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Takenaka T, Ohno Y, Eguchi K, Miyashita H, Suzuki H, Shimada K. Central and brachial pulse pressure predicts cardiovascular and renal events in treated hypertensive patients. Blood Press 2022; 31:64-70. [PMID: 35438015 DOI: 10.1080/08037051.2022.2062295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
PURPOSES Central blood pressure is a stronger predictor of cardiovascular prognosis rather than brachial blood pressure. The reflection wave reaches the abdominal aorta sooner than ascending aorta. Thus, the contribution of central pulse pressure (cPP) to renal events may differ from that of cardiovascular events. METHODS The subanalysis of the ABC-J II study was performed. Subjects were 3434 treated hypertensive patients with a mean follow-up of 4.7 years. Left ventricular hypertrophy, an index of cardiovascular risk, correlated with cPP better than central systolic blood pressure in this cohort. The contribution of brachial pulse pressure (bPP) and cPP to cardiovascular and renal events was analysed. RESULTS Cox proportional-hazard analysis revealed that sex (p < 0.001), height (p < 0.05), history of cardiovascular diseases (p < 0.001), number of antihypertensive drugs (p < 0.05), and cPP (p < 0.05) contributed to cardiovascular events. However, Cox proportional-hazard analysis disclosed that baseline serum creatinine (p < 0.001) and bPP (p < 0.05) predicted renal events. After adjusting for the history of cardiovascular diseases, Cox regression demonstrated only sex as a significant predictor of cardiovascular events. After adjusting for baseline serum creatinine, no parameters were shown to predict renal events. CONCLUSIONS The present findings support our previous data that the absence of cardiovascular or renal diseases is an important determinant for event-free survival, and suggest that cPP and bPP contribute to cardiovascular and renal events in treated hypertensive patients.
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Affiliation(s)
- Tsuneo Takenaka
- Kokusai Iryo Fukushi Daigaku, Nephrology, Minato-ku, Tokyo, Japan
| | - Yoichi Ohno
- Saitama Ika Daigaku, Nephrology, Iruma-gun, Saitama, Japan
| | - Kazuo Eguchi
- Jichi Ika Daigaku Fuzoku Byoin, Cardiology, Shimotsuke, Tochigi, Japan
| | - Hiroshi Miyashita
- Jichi Ika Daigaku Fuzoku Byoin, Cardiology, Shimotsuke, Tochigi, Japan
| | | | - Kazuyuki Shimada
- Jichi Ika Daigaku Fuzoku Byoin, Cardiology, Shimotsuke, Tochigi, Japan
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Zhang Y, Lacolley P, Protogerou AD, Safar ME. Arterial Stiffness in Hypertension and Function of Large Arteries. Am J Hypertens 2020; 33:291-296. [PMID: 32060496 DOI: 10.1093/ajh/hpz193] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 11/28/2019] [Accepted: 02/12/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Arterial stiffness-typically assessed from non-invasive measurement of pulse wave velocity along a straight portion of the vascular tree between the right common carotid and femoral arteries-is a reliable predictor of cardiovascular risk in patients with essential hypertension. METHODS We reviewed how carotid-femoral pulse wave velocity increases with age and is significantly higher in hypertension (than in age- and gender-matched individuals without hypertension), particularly when hypertension is associated with diabetes mellitus. RESULTS From the elastic aorta to the muscular peripheral arteries of young healthy individuals, there is a gradual but significant increase in stiffness, with a specific gradient. This moderates the transmission of pulsatile pressure towards the periphery, thus protecting the microcirculatory network. The heterogeneity of stiffness between the elastic and muscular arteries causes the gradient to disappear or be inversed with aging, particularly in long-standing hypertension. CONCLUSIONS In hypertension therefore, pulsatile pressure transmission to the microcirculation is augmented, increasing the potential risk of damage to the brain, the heart, and the kidney. Furthermore, elevated pulse pressure exacerbates end-stage renal disease, particularly in older hypertensive individuals. With increasing age, the elastin content of vessel walls declines throughout the arterial network, and arterial stiffening increases further due to the presence of rigid wall material such as collagen, but also fibronectin, proteoglycans, and vascular calcification. Certain genes, mainly related to angiotensin and/or aldosterone, affect this aging process and contribute to the extent of arterial stiffness, which can independently affect both forward and reflected pressure waves.
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Affiliation(s)
- Yi Zhang
- Department of Cardiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | | | - Athanase D Protogerou
- Cardiovascular Prevention and Research Unit, Department of Pathophysiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Michel E Safar
- Diagnosis and Therapeutics Department, Hôtel-Dieu Hospital, Paris, France
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Validation and Critical Evaluation of the Effective Arterial Elastance in Critically Ill Patients. Crit Care Med 2019; 47:e317-e324. [DOI: 10.1097/ccm.0000000000003645] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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4
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Zuo J, Chu S, Tan I, Butlin M, Zhao J, Avolio A. Association of Haemodynamic Indices of Central and Peripheral Pressure with Subclinical Target Organ Damage. Pulse (Basel) 2018; 5:133-143. [PMID: 29761089 DOI: 10.1159/000484441] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 10/14/2017] [Indexed: 12/12/2022] Open
Abstract
Background Central aortic pressure has often been shown to be more closely associated with markers of vascular function and incidence of cardiovascular events compared to peripheral pressure. However, the potential clinical use of central aortic or peripheral haemodynamic indices as markers of target organ damage (TOD) has not been fully established. Methods We evaluated associations of TOD with central aortic and peripheral haemodynamic indices (central aortic [cPP] and peripheral pulse pressure [pPP], central aortic augmentation index, and central and peripheral waveform factor) in 770 hospital inpatients (age 60 ± 10 years, 473 males) with primary hypertension. TOD was quantified in terms of arterial stiffness as measured by carotid-femoral pulse wave velocity (cfPWV), carotid intima-media thickness (IMT), and urine albumin-to-creatinine ratio (ACR). Subclinical TOD was defined as carotid IMT >0.9 mm, urine ACR >3.5 mg/mmol in females and >2.5 mg/mmol in males and/or cfPWV >12 m/s. Results Both cPP and pPP showed significant correlation with cfPWV (r = 0.41 vs. 0.40; p < 0.01), ACR (r = 0.24 vs. 0.27; p < 0.01) and carotid IMT (r = 0.14 vs. 0.15; p < 0.01). Each SD increase in pPP and cPP was associated with increased risk of cfPWV >12 m/s (odds ratio [OR] = 2.7 and 2.9 for pPP and cPP, respectively), ACR >2.5 mg/mmol (OR = 1.2 and 1.4, respectively), and carotid IMT >0.9 mm (OR = 1.46 and 1.53, respectively). Compared to pPP, cPP had higher predictive power for TOD for age ≥60 years (OR = 3.07, p < 0.001). Conclusions Although both pPP and cPP show an association with TOD in a hypertensive population, cPP provides additional information beyond pPP associated with TOD in a hypertensive cohort. Central aortic haemodynamic indices as potential biomarkers of subclinical TOD need to be validated by further prospective studies.
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Affiliation(s)
- Junli Zuo
- Department of Hypertension, Ruijin Hospital North, Shanghai Jiaotong University School of Medicine, Shanghai, PR China.,Department of Geriatrics, Ruijin Hospital North, Shanghai Jiaotong University School of Medicine, Shanghai, PR China
| | - Shaoli Chu
- Department of Hypertension, Ruijin Hospital North, Shanghai Jiaotong University School of Medicine, Shanghai, PR China
| | - Isabella Tan
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Mark Butlin
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Jiehui Zhao
- Department of The Department of Geriatric Nursing Hospital, Baohua, Shanghai, PR China
| | - Alberto Avolio
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
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Fu S, Guo Y, Luo L, Ye P. Association of arterial stiffness and central hemodynamics with moderately reduced glomerular filtration rate in Chinese middle-aged and elderly community residents: a cross-sectional analysis. BMC Nephrol 2018; 19:103. [PMID: 29720100 PMCID: PMC5930394 DOI: 10.1186/s12882-018-0897-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 04/15/2018] [Indexed: 01/09/2023] Open
Abstract
Background Kidney impairment constitutes severe risk for cardiovascular disease, stroke and all-cause mortality, and early identification and prevention of kidney impairment is critical to effective management of prognostic risk in community residents. Previous studies have validated that carotid-femoral pulse wave velocity (cfPWV) is a significant factor associated with chronic kidney disease. However, whether cfPWV is associated with moderately reduced glomerular filtration rate (GFR) remains unclear. This analysis was designed to examine the association of moderately reduced GFR with cfPWV and central pulse pressure (cPP) in Chinese middle-aged and elderly community residents. Methods There were 875 community residents enrolled in this analysis, and then cfPWV and cPP were assessed in all participants following the standard procedure. Results Entire cohort had a median (range) age of 66 (45–88) years, and 65.4% were women. Both cfPWV and cPP differed significantly between participants with and without moderately reduced GFR (P < 0.05 for all). Logistic regression analyses indicated that cfPWV and cPP had the significant association with moderately reduced GFR (P < 0.05 for all). Conclusion This analysis demonstrated the significant association of cfPWV and cPP with moderately reduced GFR in Chinese middle-aged and elderly community residents.
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Affiliation(s)
- Shihui Fu
- Department of Geriatric Cardiology, Chinese People's Liberation Army General Hospital, Beijing, 100853, China.,Department of Cardiology and Hainan Branch, Chinese People's Liberation Army General Hospital, Beijing, 100853, China
| | - Yi Guo
- Department of Cardiology and Hainan Branch, Chinese People's Liberation Army General Hospital, Beijing, 100853, China
| | - Leiming Luo
- Department of Geriatric Cardiology, Chinese People's Liberation Army General Hospital, Beijing, 100853, China.
| | - Ping Ye
- Department of Geriatric Cardiology, Chinese People's Liberation Army General Hospital, Beijing, 100853, China.
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Abstract
In patients with uncomplicated essential hypertension, cardiac output remains within normal ranges and intravascular volume is normal or low, assuming the presence of a sufficient Windkessel effect and usual resistance and compliance calculations. However, mean circulatory pressure is elevated in these patients. In addition, vascular resistance is augmented, and most importantly, the viscoelasticity of the cardiovascular system is substantially impaired. Such considerations are essential to understanding the mechanisms behind carotid-femoral arterial stiffness, a major risk factor in individuals with hypertension. Arterial stiffness, measured from pulse wave velocity, is substantially increased in hypertension even independently of blood pressure levels. Structural vascular changes and endothelial dysfunction are consistently associated with vessel impairments in animal models of hypertension. Increased arterial stiffness has a major effect on pulse pressure (the difference between systolic and diastolic blood pressure), wave reflections, kidney function, and above all, cardiovascular risk. This increased cardiovascular risk is particularly deleterious in patients with hypertension and/or type 2 diabetes mellitus, who are at risk of both renal and cardiovascular events. In this Review, we discuss the importance of arterial stiffness in the diagnosis and management of hypertension and the need for new approaches for the treatment of hypertension in patients with or without diabetes and/or renal impairment.
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Accuracy of Cuff-Measured Blood Pressure. J Am Coll Cardiol 2017; 70:572-586. [DOI: 10.1016/j.jacc.2017.05.064] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 05/26/2017] [Accepted: 05/30/2017] [Indexed: 12/20/2022]
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9
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Abstract
Arteriosclerosis, particularly aortosclerosis, is the most critical risk factor associated with cardiovascular, cerebrovascular, and renal diseases. The pulsatile hemodynamics in the central aorta consists of blood pressure, flow, and stiffness and substantially differs from the peripheral hemodynamics in muscular arteries. Arteriosclerotic changes with age appear earlier in the elastic aorta, and age-dependent increases in central pulse pressure are more marked than those apparent from brachial pressure measurement. Central pressure can be affected by lifestyle habits, metabolic disorders, and endocrine and inflammatory diseases in a manner different from brachial pressure. Central pulse pressure widening due to aortic stiffening increases left ventricular afterload in systole and reduces coronary artery flow in diastole, predisposing aortosclerotic patients to myocardial hypertrophy and ischemia. The widened pulse pressure is also transmitted deep into low-impedance organs such as the brain and kidney, causing microvascular damage responsible for lacunar stroke and albuminuria. In addition, aortic stiffening increases aortic blood flow reversal, which can lead to retrograde embolic stroke and renal function deterioration. Central pressure has been shown to predict cardiovascular events in most previous studies and potentially serves as a surrogate marker for intervention. Quantitative and comprehensive evaluation of central hemodynamics is now available through various noninvasive pressure/flow measurement modalities. This review will focus on the clinical usefulness and mechanistic rationale of central hemodynamic measurements for cardiovascular risk management.
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Vallée F, Le Gall A, Joachim J, Passouant O, Matéo J, Mari A, Millasseau S, Mebazaa A, Gayat E. Beat-by-beat assessment of cardiac afterload using descending aortic velocity-pressure loop during general anesthesia: a pilot study. J Clin Monit Comput 2017; 32:23-32. [PMID: 28108832 DOI: 10.1007/s10877-017-9982-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 01/06/2017] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Continuous cardiac afterload evaluation could represent a useful tool during general anesthesia (GA) to titrate vasopressor effect. Using beat to beat descending aortic pressure(P)/flow velocity(U) loop obtained from esophageal Doppler and femoral pressure signals might allow to track afterload changes. Methods We defined three angles characterizing the PU loop (alpha, beta and Global After-Load Angle (GALA)). Augmentation index (AIx) and total arterial compliance (Ctot) were measured via radial tonometry. Peripheral Vascular Resistances (PVR) were also calculated. Twenty patients were recruited and classified into low and high cardiovascular (CV) risk group. Vasopressors were administered, when baseline mean arterial pressure (MAP) fell by 20%. Results We studied 118 pairs of pre/post bolus measurements. At baseline, patients in the lower CV risk group had higher cardiac output (6.1 ± 1.7 vs 4.2 ± 0.6 L min; p = 0.005), higher Ctot (2.7 ± 1.0 vs 2.0 ± 0.4 ml/mmHg, p = 0.033), lower AIx and PVR (13 ± 10 vs 32 ± 11% and 1011 ± 318 vs 1390 ± 327 dyn s/cm5; p < 0.001 and p = 0.016, respectively) and lower GALA (41 ± 15 vs 68 ± 6°; p < 0.001). GALA was the only PU Loop parameter associated with Ctot, AIx and PVR. After vasopressors, MAP increase was associated with a decrease in Ctot, an increase in AIx and PVR and an increase in alpha, beta and GALA (p < 0.001 for all). Changes in GALA and Ctot after vasopressors were strongly associated (p = 0.004). Conclusions PU Loop assessment from routine invasive hemodynamic optimization management during GA and especially GALA parameter could monitor cardiac afterload continuously in anesthetized patients, and may help clinicians to titrate vasopressor therapy.
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Affiliation(s)
- Fabrice Vallée
- Department of Anesthesiology and Critical Care, Anesthesiology - Intensive care - SMUR Department, St-Louis-Lariboisière-Fernand Widal University Hospitals, Assistance Publique-Hôpitaux de Paris, Paris, France.
- INSERM UMR-942, Paris, France.
- Paris Diderot University, Paris, France.
- LMS, Ecole Polytechnique, CNRS, Université Paris-Saclay, Saclay, France.
| | - Arthur Le Gall
- Department of Anesthesiology and Critical Care, Anesthesiology - Intensive care - SMUR Department, St-Louis-Lariboisière-Fernand Widal University Hospitals, Assistance Publique-Hôpitaux de Paris, Paris, France
- INSERM UMR-942, Paris, France
- Paris Diderot University, Paris, France
- Inria, Paris Saclay University, Saclay, France
| | - Jona Joachim
- Department of Anesthesiology and Critical Care, Anesthesiology - Intensive care - SMUR Department, St-Louis-Lariboisière-Fernand Widal University Hospitals, Assistance Publique-Hôpitaux de Paris, Paris, France
- INSERM UMR-942, Paris, France
- Paris Diderot University, Paris, France
- Inria, Paris Saclay University, Saclay, France
| | - Olivier Passouant
- Department of Anesthesiology and Critical Care, Anesthesiology - Intensive care - SMUR Department, St-Louis-Lariboisière-Fernand Widal University Hospitals, Assistance Publique-Hôpitaux de Paris, Paris, France
- INSERM UMR-942, Paris, France
- Paris Diderot University, Paris, France
| | - Joaquim Matéo
- Department of Anesthesiology and Critical Care, Anesthesiology - Intensive care - SMUR Department, St-Louis-Lariboisière-Fernand Widal University Hospitals, Assistance Publique-Hôpitaux de Paris, Paris, France
- Paris Diderot University, Paris, France
| | - Arnaud Mari
- Department of Anesthesiology and Intensive Care, Service de Réanimation et Surveillance Continue, Saint Brieuc, France
| | | | - Alexandre Mebazaa
- Department of Anesthesiology and Critical Care, Anesthesiology - Intensive care - SMUR Department, St-Louis-Lariboisière-Fernand Widal University Hospitals, Assistance Publique-Hôpitaux de Paris, Paris, France
- INSERM UMR-942, Paris, France
- Paris Diderot University, Paris, France
| | - Etienne Gayat
- Department of Anesthesiology and Critical Care, Anesthesiology - Intensive care - SMUR Department, St-Louis-Lariboisière-Fernand Widal University Hospitals, Assistance Publique-Hôpitaux de Paris, Paris, France
- INSERM UMR-942, Paris, France
- Paris Diderot University, Paris, France
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Namikoshi T, Fujimoto S, Yorimitsu D, Ihoriya C, Fujimoto Y, Komai N, Sasaki T, Kashihara N. Relationship between vascular function indexes, renal arteriolosclerosis, and renal clinical outcomes in chronic kidney disease. Nephrology (Carlton) 2015; 20:585-90. [DOI: 10.1111/nep.12483] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Tamehachi Namikoshi
- Department of Nephrology and Hypertension; Kawasaki Medical School; Kurashiki Japan
| | - Sohachi Fujimoto
- Department of Nephrology and Hypertension; Kawasaki Medical School; Kurashiki Japan
| | - Daisuke Yorimitsu
- Department of Nephrology and Hypertension; Kawasaki Medical School; Kurashiki Japan
| | - Chieko Ihoriya
- Department of Nephrology and Hypertension; Kawasaki Medical School; Kurashiki Japan
| | - Yasuo Fujimoto
- Department of Nephrology and Hypertension; Kawasaki Medical School; Kurashiki Japan
| | - Norio Komai
- Department of Nephrology and Hypertension; Kawasaki Medical School; Kurashiki Japan
| | - Tamaki Sasaki
- Department of Nephrology and Hypertension; Kawasaki Medical School; Kurashiki Japan
| | - Naoki Kashihara
- Department of Nephrology and Hypertension; Kawasaki Medical School; Kurashiki Japan
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Hashimoto J, Ito S. Aortic Blood Flow Reversal Determines Renal Function. Hypertension 2015; 66:61-7. [DOI: 10.1161/hypertensionaha.115.05236] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 03/13/2015] [Indexed: 01/09/2023]
Abstract
Aortic stiffness determines the glomerular filtration rate (GFR) and predicts the progressive decline of the GFR. However, the underlying pathophysiological mechanism remains obscure. Recent evidence has shown a close link between aortic stiffness and the bidirectional (systolic forward and early diastolic reverse) flow characteristics. We hypothesized that the aortic stiffening–induced renal dysfunction is attributable to altered central flow dynamics. In 222 patients with hypertension, Doppler velocity waveforms were recorded at the proximal descending aorta to calculate the reverse/forward flow ratio. Tonometric waveforms were recorded to measure the carotid-femoral (aortic) and carotid-radial (peripheral) pulse wave velocities, to estimate the aortic pressure from the radial waveforms, and to compute the aortic characteristic impedance. In addition, renal hemodynamics was evaluated by duplex ultrasound. The estimated GFR was inversely correlated with the aortic pulse wave velocity, reverse/forward flow ratio, pulse pressure, and characteristic impedance, whereas it was not correlated with the peripheral pulse wave velocity or mean arterial pressure. The association between aortic pulse wave velocity and estimated GFR was independent of age, diabetes mellitus, hypercholesterolemia, and antihypertensive medication. However, further adjustment for the aortic reverse/forward flow ratio and pulse pressure substantially weakened this association, and instead, the reverse/forward flow ratio emerged as the strongest determinant of estimated GFR (
P
=0.001). A higher aortic reverse/forward flow ratio was also associated with lower intrarenal forward flow velocities. These results suggest that an increase in aortic flow reversal (ie, retrograde flow from the descending thoracic aorta toward the aortic arch), caused by aortic stiffening and impedance mismatch, reduces antegrade flow into the kidney and thereby deteriorates renal function.
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Affiliation(s)
- Junichiro Hashimoto
- From the Division of Nephrology, Endocrinology and Vascular Medicine, Department of Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (J.H., S.I.)
| | - Sadayoshi Ito
- From the Division of Nephrology, Endocrinology and Vascular Medicine, Department of Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (J.H., S.I.)
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Safar ME, Plante GE, Mimran A. Arterial stiffness, pulse pressure, and the kidney. Am J Hypertens 2015; 28:561-9. [PMID: 25480804 DOI: 10.1093/ajh/hpu206] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 09/26/2014] [Indexed: 12/17/2022] Open
Abstract
Classical studies indicate that the contribution of kidneys to hypertension is almost exclusively related to the association between mean arterial pressure (MAP) and vascular resistance. Recent reports including estimates of glomerular filtration rate (GFR) have shown that pulse pressure (PP) and pulse wave velocity, 2 major indices of arterial stiffness, now emerge as significant predictors of cardiovascular risk and age-associated decline in GFR. Such findings are mainly observed in patients with hypertension and renal failure and in atherosclerotic subjects undergoing coronary angiography. In such patients, amplification of PP between ascending and terminal aorta at the renal site is constantly increased over 10mm Hg (P < 0.001), whereas MAP level remains continuously unmodified. This PP amplification is significantly associated with presence of proteinuria. Furthermore, increases in plasma creatinine and aortic stiffness are independently and positively correlated (P < 0.001) both in cross-sectional and longitudinal studies. All these relationships associating PP, arterial stiffness, and renal function are mainly observed in patients 60 years of age or older. Furthermore, in renal transplant patients and their donors, subjects have been recruited for evaluations of arterial stiffness and posttransplant decline in GFR. Determinants of GFR decline were evaluated 1 and 9 years after transplantation. The first year GFR decline was related to smoking and acute rejection, whereas the later was significantly and exclusively associated with donor age and aortic stiffness. Thus, in hypertensive humans, the observed association between PP and GFR suggests that the 2 parameters are substantially mediated by arterial stiffness, not exclusively by vascular resistance.
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Affiliation(s)
- Michel E Safar
- Faculty of Medicine, Paris Descartes University, Hôtel-Dieu Hospital, AP-HP, Diagnosis and Therapeutic Center, Paris, France;
| | | | - Albert Mimran
- Department of Internal Medicine, Lapeyronie Hospital, CHU Montpellier, Montpellier, France
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Protogerou A, van Sloten T, Henry R, Dekker J, Nijpels G, Stehouwer C. Pulse pressure measured at the level of the femoral artery, but not at the level of the aorta, carotid and brachial arteries, is associated with the incidence of coronary heart disease events in a population with a high prevalence of type 2 diabetes and impaired glucose metabolism – The Hoorn study. Artery Res 2015. [DOI: 10.1016/j.artres.2014.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Go OD, Safar ME, Smulyan H. Assessment of Aortic Stiffness by Transesophageal Echocardiography. Echocardiography 2014; 31:1105-12. [DOI: 10.1111/echo.12528] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Orson D. Go
- Cardiology Division; Department of Medicine; Upstate Medical University, State University of New York; Syracuse New York
| | - Michel E. Safar
- Centre de Diagnostique et de Therapeutique; Hôpital Hôtel Dieu; Paris France
| | - Harold Smulyan
- Cardiology Division; Department of Medicine; Upstate Medical University, State University of New York; Syracuse New York
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Hashimoto J. Central Hemodynamics and Target Organ Damage in Hypertension. TOHOKU J EXP MED 2014; 233:1-8. [DOI: 10.1620/tjem.233.1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Junichiro Hashimoto
- Department of Blood Pressure Research, Tohoku University Graduate School of Medicine
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Sung SH, Chen CH. Role of Pulsatile Hemodynamics in Acute Heart Failure: Implications for Type 1 Cardiorenal Syndrome. ACTA ACUST UNITED AC 2013; 1:89-96. [PMID: 26587428 PMCID: PMC4315344 DOI: 10.1159/000354107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Heart failure has become a major health problem worldwide with a substantial financial burden mainly from hospitalization due to acute heart failure syndrome (AHFS). A considerable number of patients hospitalized for the treatment of AHFS experience significant worsening of renal function, which is now recognized as type 1 cardiorenal syndrome (CRS) and is associated with worse outcomes. Currently known risk factors for acute CRS in AHFS include obesity, cachexia, hypertension, diabetes, proteinuria, uremic solute retention, anemia, and repeated subclinical acute kidney injury events. Venous renal congestion due to hemodynamic changes also contributes to type 1 CRS. Vascular aging and its aggravated pulsatile hemodynamics have been shown to be involved in the pathogenesis of AHFS. Suboptimal recovery of the perturbation of the pulsatile hemodynamics may predict 6-month post-discharge cardiovascular outcomes in patients hospitalized due to AHFS. Furthermore, on-admission pulsatile hemodynamics may also be helpful to identify and stratify patients with aggravated pulsatile hemodynamics who may benefit from customized therapy. There are close interplays and feedback loops between heart and kidney dysfunction. Increased arterial stiffness accelerates pulse wave velocity and causes an earlier return of the reflected wave, resulting in higher systolic, lower diastolic, and higher pulse pressure in the central aorta and renal arteries. Increased pulsatile hemodynamics have been associated with deterioration of renal function in subjects with a high coronary risk and patients with hypertension or chronic kidney disease. Thus, there is a potential role of vascular aging/pulsatile hemodynamics in the pathophysiological pathways of acute CRS in AHFS.
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Affiliation(s)
- Shih-Hsien Sung
- Department of Medicine, Taipei, Taiwan, ROC ; Department of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC ; Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Chen-Huan Chen
- Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan, ROC ; Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan, ROC
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Central pulse pressure in patients with chronic kidney disease and in renal transplant recipients. J Hum Hypertens 2013; 28:180-5. [DOI: 10.1038/jhh.2013.71] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Revised: 06/03/2013] [Accepted: 06/28/2013] [Indexed: 11/09/2022]
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Exercise aortic stiffness: reproducibility and relation to end-organ damage in men. J Hum Hypertens 2013; 27:516-22. [PMID: 23389297 DOI: 10.1038/jhh.2013.5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 12/19/2012] [Accepted: 01/01/2013] [Indexed: 11/09/2022]
Abstract
Resting aortic stiffness (pulse wave velocity; aortic PWV (aPWV)) independently predicts end-organ damage and mortality. Exercise haemodynamics have been shown to unmask cardiovascular abnormalities, otherwise undetectable at rest, but the response of aPWV to exercise has never been examined. This study aimed to develop a technique to measure exercise aPWV, determine reproducibility and relation to subclinical end-organ damage with aging. Healthy younger (n=17, 30±8 years) and older (n=18, 54±8 years) untreated men underwent cardiovascular assessment at rest and during low intensity semirecumbent cycling. Tonometry was used to assess aPWV and central blood pressure (BP). All participants underwent 24 h ambulatory BP (ABP) monitoring. Kidney function was assessed by estimated glomerular filtration rate (eGFR). Fifteen participants had testing repeated within 28±18 days. Exercise aPWV had good reproducibility (mean difference=-0.35±0.61 m s(-1), intraclass correlations=0.874, P<0.001) and was increased 26% above resting values in younger men (5.8±0.9 vs 7.3±1.6 m s(-1), P<0.001) and 19% above resting values in older men (6.3±1.0 vs 7.4±0.9 m s(-1), P<0.001). Exercise, but not resting, aPWV was significantly correlated with eGFR in older men (r=-0.633, P=0.005), and this was maintained after correction for age, body mass index and daytime systolic ABP (r=-0.656, P=0.008). Conversely, in younger men there was no significant association between eGFR and aPWV either at rest (r=-0.031, P=0.906) or during exercise (r=-0.117, P=0.655). Exercise aPWV is reproducible and significantly associated with kidney function in healthy older men. Further studies to determine the physiology and clinical relevance of raised exercise aPWV are warranted.
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21
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Vašků A, Bienertová-Vašků J, Pařenica J, Goldbergová MP, Lipková J, Zlámal F, Kala P, Spinar J. ACE2 gene polymorphisms and invasively measured central pulse pressure in cardiac patients indicated for coronarography. J Renin Angiotensin Aldosterone Syst 2012; 14:220-6. [PMID: 23077079 DOI: 10.1177/1470320312460291] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND AND AIM The objective of this research was to determine whether invasively measured central pulse pressure (PP) in patients indicated for coronarography is associated with two common polymorphisms in the ACE2 region (rs4646156 and rs4646174). METHODS A total of 307 patients were enrolled in the study. The genotyping of both SNPs from peripheral blood samples was carried out using 5'exonuclease (Taqman®) chemistry on the ABI Prism® 7000 system (Applied Biosystems, Foster City, CA, USA). RESULTS In both polymorphisms, the associations with central PP were found to be highly significant when all five possible genotypes in the population had been compared (p = 0.0001). In men, there was a higher incidence of previous myocardial infarction in G0 genotype carriers of rs54646174 (OR ratio = 7; p = 0.005). The AA genotype of rs4646156 had a 7.81× higher risk of severe angina pectoris in women (OR = 7.81, p = 0.05). A significant difference in allelic frequency of ACE2rs4646174 was found between women with and without significant stenoses of the circumflex branch of the left coronary artery. CONCLUSION More research into the role of ACE2 genetic variability in PP regulations is necessary for more detailed physiological and pathophysiological comprehension of PP regulation.
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Affiliation(s)
- Anna Vašků
- Department of Pathophysiology, Faculty of Medicine, Masaryk University Brno, Czech Republic.
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22
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Neisius U, Bilo G, Taurino C, McClure JD, Schneider MP, Kawecka-Jaszcz K, Stolarz-Skrzypek K, Klima Ł, Staessen JA, Kuznetsova T, Redon J, Martinez F, Rosei EA, Muiesan ML, Melander O, Zannad F, Rossignol P, Laurent S, Collin C, Lonati L, Zanchetti A, Dominiczak AF, Delles C. Association of central and peripheral pulse pressure with intermediate cardiovascular phenotypes. J Hypertens 2012; 30:67-74. [DOI: 10.1097/hjh.0b013e32834e12d8] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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23
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Peripheral augmentation index as a biomarker of vascular aging: an invasive hemodynamics approach. Eur J Appl Physiol 2011; 112:2871-9. [DOI: 10.1007/s00421-011-2255-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Accepted: 11/18/2011] [Indexed: 10/14/2022]
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Hashimoto J, Ito S. Central pulse pressure and aortic stiffness determine renal hemodynamics: pathophysiological implication for microalbuminuria in hypertension. Hypertension 2011; 58:839-46. [PMID: 21968753 DOI: 10.1161/hypertensionaha.111.177469] [Citation(s) in RCA: 181] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A significant link has been reported between aortic stiffening and renal microvascular damage, but the underlying mechanism remains poorly understood. We hypothesized that alterations in central and renal hemodynamics are responsible for this link. In 133 patients with hypertension, pressure waveforms were recorded on the radial, carotid, femoral, and dorsalis pedis arteries with applanation tonometry to estimate the aortic pressures and aortic (carotid-femoral) and peripheral (carotid-radial and femoral-dorsalis pedis) pulse wave velocities. Flow-velocity waveforms were recorded on the renal segmental arteries with duplex ultrasound to calculate the resistive index (RI) as [1 - (end-diastolic velocity/peak systolic velocity)] and on the femoral arteries to calculate the reverse/forward flow index and diastolic/systolic forward-flow ratio. Albuminuria was defined as urinary albumin/creatinine ratio ≥30 mg/g of creatinine. The renal RI (mean: 0.65±0.07) was strongly correlated (P<0.001) with the aortic pulse pressure (r=0.62), incident pressure wave (r=0.55), augmented pressure (r=0.49), and aortic pulse wave velocity (r=0.51), although not with the mean arterial pressure or peripheral pulse wave velocities. The correlations remained highly significant after consideration of confounders including age, cholesterol, hemoglobin A(1c), and glomerular filtration rate. The renal RI was inversely correlated with the femoral reverse and diastolic forward flow indices. Both aortic pulse pressure and renal RI correlated with the urinary albumin/creatinine ratio independent of confounders. Each 0.1 increase in renal RI was associated with a 5.4-fold increase in the adjusted relative risk of albuminuria. In conclusion, increased aortic pulse pressure causes renal microvascular damage through altered renal hemodynamics resulting from increased peripheral resistance and/or increased flow pulsation.
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Affiliation(s)
- Junichiro Hashimoto
- Department of Blood Pressure Research, Tohoku University Graduate School of Medicine, 1-1 Seiryo-cho, Aoba-ku, Sendai 980-8574, Japan.
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25
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Arterial stiffness, pulse pressure, and cardiovascular disease—Is it possible to break the vicious circle? Atherosclerosis 2011; 218:263-71. [DOI: 10.1016/j.atherosclerosis.2011.04.039] [Citation(s) in RCA: 148] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2010] [Revised: 04/26/2011] [Accepted: 04/27/2011] [Indexed: 01/02/2023]
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26
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Matsui Y, Eguchi K, Ishikawa J, Shimada K, Kario K. Urinary albumin excretion during angiotensin II receptor blockade: comparison of combination treatment with a diuretic or a calcium-channel blocker. Am J Hypertens 2011; 24:466-73. [PMID: 21164498 DOI: 10.1038/ajh.2010.240] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND We aimed to test the hypothesis that the angiotensin II receptor blocker (ARB)/diuretic combination decreases the urinary albumin/creatinine ratio (UACR) to a greater extent than treatment with the ARB/calcium-channel blocker (CCB) combination through a mechanism related to a greater reduction of sleep blood pressure (BP). METHODS We conducted a prospective, randomized, open-label, blinded end-point trial in hypertensive patients. Patients received olmesartan monotherapy for 12 weeks, followed by an additional use of hydrochlorothiazide (HCTZ) (n = 104) or azelnidipine (n = 103) for 24 weeks after randomization. The measurements of central and ambulatory BP, and laboratory tests were performed at baseline and the end of the study. RESULTS The adjusted percent reduction in UACR in the olmesartan/HCTZ group was significantly greater than that in the olmesartan/azelnidipine group (-43.2 vs. -24.0%, P = 0.0014), although the olmesartan/azelnidipine group showed greater decreases in central systolic BP (SBP; P = 0.04), oxidative stress (urinary 8-isoprostane; P = 0.02), inflammation (high-sensitivity C-reactive protein; P = 0.04), and insulin resistance (the homeostasis model assessment insulin resistance index (HOMA(IR)); P < 0.001) than the olmesartan/HCTZ group. In multivariate regression analyses, the significant determinants of change in UACR in the olmesartan/HCTZ group were changes in sleep SBP (P < 0.001), central SBP (P = 0.01), estimated glomerular filtration rate (eGFR) (P = 0.02), and HOMA(IR) (P = 0.03), and those in the olmesartan/azelnidipine group were changes in central SBP (P = 0.001) and urinary 8-isoprostane (P = 0.02). CONCLUSIONS These data showed that the ARB/diuretic combination decreased UACR significantly more than the ARB/CCB combination, and this decrease in UACR was associated with a greater magnitude reduction in sleep SBP.
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Payne RA, Lilitkarntakul P, Dhaun N, Melville V, Asai T, Goddard J, Webb DJ. Renal Dysfunction Does Not Affect the Peripheral-to-Central Arterial Pressure Transfer Function. Hypertension 2010; 56:1083-8. [DOI: 10.1161/hypertensionaha.110.159194] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Arterial generalized transfer functions (GTFs) are increasingly used to estimate central pressure from peripheral measurements. Analysis of derived central waveforms may be valuable in the assessment of patients with chronic kidney disease. The aim of this study was to assess whether the GTF is affected by renal disease. Ninety-four subjects with varying degrees of renal function (Kidney Disease Outcomes Quality Initiative stages 1 to 5; 14 controls) had simultaneous measurements of carotid and radial waveforms made by applanation tonometry. GTFs were calculated by Fourier analysis for each subject group. Derived carotid waveforms were obtained by applying an independently generated GTF to the radial waveform. Glomerular filtration rate inversely correlated with central systolic (
R
=−0.42;
P
<0.001), mean (
R
=−0.34;
P
<0.01) and diastolic (
R
=−-0.27,
P
<0.01) blood pressures, as well as central augmentation index (
R
=−0.30;
P
<0.01) and carotid-femoral pulse wave velocity (
R
=−0.33;
P
<0.001). Derived waveforms were not significantly different from measured waveforms in terms of systolic blood pressure, augmentation index, maximum slope, or the delay between the incident and reflected waves, although the derived waveforms slightly underestimated the systolic ejection period (−4.4±0.9 ms;
P
<0.001). Overall root-mean-square error was 2.4±0.1 mm Hg. No significant relationship existed between the degree of bias of any derived waveform measure and glomerular filtration rate or chronic kidney disease stage (
P
>0.16). No significant differences between chronic kidney disease stages were observed in transfer function gain or phase (
P
>0.05). We conclude that the peripheral-to-central GTF is not affected by degree of renal dysfunction and can be used with equivalence in patients with varying degrees of chronic kidney disease.
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Affiliation(s)
- Rupert A. Payne
- From the Clinical Pharmacology Unit (R.A.P., P.L., N.D., V.M., T.A., D.J.W.), Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; Department of Renal Medicine (N.D., J.G.), Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Pajaree Lilitkarntakul
- From the Clinical Pharmacology Unit (R.A.P., P.L., N.D., V.M., T.A., D.J.W.), Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; Department of Renal Medicine (N.D., J.G.), Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Neeraj Dhaun
- From the Clinical Pharmacology Unit (R.A.P., P.L., N.D., V.M., T.A., D.J.W.), Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; Department of Renal Medicine (N.D., J.G.), Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Vanessa Melville
- From the Clinical Pharmacology Unit (R.A.P., P.L., N.D., V.M., T.A., D.J.W.), Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; Department of Renal Medicine (N.D., J.G.), Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Takae Asai
- From the Clinical Pharmacology Unit (R.A.P., P.L., N.D., V.M., T.A., D.J.W.), Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; Department of Renal Medicine (N.D., J.G.), Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Jane Goddard
- From the Clinical Pharmacology Unit (R.A.P., P.L., N.D., V.M., T.A., D.J.W.), Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; Department of Renal Medicine (N.D., J.G.), Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - David J. Webb
- From the Clinical Pharmacology Unit (R.A.P., P.L., N.D., V.M., T.A., D.J.W.), Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; Department of Renal Medicine (N.D., J.G.), Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
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Hashimoto J, Ito S. Pulse Pressure Amplification, Arterial Stiffness, and Peripheral Wave Reflection Determine Pulsatile Flow Waveform of the Femoral Artery. Hypertension 2010; 56:926-33. [DOI: 10.1161/hypertensionaha.110.159368] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Junichiro Hashimoto
- From the Department of Blood Pressure Research (J.H., S.I.) and Division of Nephrology, Endocrinology, and Vascular Medicine (S.I.), Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Sadayoshi Ito
- From the Department of Blood Pressure Research (J.H., S.I.) and Division of Nephrology, Endocrinology, and Vascular Medicine (S.I.), Tohoku University Graduate School of Medicine, Sendai, Japan
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Safar ME, Jankowski P. Antihypertensive therapy and de-stiffening of the arteries. Expert Opin Pharmacother 2010; 11:2625-34. [DOI: 10.1517/14656566.2010.496452] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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