSS software, and values of p≤0.05 were considered significant.

RESULTS

A cut-off cfPWV value of 7.9 m/s was identified for T2DM [Sensitivity (SE): 90% and Specificity (SP): 80%]. A subgroup analysis revealed higher glycated hemoglobin (Hb1Ac) (p=0.006), obesity (p=0.036), and dyslipidemia (p=0.013) than those with cfPWV ≥7.9 m/s. Multivariate analysis identified higher stage glucose (p=0.04), Hb1Ac (p=0.04), hypertension (p=0.001), and dyslipidemia (p=0.01) as determinant factors of cfPWV; positive and significant correlation between cfPWV and glucose (r=0.62; p=0.0003) and Hb1Ac (r=0.55; p=0.0031).

CONCLUSIONS

In T2DM, an indicator of the discriminative value of arterial stiffness was cfPWV of 7.9 m/s. Clinical findings and comorbidities, such as hypertension, glucose, poor glycemic control, and dyslipidemia, were associated with and were determinants of arterial stiffness in T2DM. Reinforcement of monitoring risk factors, such as hypertension, dyslipidemia, and glycemic control, seems to be essential to the process of arterial stiffening. Confirmation of this discriminative value in larger populations is recommended.

Probability of At Least One High Arterial Blood Pressure Measurement in Elderly Patients with Healthy Vascular Aging in Two Years of Follow-Up

BACKGROUND/AIMS

Elderly patients with normal systemic arterial blood pressure associated with femoral carotid pulse velocity (cf-PWV) less than 7.6 m/s and without associated comorbidities are considered to have good vascular health. The aim of the current study was to verify the probability that elderly patients with good vascular health have at least one blood pressure measurement above the different thresholds for systolic blood pressure (120, 130 and 140 mmHg) during two years of follow-up.

METHODS

We selected 72 normotensive patients (< 140/90 mmHg) without comorbidities and divided them into group A, with cf-PWV < 7.6 m/s (n = 27; 65 ± 4 years), and group B, with cf-PWV ≥ 7.6 m/s (n = 45; 66± 8 years). These patients were followed for two years and were observed in 3 outpatient visits (0, 12 and 24 months). At each visit, the brachial pressures were indirectly measured in triplicate, and applanation tonometry was performed.

RESULTS

When group A and group B were compared, the odds ratio (OR) of having a systolic pressure measurement ≥ 140 mmHg in two years of follow-up was 0.22 (P < 0.0001); ≥ 130 mmHg, the OR was 0.49 (P < 0.0007), and ≥ 120 mmHg, the OR was 0.54 (P < 0.001). Group A and group B showed increased values of cf-PWV during the two years of follow-up (P < 0.05). Changes in the average systolic brachial pressure were not significant during the two years in groups A or B.

CONCLUSION

Vascular health in elderly individuals seems to protect against occasional elevations in systemic arterial pressure.