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Hashimoto J. Pulse pressure amplification as a hemodynamic predictor of cardiovascular disease. Hypertens Res 2024:10.1038/s41440-024-01880-8. [PMID: 39261706 DOI: 10.1038/s41440-024-01880-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2024] [Accepted: 08/13/2024] [Indexed: 09/13/2024]
Affiliation(s)
- Junichiro Hashimoto
- Medical Center, Miyagi University of Education, Sendai, Japan.
- Department of Nephrology, Tohoku University Graduate School of Medicine, Sendai, Japan.
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2
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Inokuchi Y, Takashina T, Hayashi Y, Sakihara J, Uematsu M, Kurosaki H. An Evaluation of Renal Sinus Fat Accumulation Using the Anteroposterior Diameter of the Renal Sinus on a Computed Tomography Axial Image. Cureus 2024; 16:e58006. [PMID: 38738023 PMCID: PMC11087672 DOI: 10.7759/cureus.58006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2024] [Indexed: 05/14/2024] Open
Abstract
Backgrounds and objectives Renal sinus fat (RSF) is an indicator of obesity-related complications. However, the measurement and imaging process are complicated. For a simple measurement of RSF, we focused on the kidney's shape change caused by RSF accumulation. Thus, this study aimed to investigate whether the anteroposterior diameter of the renal sinus (APDRS) on a computed tomography (CT) axial image is useful for evaluating RSF accumulation. Materials and methods The correlation between APDRS and RSF was investigated in 98 outpatients who underwent abdominal CT. In addition, the correlation between APDRS or RSF and obesity indicators (estimated glomerular filtration rate from serum creatinine levels (eGFRcreat), body mass index (BMI), and visceral adipose tissue (VAT)) was also investigated. We classified patients based on the presence or absence of at least one underlying disease (chronic kidney disease (CKD), cardiovascular diseases (CVD), hypertension, and type 2 diabetes (T2D)) and investigated significant differences between the two groups at APDRS and RSF. The intraclass correlation coefficient (ICC) was also calculated for APDRS. Results There was a strong positive correlation between RSF and APDRS (r = 0.802, P < 0.01). The obesity indicators (eGFRcreat, BMI, and VAT) were correlated with RSF and APDRS (P < 0.01). Out of 98 outpatients, 48 had at least one underlying disease. There were statistically significant differences in APDRS and RSF between the patients with and without at least one of the underlying diseases caused by obesity (P < 0.01). The inter-reader ICC for the measurement of the APDRS was 0.98. Conclusions APDRS on a CT axial image may be useful for the evaluation of RSF accumulation.
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Affiliation(s)
| | | | | | - Jo Sakihara
- Department of Radiology, Edogawa Hospital, Tokyo, JPN
| | - Masahiro Uematsu
- Department of Radiology and Radiation Oncology, Edogawa Hospital, Tokyo, JPN
| | - Hiromasa Kurosaki
- Department of Radiology and Radiation Oncology, Edogawa Hospital, Tokyo, JPN
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3
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Liu J, Wu J. The Pathogenesis and Impact of Arterial Stiffening in Hypertension: The 2023 John H. Laragh Research Award. Am J Hypertens 2024; 37:241-247. [PMID: 38214376 DOI: 10.1093/ajh/hpae006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 01/13/2024] Open
Abstract
Fifty years ago, Dr. John Laragh brought forward the "vasoconstriction-volume hypothesis" of hypertension. This is Ohm's Law in blood pressure regulation, explicating hypertension as a consequence of increased peripheral vascular resistance, cardiac output, or both. Resistance vessels, those of a diameter less than 200 μm, determines mean arterial pressure by controlling peripheral vascular resistance. In comparison, large capacitance arteries, particularly the aorta, confines the systolic and diastolic blood pressure in physiological range through the "windkessel effect." Loss of this cushioning function results in aortic stiffening and isolated systolic hypertension, both of which are independently associated with increased risk for coronary, cerebral, and renal diseases. Aortic stiffening is both a cause and a consequence of hypertension. On one hand, aortic stiffness precedes the onset of hypertension in populations and experimental models, and hemodynamic derangements related to aortic stiffening contributes to the development of hypertension by promoting renal dysfunction. On the other hand, the vasculature itself is a hypertensive target organ and hypertensive mechanical stretch directly induces the pathogenesis of aortic adventitial remodeling. Various cell types, including bone marrow-derived circulating fibrocytes, vascular stem cell antigen-1 positive progenitors, and endothelial to mesenchymal transition, and to a lesser extent resident fibroblasts, contribute to adventitial matrix deposition and aortic stiffening in hypertension. Vascular smooth muscle stiffness is another important contributor of aortic stiffening. Understanding the roles of immune components and specific signal pathways in the pathogenesis aortic stiffening paves the path to novel antihypertensive and anti-fibrosis therapies.
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Affiliation(s)
- Jing Liu
- Division of Nephrology, Department of Medicine, School of Medicine & Dentistry, University of Rochester, Rochester, NY 14642, USA
| | - Jing Wu
- Division of Nephrology, Department of Medicine, School of Medicine & Dentistry, University of Rochester, Rochester, NY 14642, USA
- Department of Pharmacology & Physiology, School of Medicine & Dentistry, University of Rochester, Rochester, NY 14642, USA
- Environmental Health Science Center, Institute of Human Health and the Environment, University of Rochester Medical Center, Rochester, NY 14642, USA
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4
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Kosaki K, Park J, Matsui M, Sugaya T, Kuro-O M, Saito C, Yamagata K, Maeda S. Elevated urinary angiotensinogen excretion links central and renal hemodynamic alterations. Sci Rep 2023; 13:11518. [PMID: 37460637 PMCID: PMC10352254 DOI: 10.1038/s41598-023-38507-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/11/2023] [Indexed: 07/20/2023] Open
Abstract
Inappropriate activation of intrarenal renin-angiotensin system (RAS) may contribute to the pathogenesis of cardio-renal syndrome (CRS). We aimed to examine the cross-sectional associations of urinary angiotensinogen (AGT) excretion, a biomarker of intrarenal RAS activity, with central (aortic) and renal hemodynamic parameters in middle-aged and older adults, including patients with chronic kidney disease. Aortic and renal hemodynamic parameters were measured using applanation tonometry and duplex ultrasonography in 282 participants. Urinary AGT, liver-type fatty acid-binding protein (L-FABP), and plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels were measured for each participant. Multiple linear regression analyses demonstrated that urinary AGT levels were associated with aortic blood pressures, pulsatile measures of renal blood flow, plasma NT-proBNP and urinary L-FABP levels after adjusting for potential covariates, including age, sex, body mass index, estimated glomerular filtration rate (GFR), and medication use. Additionally, when classified based on GFR stages and urinary AGT levels, plasma NT-proBNP and urinary L-FABP levels increased in participants with lower GFR and higher AGT groups. Our findings suggest that urinary AGT excretion is a shared determinant of central (aortic) and renal hemodynamics in middle-aged and older adults, providing clinical evidence for the potential role of intrarenal RAS activity in the development of CRS.
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Affiliation(s)
- Keisei Kosaki
- Institute of Health and Sport Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8574, Japan.
- Advanced Research Initiative for Human High Performance (ARIHHP), University of Tsukuba, Ibaraki, Japan.
| | - Jiyeon Park
- Institute of Health and Sport Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8574, Japan
| | - Masahiro Matsui
- Institute of Health and Sport Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8574, Japan
| | - Takeshi Sugaya
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Makoto Kuro-O
- Division of Anti-aging Medicine, Center for Molecular Medicine, Jichi Medical University, Tochigi, Japan
| | - Chie Saito
- Department of Nephrology, Institute of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Kunihiro Yamagata
- Department of Nephrology, Institute of Medicine, University of Tsukuba, Ibaraki, Japan
- R&D Center for Smart Wellness City Policies, University of Tsukuba, Tokyo, Japan
| | - Seiji Maeda
- Institute of Health and Sport Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8574, Japan
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
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5
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Colvert CA, Hawkins KP, Semenikhina M, Stefanenko M, Pavlykivska O, Oates JC, DeLeon-Pennell KY, Palygin O, Van Beusecum JP. Endothelial mechanical stretch regulates the immunological synapse interface of renal endothelial cells in a sex-dependent manner. Am J Physiol Renal Physiol 2023; 325:F22-F37. [PMID: 37167273 PMCID: PMC10292970 DOI: 10.1152/ajprenal.00258.2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 04/27/2023] [Accepted: 04/27/2023] [Indexed: 05/13/2023] Open
Abstract
Increased mechanical endothelial cell stretch contributes to the development of numerous cardiovascular and renal pathologies. Recent studies have shone a light on the importance of sex-dependent inflammation in the pathogenesis of renal disease states. The endothelium plays an intimate and critical role in the orchestration of immune cell activation through upregulation of adhesion molecules and secretion of cytokines and chemokines. While endothelial cells are not recognized as professional antigen-presenting cells, in response to cytokine stimulation, endothelial cells can express both major histocompatibility complex (MHC) I and MHC II. MHCs are essential to forming a part of the immunological synapse interface during antigen presentation to adaptive immune cells. Whether MHC I and II are increased under increased mechanical stretch is unknown. Due to hypertension being multifactorial, we hypothesized that increased mechanical endothelial stretch promotes the regulation of MHCs and key costimulatory proteins on mouse renal endothelial cells (MRECs) in a stretch-dependent manner. MRECs derived from both sexes underwent 5%, 10%, or 15% uniaxial cyclical stretch, and immunological synapse interface proteins were determined by immunofluorescence microscopy, immunoblot analysis, and RNA sequencing. We found that increased endothelial mechanical stretch conditions promoted downregulation of MHC I in male MRECs but upregulation in female MRECs. Moreover, MHC II was upregulated by mechanical stretch in both male and female MRECs, whereas CD86 and CD70 were regulated in a sex-dependent manner. By bulk RNA sequencing, we found that increased mechanical endothelial cell stretch promoted differential gene expression of key antigen processing and presentation genes in female MRECs, demonstrating that females have upregulation of key antigen presentation pathways. Taken together, our data demonstrate that mechanical endothelial stretch regulates endothelial activation and immunological synapse interface formation in renal endothelial cells in a sex-dependent manner.NEW & NOTEWORTHY Endothelial cells contribute to the development of renal inflammation and have the unique ability to express antigen presentation proteins. Whether increased endothelial mechanical stretch regulates immunological synapse interface proteins remains unknown. We found that antigen presentation proteins and costimulatory proteins on renal endothelial cells are modulated by mechanical stretch in a sex-dependent manner. Our data provide novel insights into the sex-dependent ability of renal endothelial cells to present antigens in response to endothelial mechanical stimuli.
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Affiliation(s)
- C Alex Colvert
- Division of Nephrology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, United States
| | - Kennedy P Hawkins
- Division of Nephrology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, United States
| | - Marharyta Semenikhina
- Division of Nephrology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, United States
| | - Mariia Stefanenko
- Division of Nephrology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, United States
| | - Olesia Pavlykivska
- Division of Nephrology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, United States
| | - Jim C Oates
- Division of Rheumatology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, United States
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina, United States
| | - Kristine Y DeLeon-Pennell
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina, United States
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, United States
| | - Oleg Palygin
- Division of Nephrology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, United States
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, South Carolina, United States
| | - Justin P Van Beusecum
- Division of Nephrology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, United States
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina, United States
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6
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Li Z, Li X, Yan F, Liu L, Bai T, Jiang W, Dong R. Remodeling of the cardiovascular hemodynamic environment by lower limb heat exposure: A computational fluid dynamic study. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 238:107626. [PMID: 37263116 DOI: 10.1016/j.cmpb.2023.107626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/15/2023] [Accepted: 05/27/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Lower limb heat exposure (LLHE) is a promising strategy for the daily management of cardiovascular health because of its non-pharmaceutical advantages. To support the application of this strategy in cardiovascular protection, we examined its impact on the global hemodynamic environment. METHODS Skin blood flow (SBF) of eight locations on the lower limbs was measured before and after LLHE (40 °C and 44 °C) in ten healthy subjects by using a laser Doppler flowmeter. A closed-loop model of circulation uses changes in SBF to quantify the influence of LLHE on the blood flow of the arterial trunk (from ascending aorta to the femoral artery) and visceral branches (coronary, celiac, renal, and mesenteric arteries). RESULTS The SBF in all locations tested on the lower limbs increased significantly (p<0.001) with LLHE and a 3.39-fold and 7.40-fold increase in mean SBF were observed under 40 °C and 44 °C conditions, respectively. In the model, the peak (3.9-25.1%), end-diastolic (13.7-107.3%), and mean blood flow (8.5-86.5%) in the arterial trunk increased with the increase in temperature, but the retrograde flow in the thoracic aorta and abdominal aorta Ⅰ increased at least twice in the diastolic period. Furthermore, LLHE also increased the blood flow of the visceral branches (2.5-20.7%). CONCLUSION These findings suggest that LLHE is expected to be a daily strategy for enhancing the functions of both the arterial trunk and visceral arteries, but the increased blood flow reversal in the thoracic and abdominal aortas warrants further investigation.
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Affiliation(s)
- Zhongyou Li
- Sichuan Province Biomechanical Engineering Laboratory, Chengdu, China; Department of Mechanical Science and Engineering, Sichuan University, Chengdu, China
| | - Xiao Li
- Sichuan Province Biomechanical Engineering Laboratory, Chengdu, China; Department of Mechanical Science and Engineering, Sichuan University, Chengdu, China
| | - Fei Yan
- Chongqing University Three Gorges Hospital, Chongqing University, Chongqing, China
| | - Lingjun Liu
- Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Taoping Bai
- Sichuan Province Biomechanical Engineering Laboratory, Chengdu, China; Department of Mechanical Science and Engineering, Sichuan University, Chengdu, China
| | - Wentao Jiang
- Sichuan Province Biomechanical Engineering Laboratory, Chengdu, China; Department of Mechanical Science and Engineering, Sichuan University, Chengdu, China.
| | - Ruiqi Dong
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, China
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7
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Abi Rached NM, Gbotosho OT, Archer DR, Jones JA, Sterling MS, Hyacinth HI. Adhesion molecules and cerebral microvascular hemodynamic abnormalities in sickle cell disease. Front Neurol 2022; 13:976063. [PMID: 36570439 PMCID: PMC9767957 DOI: 10.3389/fneur.2022.976063] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022] Open
Abstract
Cerebrovascular abnormalities are a common feature of sickle cell disease that may be associated with risk of vaso-occlusive pain crises, microinfarcts, and cognitive impairment. An activated endothelium and adhesion factors, VCAM-1 and P-selectin, are implicated in sickle cell vasculopathy, including abnormal hemodynamics and leukocyte adherence. This study examined the association between cerebral expression of these adhesion factors and cortical microvascular blood flow dynamics by using in-vivo two-photon microscopy. We also examined the impact of blood transfusion treatment on these markers of vasculopathy. Results showed that sickle cell mice had significantly higher maximum red blood cell (RBC) velocity (6.80 ± 0.25 mm/sec, p ≤ 0.01 vs. 5.35 ± 0.35 mm/sec) and more frequent blood flow reversals (18.04 ± 0.95 /min, p ≤ 0.01 vs. 13.59 ± 1.40 /min) in the cortical microvasculature compared to controls. In addition, sickle cell mice had a 2.6-fold (RFU/mm2) increase in expression of VCAM-1 and 17-fold (RFU/mm2) increase in expression of P-selectin compared to controls. This was accompanied by an increased frequency in leukocyte adherence (4.83 ± 0.57 /100 μm/min vs. 2.26 ± 0.37 /100 μm/min, p ≤ 0.001). We also found that microinfarcts identified in sickle cell mice were 50% larger than in controls. After blood transfusion, many of these parameters improved, as results demonstrated that sickle cell mice had a lower post-transfusion maximum RBC velocity (8.30 ± 0.98 mm/sec vs. 11.29 ± 0.95 mm/sec), lower frequency of blood flow reversals (12.80 ± 2.76 /min vs. 27.75 ± 2.09 /min), and fewer instances of leukocyte adherence compared to their pre-transfusion imaging time point (1.35 ± 0.32 /100 μm/min vs. 3.46 ± 0.58 /100 μm/min). Additionally, we found that blood transfusion was associated with lower expression of adhesion factors. Our results suggest that blood transfusion and adhesion factors, VCAM-1 and P-selectin, are potential therapeutic targets for addressing cerebrovascular pathology, such as vaso-occlusion, in sickle cell disease.
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Affiliation(s)
- Noor Mary Abi Rached
- Neuroscience and Behavioral Biology Undergraduate Program, Emory University, Atlanta, GA, United States
| | - Oluwabukola T. Gbotosho
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - David R. Archer
- Aflac Cancer and Blood Disorders Center, Emory University Department of Pediatrics and Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Jayre A. Jones
- Aflac Cancer and Blood Disorders Center, Emory University Department of Pediatrics and Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Morgan S. Sterling
- Aflac Cancer and Blood Disorders Center, Emory University Department of Pediatrics and Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Hyacinth I. Hyacinth
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, United States
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8
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Aizawa K, Hughes AD, Casanova F, Gates PE, Mawson DM, Gooding KM, Gilchrist M, Goncalves I, Nilsson J, Khan F, Colhoun HM, Palombo C, Parker KH, Shore AC. Reservoir Pressure Integral Is Independently Associated With the Reduction in Renal Function in Older Adults. Hypertension 2022; 79:2364-2372. [PMID: 35993228 DOI: 10.1161/hypertensionaha.122.19483] [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: 11/16/2022]
Abstract
BACKGROUND Arterial hemodynamic parameters derived from reservoir-excess pressure analysis exhibit prognostic utility. Reservoir-excess pressure analysis may provide useful information about an influence of altered hemodynamics on target organ such as the kidneys. We determined whether the parameters derived from the reservoir-excess pressure analysis were associated with the reduction in estimated glomerular filtration rate in 542 older adults (69.4±7.9 years, 194 females) at baseline and after 3 years. METHODS Reservoir-excess pressure parameters, including reservoir pressure integral, excess pressure integral, systolic, and diastolic rate constants, were obtained by radial artery tonometry. RESULTS After 3 years, and in a group of 94 individuals (72.4±7.6 years, 26 females), there was an estimated glomerular filtration rate reduction of >5% per year (median reduction of 20.5% over 3 years). A multivariable logistic regression analysis revealed that higher baseline reservoir pressure integral was independently associated with a smaller reduction in estimated glomerular filtration rate after accounting for conventional cardiovascular risk factors and study centers (odds ratio: 0.660 [95% CIs, 0.494-0.883]; P=0.005). The association remained unchanged after further adjustments for potential confounders and baseline renal function (odds ratio: 0.528 [95% CIs, 0.351-0.794]; P=0.002). No other reservoir-excess pressure parameters exhibited associations with the reduction in renal function. CONCLUSIONS This study demonstrates that baseline reservoir pressure integral was associated with the decline in renal function in older adults at 3-year follow-up, independently of conventional cardiovascular risk factors. This suggests that reservoir pressure integral may play a role in the functional decline of the kidneys.
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Affiliation(s)
- Kunihiko Aizawa
- Diabetes and Vascular Medicine Research Centre, NIHR Exeter Clinical Research Facility, University of Exeter Medical School, United Kingdom (K.A., F.C., P.E.G., D.M.M., K.M.G., M.G., A.C.S.)
| | - Alun D Hughes
- MRC unit for Lifelong Health and Ageing, Institute of Cardiovascular Science, University College London, United Kingdom (A.D.H.)
| | - Francesco Casanova
- Diabetes and Vascular Medicine Research Centre, NIHR Exeter Clinical Research Facility, University of Exeter Medical School, United Kingdom (K.A., F.C., P.E.G., D.M.M., K.M.G., M.G., A.C.S.)
| | - Phillip E Gates
- Diabetes and Vascular Medicine Research Centre, NIHR Exeter Clinical Research Facility, University of Exeter Medical School, United Kingdom (K.A., F.C., P.E.G., D.M.M., K.M.G., M.G., A.C.S.)
| | - David M Mawson
- Diabetes and Vascular Medicine Research Centre, NIHR Exeter Clinical Research Facility, University of Exeter Medical School, United Kingdom (K.A., F.C., P.E.G., D.M.M., K.M.G., M.G., A.C.S.)
| | - Kim M Gooding
- Diabetes and Vascular Medicine Research Centre, NIHR Exeter Clinical Research Facility, University of Exeter Medical School, United Kingdom (K.A., F.C., P.E.G., D.M.M., K.M.G., M.G., A.C.S.)
| | - Mark Gilchrist
- Diabetes and Vascular Medicine Research Centre, NIHR Exeter Clinical Research Facility, University of Exeter Medical School, United Kingdom (K.A., F.C., P.E.G., D.M.M., K.M.G., M.G., A.C.S.)
| | - Isabel Goncalves
- Department of Clinical Sciences, Lund University, Malmö, Sweden (I.G., J.N.).,Department of Cardiology, Skåne University Hospital, Malmö, Sweden (I.G.)
| | - Jan Nilsson
- Department of Clinical Sciences, Lund University, Malmö, Sweden (I.G., J.N.)
| | - Faisel Khan
- Division of Systems Medicine, University of Dundee, United Kingdom (F.K.)
| | - Helen M Colhoun
- Centre for Genomic and Experimental Medicine, University of Edinburgh, United Kingdom (H.M.C.)
| | - Carlo Palombo
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Italy (C.P.)
| | - Kim H Parker
- Department of Bioengineering, Imperial College, London, United Kingdom (K.H.P.)
| | - Angela C Shore
- Diabetes and Vascular Medicine Research Centre, NIHR Exeter Clinical Research Facility, University of Exeter Medical School, United Kingdom (K.A., F.C., P.E.G., D.M.M., K.M.G., M.G., A.C.S.)
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9
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Kosaki K, Tarumi T, Mori S, Matsui M, Sugawara J, Sugaya T, Kuro-O M, Saito C, Yamagata K, Oka K, Maeda S. Cerebral and renal hemodynamics: similarities, differences, and associations with chronic kidney disease and aortic hemodynamics. Hypertens Res 2022; 45:1363-1372. [PMID: 35665784 DOI: 10.1038/s41440-022-00944-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 04/08/2022] [Accepted: 04/21/2022] [Indexed: 11/09/2022]
Abstract
Elevated arterial pulsatility is a common risk factor for cerebrovascular disease and chronic kidney disease (CKD), which suggests that the brain and kidneys may have similar hemodynamic profiles. The objectives of this study were twofold: 1) to compare and contrast the cerebral and renal blood flow parameters in adults without CKD (hereafter, non-CKD adults) and CKD patients and 2) to determine the common predictor(s) of cerebral and renal hemodynamics among pressure pulsatility and several cardiovascular risk factors. In 110 non-CKD adults and 66 CKD patients, cerebral and renal blood flow velocity (BFV) were measured by transcranial Doppler and Duplex ultrasonography, respectively. Pulsatile hemodynamics were assessed by the pulsatility (PI) and resistive (RI) indices. Aortic pulse pressure was measured by tonometry. Compared with non-CKD adults, CKD patients showed greater pulsatility of the BFV (i.e., systolic minus diastolic BFV), PI, and RI in the kidneys but not the brain. However, the cerebral and renal PI and RI values were strongly correlated in both non-CKD adults (both PI and RI values: rs = 0.695) and CKD patients (both PI and RI values: rs = 0.640) (all P < 0.001). Multiple linear regression analysis further demonstrated that the cerebral and renal PI and RI associations remained significant after adjustment for potential covariates (e.g., age, sex, the presence of CKD). The aortic pulse pressure was a significant predictor for both cerebral and renal PI and RI values. Collectively, our findings suggest that CKD patients have higher renal flow pulsatility, which is strongly and independently associated with cerebral flow pulsatility and aortic hemodynamics.
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Affiliation(s)
- Keisei Kosaki
- Faculty of Health and Sport Sciences, University of Tsukuba, Ibaraki, Japan
| | - Takashi Tarumi
- Faculty of Health and Sport Sciences, University of Tsukuba, Ibaraki, Japan.,Human Informatics and Interaction Research Institute, National Institute of Advanced Industrial Science and Technology, Ibaraki, Japan
| | - Shoya Mori
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan.,Japan Society for the Promotion of Science, Tokyo, Japan
| | - Masahiro Matsui
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan.,Japan Society for the Promotion of Science, Tokyo, Japan
| | - Jun Sugawara
- Faculty of Health and Sport Sciences, University of Tsukuba, Ibaraki, Japan.,Human Informatics and Interaction Research Institute, National Institute of Advanced Industrial Science and Technology, Ibaraki, Japan
| | - Takeshi Sugaya
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Makoto Kuro-O
- Division of Anti-aging Medicine, Center for Molecular Medicine, Jichi Medical University, Tochigi, Japan
| | - Chie Saito
- Department of Nephrology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Kunihiro Yamagata
- Department of Nephrology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.,R&D Center for Smart Wellness City Policies, University of Tsukuba, Ibaraki, Japan
| | - Koichiro Oka
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
| | - Seiji Maeda
- Faculty of Health and Sport Sciences, University of Tsukuba, Ibaraki, Japan. .,Faculty of Sport Sciences, Waseda University, Saitama, Japan.
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10
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Jovanovich A, Cai X, Frazier R, Bundy JD, He J, Rao P, Lora C, Dobre M, Go A, Shafi T, Feldman HI, Rhee EP, Miyazaki M, Isakova T, Chonchol M. Deoxycholic Acid and Coronary Artery Calcification in the Chronic Renal Insufficiency Cohort. J Am Heart Assoc 2022; 11:e022891. [PMID: 35322682 PMCID: PMC9075491 DOI: 10.1161/jaha.121.022891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 02/17/2022] [Indexed: 11/16/2022]
Abstract
Background Deoxycholic acid (DCA) is a secondary bile acid that may promote vascular calcification in experimental settings. Higher DCA levels were associated with prevalent coronary artery calcification (CAC) in a small group of individuals with advanced chronic kidney disease. Whether DCA levels are associated with CAC prevalence, incidence, and progression in a large and diverse population of individuals with chronic kidney disease stages 2 to 4 is unknown. Methods and Results In the CRIC (Chronic Renal Insufficiency Cohort) study, we evaluated cross-sectional (n=1057) and longitudinal (n=672) associations between fasting serum DCA levels and computed tomographic CAC using multivariable-adjusted regression models. The mean age was 57±12 years, 47% were women, and 41% were Black. At baseline, 64% had CAC (CAC score >0 Agatston units). In cross-sectional analyses, models adjusted for demographics and clinical factors showed no association between DCA levels and CAC >0 compared with no CAC (prevalence ratio per 1-SD higher log DCA, 1.08 [95% CI, 0.91-1.26). DCA was not associated with incident CAC (incidence per 1-SD greater log DCA, 1.08 [95% CI, 0.85-1.39]) or CAC progression (risk for increase in ≥100 and ≥200 Agatston units per year per 1-SD greater log DCA, 1.05 [95% CI, 0.84-1.31] and 1.26 [95% CI, 0.77-2.06], respectively). Conclusions Among CRIC study participants, DCA was not associated with prevalent, incident, or progression of CAC.
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Affiliation(s)
- Anna Jovanovich
- Renal SectionVA Eastern Colorado Healthcare SystemAuroraCO
- Division of Renal Diseases and HypertensionUniversity of Colorado Anschutz Medical CampusAuroraCO
| | - Xuan Cai
- Division of Nephrology/HypertensionNorthwestern UniversityChicagoIL
| | - Rebecca Frazier
- Division of Nephrology/HypertensionNorthwestern UniversityChicagoIL
| | - Josh D. Bundy
- Nephrology and HypertensionTulane UniversityNew OrleansLA
| | - Jiang He
- Nephrology and HypertensionTulane UniversityNew OrleansLA
| | | | - Claudia Lora
- Division of NephrologyUniversity of Illinois at ChicagoChicagoIL
| | - Mirela Dobre
- Division of NephrologyCase Western Reserve UniversityClevelandOH
| | - Alan Go
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCA
| | - Tariq Shafi
- Division of NephrologyUniversity of MississippiJacksonMI
| | - Harold I. Feldman
- Division of Renal Electrolyte and HypertensionUniversity of PennsylvaniaPhiladelphiaPA
| | - Eugene P. Rhee
- Nephrology DivisionMassachusetts General HospitalHarvard Medical SchoolBostonMA
| | - Makoto Miyazaki
- Division of Renal Diseases and HypertensionUniversity of Colorado Anschutz Medical CampusAuroraCO
| | - Tamara Isakova
- Division of Nephrology/HypertensionNorthwestern UniversityChicagoIL
| | - Michel Chonchol
- Division of Renal Diseases and HypertensionUniversity of Colorado Anschutz Medical CampusAuroraCO
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11
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Maimaitiming M, Liang P, Bai M, Liu H, Liang X. Study on the related factors affecting the circadian rhythm of blood pressure in patients with essential hypertension. BIOL RHYTHM RES 2022. [DOI: 10.1080/09291016.2022.2044630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Muyesaier Maimaitiming
- Department of Hypertension, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Ping Liang
- Department of Hypertension, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Mengpo Bai
- Department of Hypertension, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Huijuan Liu
- Department of Hypertension, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Xiaohui Liang
- Department of Hypertension, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
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12
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Hashimoto J, Tagawa K, Westerhof BE, Ito S. Central-to-peripheral stiffness gradients determine diastolic pressure and flow fluctuation waveforms: time domain analysis of femoral artery pulse. J Hypertens 2022; 40:338-347. [PMID: 34495902 DOI: 10.1097/hjh.0000000000003014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Blood pressure fluctuates during diastole to create a dicrotic wave but the mechanistic origin remains poorly understood. We sought to investigate the characteristics and determinants of diastolic pressure and flow fluctuations with a focus on stiffness gradients between the central aorta and peripheral arteries. METHODS Using applanation tonometry and duplex ultrasound, pulse waveforms were recorded on the femoral artery in 592 patients (age: 55 ± 14 years) to estimate the diastolic pressure fluctuation as a residual wave against the mono-exponential decay and the diastolic flow fluctuation as a bidirectional (forward and reverse) velocity wave. The radial, carotid, and dorsalis pedis pressures were also recorded to measure the peripheral/aortic pulse pressure (PP) and pulse wave velocity (PWV) ratios. RESULTS There were close resemblances between the femoral pressure and flow fluctuation waveforms. The pressure and flow fluctuations were mutually correlated in relative amplitude as indexed to the total pulse height (r = 0.63), and the former temporally followed the latter. In multivariate-adjusted models, higher peripheral/aortic PP and PWV ratios were independently associated with greater pressure and flow fluctuation indices (P < 0.001). Mediation analysis revealed that the associations of PP and PWV ratios with the pressure fluctuation index were largely mediated by the flow fluctuation index [indirect/total effect ratio: 57 (95% CI 42-80)% and 54 (30-100)%, respectively]. CONCLUSION These results suggest that central-to-peripheral pulse amplification and stiffness gradients contribute to triphasic flow fluctuations and dicrotic pressure waves. Diminished or inverted stiffness gradients caused by aortic stiffening may thus reduce diastolic runoff leading to ischemic organ damage.
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Affiliation(s)
- Junichiro Hashimoto
- Medical Center, Miyagi University of Education
- Division of Nephrology, Endocrinology, and Vascular Medicine, Department of Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | - Berend E Westerhof
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Sadayoshi Ito
- Division of Nephrology, Endocrinology, and Vascular Medicine, Department of Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
- Katta General Hospital, Shiroishi, Japan
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13
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Chang YC, Tsai JP, Wang JH, Hsu BG. A Retrospective Cohort Study of the Association between Serum Osteopontin Levels and Aortic Stiffness in Hypertensive Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:477. [PMID: 35010737 PMCID: PMC8744766 DOI: 10.3390/ijerph19010477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 12/29/2021] [Accepted: 12/30/2021] [Indexed: 12/03/2022]
Abstract
By suppressing mineralization and preventing ectopic calcium deposits, osteopontin (OPN) has an inhibitory effect on vascular calcification. Also, there is an association between OPN and aortic stiffness (AS). We aimed to investigate the association between serum OPN levels and AS measured by carotid-femoral pulse wave velocity (cfPWV) in hypertensive patients. Baseline characteristics and fasting blood sampling of 120 participants with hypertension and 120 participants without hypertension were acquired. Serum OPN concentrations were determined by enzyme-linked immunosorbent assay. In total, 43 (35.9%) participants were assigned to the AS group with cfPWV of >10 m/s in hypertensive patients. There were more patients with diabetes mellitus, old age, high systolic blood pressure, high serum intact parathyroid hormone (iPTH), elevated C-reactive protein, and high OPN levels in the AS group compared with the control group in hypertensive participants. A multivariate logistic regression analysis discloses that age, SBP, serum OPN, and iPTH levels were independently associated with AS in hypertensive patients. Moreover, according to a multivariate forward stepwise linear regression analysis, OPN level is positively associated with cfPWV. In conclusion, serum OPN level is assumed to be a potential biomarker to predict AS and is positively associated with cfPWV in patients with hypertension.
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Affiliation(s)
- Yuan-Chieh Chang
- Department of Internal Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97004, Taiwan;
| | - Jen-Pi Tsai
- Division of Nephrology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 62247, Taiwan;
- School of Medicine, Tzu Chi University, Hualien 97004, Taiwan
| | - Ji-Hung Wang
- Department of Internal Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97004, Taiwan;
- School of Medicine, Tzu Chi University, Hualien 97004, Taiwan
- Division of Cardiology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97004, Taiwan
| | - Bang-Gee Hsu
- Department of Internal Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97004, Taiwan;
- School of Medicine, Tzu Chi University, Hualien 97004, Taiwan
- Division of Nephrology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97004, Taiwan
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14
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Hopper SE, Cuomo F, Ferruzzi J, Burris NS, Roccabianca S, Humphrey JD, Figueroa CA. Comparative Study of Human and Murine Aortic Biomechanics and Hemodynamics in Vascular Aging. Front Physiol 2021; 12:746796. [PMID: 34759837 PMCID: PMC8573132 DOI: 10.3389/fphys.2021.746796] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 10/05/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Aging has many effects on the cardiovascular system, including changes in structure (aortic composition, and thus stiffening) and function (increased proximal blood pressure, and thus cardiac afterload). Mouse models are often used to gain insight into vascular aging and mechanisms of disease as they allow invasive assessments that are impractical in humans. Translation of results from murine models to humans can be limited, however, due to species-specific anatomical, biomechanical, and hemodynamic differences. In this study, we built fluid-solid-interaction (FSI) models of the aorta, informed by biomechanical and imaging data, to compare wall mechanics and hemodynamics in humans and mice at two equivalent ages: young and older adults. Methods: For the humans, 3-D computational models were created using wall property data from the literature as well as patient-specific magnetic resonance imaging (MRI) and non-invasive hemodynamic data; for the mice, comparable models were created using population-based properties and hemodynamics as well as subject-specific anatomies. Global aortic hemodynamics and wall stiffness were compared between humans and mice across age groups. Results: For young adult subjects, we found differences between species in pulse pressure amplification, compliance and resistance distribution, and aortic stiffness gradient. We also found differences in response to aging between species. Generally, the human spatial gradients of stiffness and pulse pressure across the aorta diminished with age, while they increased for the mice. Conclusion: These results highlight key differences in vascular aging between human and mice, and it is important to acknowledge these when using mouse models for cardiovascular research.
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Affiliation(s)
- Sara E. Hopper
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States
| | - Federica Cuomo
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States
| | - Jacopo Ferruzzi
- Department of Bioengineering, The University of Texas at Dallas, Richardson, TX, United States
| | - Nicholas S. Burris
- Department of Radiology, University of Michigan, Ann Arbor, MI, United States
| | - Sara Roccabianca
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI, United States
| | - Jay D. Humphrey
- Department of Biomedical Engineering, Yale University, New Haven, CT, United States
- Vascular Biology and Therapeutics Program, Yale University, New Haven, CT, United States
| | - C. Alberto Figueroa
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States
- Department of Surgery, University of Michigan, Ann Arbor, MI, United States
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15
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Miyaoka Y, Okada T, Tomiyama H, Morikawa A, Rinno S, Kato M, Tsujimoto R, Suzuki R, China R, Nagai M, Nagaoka Y, Nagao T, Kanno Y. Structural changes in renal arterioles are closely associated with central hemodynamic parameters in patients with renal disease. Hypertens Res 2021; 44:1113-1121. [PMID: 33859396 DOI: 10.1038/s41440-021-00656-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/10/2021] [Indexed: 02/06/2023]
Abstract
Although central hemodynamics are known to be closely associated with microvascular damage, their association with lesions in the small renal arteries has not yet been fully clarified. We focused on arterioles in renal biopsy specimens and analyzed whether their structural changes were associated with noninvasive vascular function parameters, including central blood pressure (BP) and brachial-ankle pulse wave velocity (baPWV). Forty-four nondiabetic patients (18-50 years of age) with preserved renal function underwent renal biopsy. Wall thickening of arterioles was analyzed based on the media/diameter ratio, and hyalinosis was analyzed by semiquantitative grading. Associations of these indexes (arteriolar wall remodeling grade index (RG index) and arteriolar hyalinosis index (Hyl index)) with clinical variables were analyzed. Multiple regression analyses demonstrated that the RG index was significantly associated with central systolic BP (β = 0.97, p = 0.009), serum cystatin C-based estimated glomerular filtration rate (β = -0.36, p = 0.04), and high-density lipoprotein cholesterol levels (β = -0.37, p = 0.02). The Hyl index was significantly associated with baPWV (β = 0.75, p = 0.01). Our results indicate that aortic stiffness and abnormal central hemodynamics are closely associated with renal microvascular damage in young to middle-aged, nondiabetic kidney disease patients with preserved renal function.
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Affiliation(s)
| | - Tomonari Okada
- Department of Nephrology, Tokyo Medical University, Tokyo, Japan
| | | | - Atsuko Morikawa
- Department of Nephrology, Tokyo Medical University, Tokyo, Japan
| | - Sho Rinno
- Department of Nephrology, Tokyo Medical University, Tokyo, Japan
| | - Miho Kato
- Department of Nephrology, Tokyo Medical University, Tokyo, Japan
| | - Ryuji Tsujimoto
- Department of Nephrology, Tokyo Medical University, Tokyo, Japan
| | - Rie Suzuki
- Department of Nephrology, Tokyo Medical University, Tokyo, Japan
| | - Rieko China
- Department of Nephrology, Tokyo Medical University, Tokyo, Japan
| | - Miho Nagai
- Department of Nephrology, Tokyo Medical University, Tokyo, Japan
| | - Yume Nagaoka
- Department of Nephrology, Tokyo Medical University, Tokyo, Japan
| | - Toshitaka Nagao
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | - Yoshihiko Kanno
- Department of Nephrology, Tokyo Medical University, Tokyo, Japan
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16
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Tagawa K, Tsuru Y, Yokoi K, Aonuma T, Hashimoto J. Albuminuria Intensifies the Link Between Urinary Sodium Excretion and Central Pulse Pressure in the General Population: The Wakuya Study. Am J Hypertens 2021; 34:851-857. [PMID: 33893813 PMCID: PMC8385571 DOI: 10.1093/ajh/hpab057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/23/2021] [Accepted: 04/23/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Central pulse pressure (cPP) is responsible for the hemodynamics of vital organs, and monitoring this parameter is important for cardiovascular disease (CVD) prevention. Excess sodium intake and (micro)albuminuria (a manifestation of renal microvascular damage) are known to be strong predictors of CVD. We sought to investigate the cross-sectional relationships among dietary sodium intake, albuminuria, and cPP in a general population cohort. METHODS The subjects were 933 apparently healthy adults (mean age, 56 ± 10 years). Radial pressure waveforms were recorded with applanation tonometry to estimate mean arterial pressure (MAP), cPP, forward and backward pressure amplitudes, and augmentation index. The urinary sodium/creatinine and albumin/creatinine ratios were measured in spot urine samples. RESULTS Both the urinary sodium/creatinine and albumin/creatinine ratios were positively correlated with cPP, even after adjusting for MAP (P < 0.001). Moreover, both ratios had a synergistic influence on increasing the cPP independent of age, sex, estimated glomerular filtration rate, hyperlipidemia, and diabetes (interaction P = 0.04). A similar synergistic influence was found on the forward pressure amplitude, but not on the backward pressure amplitude or augmentation index. The overall results were not altered when the urinary albumin/creatinine ratio was replaced with the existence of chronic kidney disease (CKD). CONCLUSIONS (Micro)albuminuria strengthens the positive association between urinary sodium excretion and cPP and systolic forward pressure. Excess sodium intake may magnify the cardiovascular risk by widening the aortic pulsatile pressure, particularly in the presence of concomitant CKD.
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Affiliation(s)
- Kaname Tagawa
- Miyagi University of Education Medical Center, Sendai, Japan
| | - Yusuke Tsuru
- Wakuya National Health Insurance Hospital, Miyagi, Japan
| | - Katsumi Yokoi
- Wakuya National Health Insurance Hospital, Miyagi, Japan
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17
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Ota M, Izumo M, Mochizuki Y, Nishikawa H, Sato Y, Watanabe M, Kaihara T, Okuyama K, Kamijima R, Tanabe Y, Harada T, Shinke T, Akashi YJ. Effect of Diastolic Flow Reversal Patterns on Clinical Outcomes Following Transcatheter Aortic Valve Implantation - An Intraprocedural Echocardiography Study. Circ J 2021; 85:1068-1075. [PMID: 33762527 DOI: 10.1253/circj.cj-20-1173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although diastolic flow reversal (DFR) in the descending aorta, assessed via transesophageal echocardiography (TEE), is a simple and easy indicator for evaluating aortic regurgitation, the association between DFR pattern and clinical outcomes following transcatheter aortic valve implantation (TAVI) is unclear. The purpose of this study was to evaluate the effect of DFR patterns on clinical outcomes following TAVI. METHODS AND RESULTS Two-hundred and eleven patients (mean age, 83.6±5.7 years; 69% female) who underwent TAVI were retrospectively assessed via intraprocedural TEE. DFR was evaluated using pulsed-wave Doppler in the descending aorta before and after TAVI. The primary endpoint was major adverse cardio-cerebrovascular events (MACCEs). Although only 7 patients (3.3%) had moderate or severe paravalvular leak, as assessed by color Doppler echocardiography, holo-DFR (HDFR) was observed in 33 patients (16.0%) after TAVI. MACCEs occurred in 40 patients during the median follow up of 282 days (interquartile range: 160-478 days). The estimated cumulative MACCE-free survival at 1 year was significantly lower in patients with HDFR than in those without HDFR. A Cox proportional hazards analysis revealed that HDFR after TAVI was independently associated with MACCEs. CONCLUSIONS HDFR was associated with an increased risk of MACCEs after TAVI. DFR evaluated by intraprocedural echocardiography could serve as a simple and easy method for predicting clinical outcomes.
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Affiliation(s)
- Masashi Ota
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Masaki Izumo
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Yasuhide Mochizuki
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Haruka Nishikawa
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Yukio Sato
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Mika Watanabe
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Toshiki Kaihara
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Kazuaki Okuyama
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Ryo Kamijima
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Yasuhiro Tanabe
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Tomoo Harada
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Toshiro Shinke
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Yoshihiro J Akashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
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18
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Renal hemodynamics across the adult lifespan: Relevance of flow pulsatility to chronic kidney disease. Exp Gerontol 2021; 152:111459. [PMID: 34171394 DOI: 10.1016/j.exger.2021.111459] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Elevated renal flow pulsatility may contribute to the pathogenesis of chronic kidney disease (CKD). The purpose of this study was to investigate the associations among age, renal flow pulsatility, and CKD biomarkers in non-CKD adults and CKD patients. METHODS Non-CKD adults (n = 415) and CKD patients (n = 136) aged between 22 and 83 years underwent the renal blood flow measurement using duplex ultrasonography. Pulsatility index (PI) and resistive index (RI) were calculated to assess renal flow pulsatility. The CKD biomarkers such as urinary liver-type fatty acid-binding protein (L-FABP) and serum fibroblast growth factor 23 (FGF23) were measured from each participant. Aortic hemodynamic parameters were measured by applanation tonometry. RESULTS In non-CKD adults, advancing age was associated with elevations of renal PI and RI which slowly increased during middle-aged (PI: β = 0.14, RI: β = 0.17) and accelerated in older adults (PI: β = 0.34, RI: β = 0.33). In CKD patients, age-related increases in renal PI and RI were observed only in the middle age group (PI: β = 0.23, RI: β = 0.26). Multivariate analysis demonstrated that renal PI and RI were independently associated with CKD biomarkers, including urinary L-FABP and serum FGF23, and aortic pulse pressure. CONCLUSIONS Advancing age is associated with a progressive elevation of renal flow pulsatility which manifests during middle age and accelerates in later life. Moreover, elevated renal flow pulsatility is associated with the presence of CKD in each age group and also with biomarker levels that reflect CKD progression.
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19
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Jarvis K, Soulat G, Scott M, Vali A, Pathrose A, Syed AA, Kinno M, Prabhakaran S, Collins JD, Markl M. Investigation of Aortic Wall Thickness, Stiffness and Flow Reversal in Patients With Cryptogenic Stroke: A 4D Flow MRI Study. J Magn Reson Imaging 2021; 53:942-952. [PMID: 32864836 DOI: 10.1002/jmri.27345] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 08/08/2020] [Accepted: 08/11/2020] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Stroke etiology is undetermined in approximately one-sixth to one-third of patients. The presence of aortic flow reversal and plaques in the descending aorta (DAo) has been identified as a potential retrograde embolic mechanism. PURPOSE To assess the relationships between aortic stiffness, wall thickness, and flow reversal in patients with cryptogenic stroke and healthy controls. STUDY TYPE Prospective. POPULATION Twenty one patients with cryptogenic stroke and proven DAo plaques (69 ± 9 years, 43% female), 18 age-matched controls (age: 65 ± 8 years, 61% female), and 14 younger controls (36 ± 9 years, 57% female). FIELD STRENGTH/SEQUENCE 1.5T; 4D flow MRI and 3D dark blood T1 -weighted turbo spin echo MRI of the aorta. ASSESSMENT Noncontrast aortic 4D flow MRI to measure 3D flow dynamics and 3D dark blood aortic wall MRI to assess wall thickness. 4D flow MRI analysis included automated quantification of aortic stiffness by pulse wave velocity (PWV) and voxelwise mapping of the flow reversal fraction (FRF). STATISTICAL TESTS Analysis of variance (ANOVA) or Kruskal-Wallis tests, Student's unpaired t-tests or Wilcoxon rank-sum tests, regression analysis. RESULTS Aortic PWV and FRF were statistically higher in patients (8.9 ± 1.7 m/s, 18.4 ± 7.7%) than younger controls (5.3 ± 0.8 m/s, P < 0.0167; 8.5 ± 2.9%, P < 0.0167), but not age-matched controls (8.2 ± 1.6 m/s, P = 0.22; 15.6 ± 5.8%, P = 0.22). Maximum aortic wall thickness was higher in patients (3.1 ± 0.7 mm) than younger controls (2.2 ± 0.2 mm, P < 0.0167) and age-matched controls (2.7 ± 0.5 mm) (P < 0.0167). For all subjects, positive relationships were found between PWV and age (R2 = 0.71, P < 0.05), aortic wall thickness (R2 = 0.20, P < 0.05), and FRF (R2 = 0.47, P < 0.05). Patients demonstrated relationships between PWV and FRF in the ascending aorta (R2 = 0.32, P < 0.05) and arch (R2 = 0.24, P < 0.05). DATA CONCLUSION This study showed the utility of 4D flow MRI for evaluating aortic PWV and voxelwise flow reversal. Positive relationships between aortic PWV, wall thickness, and flow reversal support the hypothesis that aortic stiffness is involved in this retrograde embolic mechanism. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY STAGE: 1.
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Affiliation(s)
- Kelly Jarvis
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Gilles Soulat
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michael Scott
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, USA
| | - Alireza Vali
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ashitha Pathrose
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Amer Ahmed Syed
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Menhel Kinno
- Department of Cardiology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Shyam Prabhakaran
- Department of Neurology, University of Chicago Biological Sciences, Chicago, Illinois, USA
| | | | - Michael Markl
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, USA
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20
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Influence of sprint exercise on aortic pulse wave velocity and femoral artery shear patterns. Eur J Appl Physiol 2020; 120:2635-2647. [PMID: 32880701 DOI: 10.1007/s00421-020-04483-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 08/25/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Aortic stiffness may affect shear patterns in the peripheral vasculature. This study examined if sprint exercise, which typically increases aortic stiffness is associated with increased peripheral retrograde blood flow and impaired microvascular function. METHODS Twenty participants (10 women; age: 27 ± 5 years) underwent arterial stiffness, shear rate, and microvascular function assessment at three time points: baseline; following time control; ~ 2 min post a 30-s cycle ergometer sprint against 7.0% body mass. Aortic stiffness was assessed using carotid-femoral pulse wave velocity (cfPWV). Superficial femoral artery (SFA) diameter and blood velocity were assessed using Doppler-ultrasound and were used to calculate shear rates and resistance index (RI). SFA wave reflections were obtained via wave intensity analysis. Vastus medialis microvascular function was measured as tissue saturation index reactivity pre-post exercise via near-infrared spectroscopy. RESULTS cfPWV increased by + 0.8 ± 0.7 m·s-1 following exercise (p < 0.001). Retrograde shear was reduced following exercise compared with time control (- 4.9 ± 3.8 s-1; p < 0.001), while tissue saturation index was increased post-exercise from baseline (+ 2.3 ± 4.6%; p = 0.04). Reductions in SFA wave reflections (- 1.70 ± 1.96 aU) and RI (- 0.17 ± 0.13 aU) were also noted following exercise (p < 0.001). CONCLUSION These data suggest sprint exercise-mediated changes in peripheral shear patterns and microvascular function in the exercised vasculature occur independent from increases in aortic stiffness. Exercise-induced reductions in SFA retrograde shear may be related to decreased wave reflections and peripheral vascular resistance.
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21
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Soulat G, Jarvis K, Pathrose A, Vali A, Scott M, Syed AA, Kinno M, Prabhakaran S, Collins JD, Markl M. Renin Angiotensin System Inhibitors Reduce Aortic Stiffness and Flow Reversal After a Cryptogenic Stroke. J Magn Reson Imaging 2020; 53:213-221. [PMID: 32770637 DOI: 10.1002/jmri.27279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Blood flow reversal is a possible mechanism for retrograde embolism in the setting of high-risk atherosclerotic plaques in the descending aorta (DAo). Evidence suggests that pulse wave velocity (PWV) is a determinant of blood flow reversal and can be reduced by the destiffening effect of renin-angiotensin system inhibitors (RASI). PURPOSE To evaluate the impact of antihypertensive therapy on in vivo changes in PWV and flow reversal in patients with cryptogenic stroke. STUDY TYPE Prospective. POPULATION Sixteen patients (69 ± 9 years; 10 males) included after cryptogenic stroke. FIELD STRENGTH/SEQUENCE 3T. 4D flow sequence (temporal resolution = 19.6 msec) ASSESSMENT: Patients underwent aortic MRI at baseline and at 6-month follow-up. Patients received standard-of-care antihypertensive therapy that were classified as RASI vs. non-RASI medications (ie, destiffening vs. nondestiffening).We compared aortic PWV, flow reversal fraction (FRF), aortic measurements, cardiac function, and other aortic and cardiac measurements in the antihypertensive therapy groups. STATISTICAL TESTS Two-tailed paired or unpaired Student's t-tests (normal distributions) or Wilcoxon tests (nonnormal distribution). Univariate correlations using Pearson correlation coefficients. RESULTS There was a significant decrease in PWV in the RASI (n = 10) group (9.4 ± 1.6 m/s vs. 8.3 ± 1.9 m/s; P < 0.05), as well as FRF (18.6% ± 4.1% vs. 16.3% ± 4.0%; P < 0.05) between baseline and the 6-month MRI studies. There were no changes in PWV or FRF in the non-RASI (n = 6) group (P = 0.146 and P = 0.32). A decrease in FRF was significantly correlated with a decrease in PWV (r = 0.53; P < 0.05). DATA CONCLUSION The findings of our study suggest that RASI therapy after cryptogenic stroke resulted in a decrease of blood flow reversal and aortic stiffness. EVIDENCE LEVEL 1 TECHNICAL EFFICACY STAGE: 4.
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Affiliation(s)
- Gilles Soulat
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Kelly Jarvis
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Ashitha Pathrose
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Alireza Vali
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Michael Scott
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Illinois, USA
| | - Amer A Syed
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Menhel Kinno
- Loyola's Center for Heart & Vascular Medicine, Stritch School of Medicine, Loyola University Chicago, Chicago, Illinois, USA
| | - Shyam Prabhakaran
- Neurology, The University of Chicago Biological Sciences, Chicago, Illinois, USA
| | | | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Illinois, USA
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22
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Xiao W, Wen Y, Ye P, Wang F, Cao R, Bai Y, Wu H. Noninvasive central pulse pressure is an independent determinant of renal function. J Clin Hypertens (Greenwich) 2020; 22:234-242. [PMID: 31944554 DOI: 10.1111/jch.13792] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 10/29/2019] [Accepted: 11/04/2019] [Indexed: 12/11/2022]
Abstract
The purpose of this study was to investigate the prognostic properties of different BP measurements for renal function decrement and early chronic kidney disease (CKD) in community-dwelling populations with normal renal function at baseline. A total of 1426 participants were included and followed for a median of 4.8 years (interquartile range, 4.5-5.2), and central hemodynamic profile and estimated glomerular filtration rate (eGFR) were evaluated. One main outcome was the rapid eGFR decline defined as a decline in eGFR of greater than 3 mL/min per 1.73 m2 per year; the other was the new incidence of CKD. At the end of follow-up, mean eGFR decreased from 93.39 ± 13.46 mL/min per 1.73 m2 to 85.72 ± 14.81 mL/min per 1.73 m2 , and the incidence of rapid eGFR decline and CKD were 20.7% and 5.6%, respectively. In multivariate linear regression analysis, central pulse pressure (PP), age, fasting blood glucose, and concentration of homocysteine were independent determinants of the change in renal function. Not only in the prediction of rapid eGFR decline but also in the incident of CKD, baseline central PP was the only BP component that consistently independently associated with both outcomes after adjustment for various confounders. When compared with subjects in the lowest quartile of central PP, those in the highest quartile demonstrated a significantly increased risk of CKD (hazard ratio [HR], 1.57; 95% confidence interval [CI], 1.08-2.96; P = .006). The study showed that central PP emerged as an independent predictor of the decline in renal function.
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Affiliation(s)
- Wenkai Xiao
- Department of Geriatric Cardiology, Second Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yi Wen
- Department of Outpatient, Second Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Ping Ye
- Department of Geriatric Cardiology, Second Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Fan Wang
- Department of Geriatric Cardiology, Second Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Ruihua Cao
- Department of Geriatric Cardiology, Second Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yongyi Bai
- Department of Geriatric Cardiology, Second Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Hongmei Wu
- Department of Geriatric Cardiology, Second Medical Center, Chinese PLA General Hospital, Beijing, China
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23
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Koyama D, Sasai M, Matsumura S, Inoue K, Ohinata K. A milk-derived pentapeptide reduces blood pressure in advanced hypertension in a CCK system-dependent manner. Food Funct 2020; 11:9489-9494. [DOI: 10.1039/d0fo01122c] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Orally administered KFWGK exhibits potent and long-lasting antihypertensive effects in SHR with advanced hypertension, at which known hypotensive drugs are sometimes less effective. The minimum effective dose of KFWGK was 5 μg kg−1.
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Affiliation(s)
- Daiki Koyama
- Division of Food Science and Biotechnology
- Graduate School of Agriculture
- Kyoto University
- Kyoto 611-0011
- Japan
| | - Masaki Sasai
- Division of Food Science and Biotechnology
- Graduate School of Agriculture
- Kyoto University
- Kyoto 611-0011
- Japan
| | - Shigenobu Matsumura
- Division of Food Science and Biotechnology
- Graduate School of Agriculture
- Kyoto University
- Kyoto 611-0011
- Japan
| | - Kazuo Inoue
- Division of Food Science and Biotechnology
- Graduate School of Agriculture
- Kyoto University
- Kyoto 611-0011
- Japan
| | - Kousaku Ohinata
- Division of Food Science and Biotechnology
- Graduate School of Agriculture
- Kyoto University
- Kyoto 611-0011
- Japan
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24
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Liu L, He X, Zhao M, Yang S, Wang S, Yu X, Liu J, Zang W. Regulation of DNA methylation and 2-OG/TET signaling by choline alleviated cardiac hypertrophy in spontaneously hypertensive rats. J Mol Cell Cardiol 2019; 128:26-37. [PMID: 30660679 DOI: 10.1016/j.yjmcc.2019.01.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 12/24/2018] [Accepted: 01/14/2019] [Indexed: 12/17/2022]
Abstract
DNA methylation is a well-defined epigenetic modification that regulates gene transcription. However, the role of DNA methylation in the cardiac hypertrophy seen in hypertension is unclear. This study was performed to investigate genome-wide DNA methylation profiles in spontaneously hypertensive rats (SHRs) and Wistar-Kyoto rats (WKY), and the cardioprotective effect of choline. Eight-week-old male SHRs received intraperitoneal injections of choline (8 mg/kg/day) for 8 weeks. SHRs showed aberrant methylation distribution on chromosomes and genome regions, with decreased methylation levels at CHG and CHH sites. A total of 91,559 differentially methylated regions (DMRs) were detected between SHRs and WKY rats, of which 28,197 were demethylated and 63,362 were methylated. Choline treatment partly restored the DMRs in SHRs, which were related to 131 genes. Gene ontology analysis and Kyoto Encyclopedia of Genes and Genomes analysis of DMRs suggested that choline partly reversed the dysfunctions of biological processes, cellular components and molecular functions in SHRs. Moreover, the inhibition of 2-oxoglutarate accumulation by choline, thereby inhibiting excessive activation of ten-eleven translocation methylcytosine dioxygenase enzymes, may correlate with the beneficial effects of choline on methylation levels, cardiac hypertrophy and cardiac function of SHRs, as indicated by decreased heart rate and blood pressure, and increased ejection fraction and fractional shortening. This study provides the first genome-wide DNA methylation profile of the hypertrophic myocardium of SHRs and suggests a novel role for this epigenetic modification in hypertension. Choline treatment may represent a promising approach for modification of DNA methylation and optimization of the epigenetic profile for antihypertensive therapy.
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Affiliation(s)
- Longzhu Liu
- Department of Pharmacology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, PR China
| | - Xi He
- Department of Pharmacology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, PR China
| | - Ming Zhao
- Department of Pharmacology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, PR China
| | - Si Yang
- Department of Pharmacology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, PR China
| | - Shengpeng Wang
- Cardiovascular Research Center, School of Basic Medical Sciences, Xi'an Jiaotong University, Xi'an, PR China
| | - Xiaojiang Yu
- Department of Pharmacology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, PR China
| | - Jiankang Liu
- Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, PR China
| | - Weijin Zang
- Department of Pharmacology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, PR China.
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25
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Vallée A, Yannoutsos A, Zhang Y, Henry-Bonniot G, Protogerou A, Topouchian J, Safar ME, Blacher J. Determinants of pulse pressure amplification in hypertensive and diabetic patients. Hypertens Res 2018; 42:374-384. [PMID: 30552405 DOI: 10.1038/s41440-018-0161-y] [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: 05/31/2018] [Revised: 08/29/2018] [Accepted: 08/31/2018] [Indexed: 01/12/2023]
Abstract
Hypertensive diabetic patients remain at high cardiovascular risk despite adequate blood pressure and glycemic control. Pulse pressure amplification (PPA) is expressed as the peripheral-to-central PP ratio and provides complementary information for use in assessing cardiovascular risk. The aim of our study was to determine the clinical and biological determinants of PPA in hypertensive and diabetic patients. A cross-sectional study was conducted in 624 patients. Applanation tonometry was used to determine hemodynamic parameters. Age, gender, and the association between hypertension and diabetes were the independent factors of PPA in our population (N = 624). A threshold of 55 years of age was chosen because of its link with menopause in our analysis. Multivariate regression analyses were performed to evaluate the independent determinants of PPA for hypertensive diabetic and hypertensive nondiabetic male and female patients. HbA1c level is the main factor of increased PPA regardless of age and gender (P < 0.05). Mean BP negatively regulates PPA in the overall study: men > 55 years (P = 0.0001) and women > 55 years (P = 0.03). The threshold calculated glomerular filtration rate (cGFR) < 60 mL/min/1.73 m2 was an independent and negative factor of PPA in hypertensive diabetic men regardless of age (P < 0.05) and in women > 55 years (P = 0.04). Mean BP negatively regulates PPA in hypertensive nondiabetic patients (P < 0.04) regardless of age and gender, except in women > 55 years, where cGFR < 60 (P = 0.04) negatively regulates the modulation of PPA. HbA1c and threshold cGFR < 60 have highly significant impacts on PPA in hypertensive diabetic patients, whereas mean BP appears as the main factor of PPA in hypertensive nondiabetic patients.
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Affiliation(s)
- Alexandre Vallée
- Paris-Descartes University; Diagnosis and Therapeutic Center, Hypertension and Cardiovascular Prevention Unit, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Alexandra Yannoutsos
- Service de Médecine Vasculaire, Groupe Hospitalier Paris Saint Joseph, 185 rue Raymond-Losserand, 75674, Paris, cedex 14, France
| | - Yi Zhang
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Guillaume Henry-Bonniot
- Paris-Descartes University; Diagnosis and Therapeutic Center, Hypertension and Cardiovascular Prevention Unit, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Athanase Protogerou
- Cardiovascular Prevention and Research Unit, Department of Pathophysiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Jirar Topouchian
- Paris-Descartes University; Diagnosis and Therapeutic Center, Hypertension and Cardiovascular Prevention Unit, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Michel E Safar
- Paris-Descartes University; Diagnosis and Therapeutic Center, Hypertension and Cardiovascular Prevention Unit, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Jacques Blacher
- Paris-Descartes University; Diagnosis and Therapeutic Center, Hypertension and Cardiovascular Prevention Unit, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.
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26
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Hashimoto J, Westerhof BE, Ito S. Carotid Flow Augmentation, Arterial Aging, and Cerebral White Matter Hyperintensities. Arterioscler Thromb Vasc Biol 2018; 38:2843-2853. [DOI: 10.1161/atvbaha.118.311873] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Objective—
Aortic stiffness and pressure wave reflection are associated with age-related cerebral microvascular disease, but the underlying mechanism remains obscure. We hypothesized that cerebral (carotid) flow alterations potentially mediate these associations.
Approach and Results—
Doppler waveforms were recorded in 286 patients with hypertension to measure the carotid flow augmentation index (FAIx) as the late/early-systolic velocity amplitude ratio. Tonometric waveforms were recorded to estimate the aortic pressure AIx (PAIx), aortic compliance, and carotid-femoral and carotid-radial pulse wave velocities. Additionally, white matter hyperintensities on brain magnetic resonance imaging were evaluated using the Fazekas scale. With increasing age, the carotid late systolic velocity increased, whereas the early systolic velocity decreased, although the aortic augmented pressure increased in parallel with the incident wave height (
P
<0.001). Both FAIx and PAIx increased with age, but the age-dependent curves were upwardly concave and convex, respectively. FAIx increased exponentially with increasing PAIx (
r
=0.71). Compared with PAIx, FAIx was more closely (
P
≤0.001) correlated with the aortic pulse wave velocity, aortic compliance, and elastic/muscular pulse wave velocity ratio. FAIx was associated with white matter hyperintensities scores independently of confounders including age, sex, diabetes mellitus, hypercholesterolemia, and aortic pulse wave velocity (
P
=0.01), and was more predictive of white matter hyperintensities presence than PAIx.
Conclusions—
Carotid FAIx had closer associations with age, aortic stiffness, and cerebral white matter hyperintensities than aortic PAIx. These results indicate that carotid flow augmentation (enhanced by aortic stiffening and pressure wave reflection from the lower body) causes microcerebrovascular injury potentially through increasing cerebral flow pulsations, but this detrimental effect is greater than that estimated from PAIx.
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Affiliation(s)
- Junichiro Hashimoto
- From the Medical Center, Miyagi University of Education, Sendai, Japan (J.H.)
- Division of Nephrology, Endocrinology, and Vascular Medicine, Department of Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (J.H., S.I.)
| | - Berend E. Westerhof
- Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, The Netherlands (B.E.W.)
| | - Sadayoshi Ito
- 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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27
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Sasai M, Sun X, Okuda C, Nakato J, Kanamoto R, Ohinata K. Orally active anti-hypertensive peptides found based on enteroendocrine cell responses to a dipeptide library. Biochem Biophys Res Commun 2018; 503:1070-1074. [DOI: 10.1016/j.bbrc.2018.06.118] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 06/20/2018] [Indexed: 11/26/2022]
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28
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Kumagai H, Yoshikawa T, Myoenzono K, Kosaki K, Akazawa N, Asako ZM, Tsujimoto T, Kidokoro T, Tanaka K, Maeda S. Sexual Function Is an Indicator of Central Arterial Stiffness and Arterial Stiffness Gradient in Japanese Adult Men. J Am Heart Assoc 2018; 7:JAHA.117.007964. [PMID: 29730645 PMCID: PMC6015322 DOI: 10.1161/jaha.117.007964] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background As arterial stiffness increases in the absence of subjective symptoms, a personal indicator that reflects increased risk of cardiovascular disease is necessary. Penile erection is regulated by vascular function, and atherosclerosis affects the penile artery earlier than it affects the coronary and carotid arteries. Therefore, we hypothesized that deterioration of erectile function could be a marker of increased risk for cardiovascular disease. To test our hypothesis, we assessed erectile function and arterial stiffness in a cross‐sectional study. Methods and Results Carotid‐femoral pulse wave velocity (PWV), brachial‐ankle PWV, femoral‐ankle PWV, and arterial stiffness gradient (PWV ratio: carotid‐femoral PWV/femoral‐ankle PWV) were measured as indexes of central, systemic, and peripheral arterial stiffness and peripheral organ damage, respectively, in 317 adult men. In addition, erectile function was assessed by using the questionnaire International Index of Erectile Function 5 (a descending score indicates worsening of erectile function). The scores of male sexual function were inversely correlated with carotid‐femoral PWV (rs=−0.41), brachial‐ankle PWV (rs=−0.35), femoral‐ankle PWV (rs=−0.19), and PWV ratio (rs=−0.33). Furthermore, multivariate linear regression analyses revealed that International Index of Erectile Function 5 scores were significantly associated with carotid‐femoral PWV (β=−0.22) and PWV ratio (β=−0.25), but not with brachial‐ankle PWV and femoral‐ankle PWV. Conclusions Our results indicated that erectile function is independently associated with central arterial stiffness and peripheral organ damage. These findings suggest that male sexual function could be an easily identifiable and independent marker of increased central arterial stiffness and peripheral organ damage.
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Affiliation(s)
- Hiroshi Kumagai
- Faculty of Health and Sport Sciences, University of Tsukuba, Ibaraki, Japan.,Graduate School of Health and Sports Science, Juntendo University, Inzai, Chiba, Japan.,Japan Society for the Promotion of Science, Chiyoda-ku, Tokyo, Japan
| | - Toru Yoshikawa
- Faculty of Sports and Health Science, Ryutsu Keizai University, Ryugasaki, Ibaraki, Japan
| | - Kanae Myoenzono
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan
| | - Keisei Kosaki
- Faculty of Health and Sport Sciences, University of Tsukuba, Ibaraki, Japan.,Japan Society for the Promotion of Science, Chiyoda-ku, Tokyo, Japan
| | - Nobuhiko Akazawa
- Faculty of Health and Sport Sciences, University of Tsukuba, Ibaraki, Japan.,Japan Institute of Sport Sciences, Kita-ku, Tokyo, Japan
| | - Zempo-Miyaki Asako
- Faculty of Sports and Health Science, Ryutsu Keizai University, Ryugasaki, Ibaraki, Japan
| | | | - Tetsuhiro Kidokoro
- Graduate School of Health and Sports Science, Juntendo University, Inzai, Chiba, Japan
| | - Kiyoji Tanaka
- Faculty of Health and Sport Sciences, University of Tsukuba, Ibaraki, Japan
| | - Seiji Maeda
- Faculty of Health and Sport Sciences, University of Tsukuba, Ibaraki, Japan
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Central diastolic pressure decay mediates the relationship between aortic stiffness and myocardial viability: potential implications for aortosclerosis-induced myocardial ischemia. J Hypertens 2018; 35:2034-2043. [PMID: 28614093 DOI: 10.1097/hjh.0000000000001436] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Stiffening of the aorta often precedes coronary events, but little is known about the aetiological mechanism. We hypothesized that the predisposition to myocardial ischemia could be attributable to aortosclerosis-induced alterations in the central haemodynamics during diastole. METHODS Using noninvasive tonometry and ultrasonography, we investigated the arterial pressure pulse waveforms, pulse wave velocities (PWVs) and compliance in 222 patients with hypertension. The diastolic pressure decay was quantified by fitting a mono-exponential curve as P(t) = P0e [λ: decay index; P0: end-systolic pressure; t: time from end-systole]. The myocardial oxygen supply/demand balance was estimated from the subendocardial viability index (SVI). RESULTS The aortic pressure decay fit to an exponential curve significantly (R = 0.98 ± 0.02) and more closely than the radial pressure decay (P < 0.001). The aortic decay index (median, 0.59 s) was associated with the aortic PWV and compliance (but not with the peripheral PWV or resistance), even after controlling for age, sex, renal function, diabetes and hypercholesterolemia (P < 0.001). Also, both the aortic PWV and compliance (together with the augmentation index) were related to the SVI, although these relationships were no longer significant after accounting for the decay index. Mediation analysis revealed substantial mediating effects of the decay index on the relationship between aortic PWV or compliance and SVI (75-100%), despite the lack of similar effects of the augmentation index. CONCLUSION Aortic stiffening with reduced compliance potentially impairs myocardial viability by accelerating the diastolic exponential decay (rather than through enhancing late-systolic augmentation) of the central blood pressure, thus predisposing hypertensive patients to ischemic heart disease.
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30
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Goupil R, Dupuis D, Agharazii M, Hamet P, Troyanov S, Madore F. Central blood pressures in early chronic kidney disease: an analysis of CARTaGENE. Nephrol Dial Transplant 2018; 32:976-983. [PMID: 27190343 DOI: 10.1093/ndt/gfw059] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 03/01/2016] [Indexed: 11/13/2022] Open
Abstract
Background Vascular stiffness and advanced chronic kidney disease (CKD) are strong determinants of higher central blood pressure (BP) and are associated with high cardiovascular morbidity and mortality. Whether mild-to-moderate CKD is associated with higher central BP independently of other comorbid conditions remains uncertain. Methods We evaluated the central hemodynamic profile [central systolic BP, central pulse pressure (PP), augmentation index, PP amplification, augmented pressure] of Stage 3 CKD patients and compared it with participants with estimated glomerular filtration rate (eGFR) >60 mL/min/1.73 m 2 in the CARTaGENE populational cohort through propensity score matching and multivariate regression analyses. Results Of the 20 004 participants, 13 114 had valid pulse wave analysis and eGFRs >30 mL/min/1.73 m 2 , of which 515 had Stage 3 CKD. These 515 patients had significantly higher peripheral systolic BP (127 ± 16 versus 125 ± 15 mmHg, P = 0.01) and central PP (43.0 ± 11.4 versus 39.7 ± 10.0 mmHg, P <0.001) than the control group (eGFR >60 mL/min/1.73 m 2 ). Propensity score matching allowed the creation of 500 pairs with similar clinical characteristics. In this matched cohort, central BPs were similar in Stage 3 CKD patients compared with controls (central PP 42.9 ± 11.3 versus 43.7 ± 11.3 mmHg, P = 0.3). Multivariate analysis using data from all patients also found that the higher central hemodynamic readings found in Stage 3 CKD patients disappeared after adjusting for comorbid conditions. In a subset of 609 participants in whom albuminuria levels were measured, urine albumin excretion was not independently associated with higher central hemodynamic indices. Conclusion In this large cohort from the general population, early CKD and albuminuria was not independently associated with detrimental central hemodynamic parameters.
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Affiliation(s)
- Rémi Goupil
- Department of Nephrology, Hôpital du Sacré-Cœur de Montréal, Université de Montréal, Montréal, QC, Canada
| | - Dominique Dupuis
- Department of Nephrology, Hôpital du Sacré-Cœur de Montréal, Université de Montréal, Montréal, QC, Canada
| | - Mohsen Agharazii
- CHU de Québec, Hôtel-Dieu de Québec and Université Laval, Québec, QC, Canada
| | - Pavel Hamet
- CHUM, Université de Montréal, Montréal, QC, Canada
| | - Stéphan Troyanov
- Department of Nephrology, Hôpital du Sacré-Cœur de Montréal, Université de Montréal, Montréal, QC, Canada
| | - François Madore
- Department of Nephrology, Hôpital du Sacré-Cœur de Montréal, Université de Montréal, Montréal, QC, Canada
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31
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Does elastin deficiency cause chronic kidney disease? Kidney Int 2017; 92:1036-1038. [DOI: 10.1016/j.kint.2017.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 05/09/2017] [Indexed: 11/18/2022]
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32
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Affiliation(s)
- Gary L Pierce
- From the Department of Health and Human Physiology (G.L.P.), Abboud Cardiovascular Research Center (G.L.P.), and UIHC Center for Hypertension Research (G.L.P.), The University of Iowa, Iowa City.
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Noninvasive assessment of haemodynamics in resistant hypertension: the role of the renal resistive index. J Hypertens 2017; 35:578-584. [PMID: 27984414 DOI: 10.1097/hjh.0000000000001206] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The association of resistant hypertension (RHTN) with renal haemodynamics is unclear. Our aim was to evaluate differences in haemodynamic characteristics of patients with RHTN compared with patients with controlled hypertension (HTN) at the level of the heart, kidney and aorta. METHODS We studied 50 patients with RHTN confirmed by ambulatory blood pressure monitoring and 50 controlled hypertensive patients matched for age and sex. All participants underwent renal Doppler ultrasound to determine the renal resistive index (RRI), a complete echocardiographic study including measurements of diastolic function and evaluation of augmentation index. RESULTS Hypertensive patients with RHTN compared with those without RHTN had a significantly decreased E/A ratio (by 0.12, P = 0.043), an increased E/e' ratio (by 3.1, P < 0.001), increased albumin-to-creatinine ratio levels (by 49 mg/g, P = 0.023) and a significantly higher RRI (by 0.078, P < 0.001) but similar augmentation index values (P = 0.79). Logistic regression revealed that presence of RHTN was the strongest predictor of an RRI more than 0.7 after controlling for other haemodynamic variables including blood pressure levels. Receiver-operator characteristic analysis revealed an area under the curve for prediction of RHTN by the RRI alone of 80.3% (95% confidence interval: 0.72-0.89, P < 0.001). An RRI cut-point of 0.648 has a sensitivity of 78% and a specificity of 72% for prediction of RHTN. CONCLUSION In a well treated hypertensive population, patients with RHTN show more pronounced renal and cardiac haemodynamic dysfunction compared with patients with controlled HTN. A greater RRI seems to be associated with RHTN and may help identify such patients.
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Serum resistin as an independent marker of aortic stiffness in patients with coronary artery disease. PLoS One 2017; 12:e0183123. [PMID: 28806778 PMCID: PMC5555662 DOI: 10.1371/journal.pone.0183123] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Accepted: 07/31/2017] [Indexed: 12/17/2022] Open
Abstract
Background Subjects with higher carotid–femoral pulse wave velocity (cfPWV) will be at an increased risk for cardiovascular (CV) events in future. Resistin is an inflammatory mediator and a biomarker of CV diseases. We evaluated the association between serum resistin and aortic stiffness in patients with coronary artery disease (CAD). Methods A total of 104 patients with CAD were enrolled in this study. cfPWV was measured using the SphygmoCor system. Patients with cfPWV >10 m/s were defined as the high aortic stiffness group. Results Thirty-seven patients (35.6%) had high aortic stiffness and higher percentages of diabetes (p = 0.001), were of older age (p = 0.001) and had higher waist circumference (p < 0.001), systolic blood pressure (p = 0.027), pulse pressure (p = 0.013), high-sensitivity C-reactive protein (p < 0.001) and resistin levels (p < 0.001) but lower estimated glomerular filtration rate (p = 0.009) compared to subjects with low aortic stiffness. After adjusting for factors significantly associated with aortic stiffness by multivariate logistic regression analysis, serum resistin (odds ratio = 1.275, 95% confidence interval: 1.065–1.527, p = 0.008) was also found to be an independent predictor of aortic stiffness in patients with CAD. Conclusions Serum resistin level is a biomarker for aortic stiffness in patients with CAD.
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Abstract
OBJECTIVES A reversed aortic-to-brachial stiffness gradient (ab-SG), defined as aortic pulse wave velocity (aPWV) greater than brachial PWV (bPWV), was recently shown to predict mortality independent of aPWV in dialysis patients. Patients with type 2 diabetes mellitus (T2DM) have increased risk of renal damage and exhibit haemodynamic abnormalities at rest and during exercise that may alter the ab-SG. This study aimed to examine ab-SG in patients with T2DM by comparison with nondiabetic controls during rest and exercise, and to determine associations between ab-SG, aPWV, and kidney function. METHODS Study participants were 60 patients with T2DM and 60 age and sex-matched nondiabetic controls (58 ± 8 years, 55% male both). ab-SG was defined as the quotient of bPWV (carotid-to-radial) and aPWV (carotid-to-femoral) recorded via applanation tonometry. Kidney function was assessed using estimated glomerular filtration rate (eGFR). The exercise substudy was undertaken in 21 patients with T2DM and 21 matched nondiabetic controls during semirecumbent exercise. RESULTS ab-SG was significantly lower in patients with T2DM (0.99 ± 0.2 vs. 1.2 ± 0.3, P < 0.001) and aPWV, but not bPWV, was significantly higher (P < 0.001 and P = 0.25). A total of 58% of patients with T2DM vs. 27% of nondiabetic controls (χ = 11.0, P < 0.001) had a reversed ab-SG (aPWV ≥ bPWV). ab-SG predicted eGFR independent of age, sex, T2DM status, and cardiovascular risk factors (β = 13.2, P = 0.024), whereas aPWV did not (β = -0.88, P = 0.30). Exercise ab-SG was significantly lower in patients with T2DM (0.97 ± 0.2 vs. 1.2 ± 0.2, P < 0.001), but did not predict eGFR. CONCLUSIONS Patients with T2DM have a reversed ab-SG during rest and exercise. Resting ab-SG predicts kidney function independent of aPWV, implying a reversed ab-SG may have a pathophysiological function.
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Climie RED, Picone DS, Sharman JE. Longitudinal Changes in Excess Pressure Independently Predict Declining Renal Function Among Healthy Individuals-A Pilot Study. Am J Hypertens 2017; 30:772-775. [PMID: 28575172 DOI: 10.1093/ajh/hpx091] [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: 02/26/2017] [Accepted: 05/10/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Aortic reservoir function independently predicts end-organ damage in cross-sectional analyses. However, longitudinal associations are more important regarding causation, but this has never been examined at rest or in response to light-moderate intensity exercise. The aim of this study was to determine the association between the change in aortic reservoir characteristics, in particular excess pressure integral (Pexcess) at rest and in response to exercise and the change in kidney function among healthy individuals followed over time. METHODS Aortic reservoir function (Pexcess and reservoir pressure), aortic stiffness, brachial and central blood pressure (BP), and renal function (estimated glomerular filtration rate [eGFR]) were recorded among 33 healthy individuals (57 ± 9 years; 55% male) at baseline and after an average 3.0 ± 0.3 years. RESULTS Over the follow up period, there was a significant increase in resting brachial BP, central BP, Pexcess, and aortic stiffness (P < 0.05 all). The change over time in resting Pexcess (but not aortic stiffness) was significantly related to the change in eGFR (r = -0.38, P = 0.038) and remained independent of age at follow up, change in 24-hour ambulatory systolic BP and body mass index (β = -0.0300, P = 0.043). There was no association between the change in aortic pulse wave velocity and the change eGFR (P = 0.46) nor were there any associations with exercising hemodynamics. CONCLUSIONS Pexcess is independently associated with a decline in renal function among healthy people followed over 3 years. These novel findings indicate the need to determine the underlying physiological determinants of aortic reservoir function.
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Affiliation(s)
- Rachel E D Climie
- Baker Heart and Diabetes Institute, Melbourne, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Dean S Picone
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - James E Sharman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
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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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Kosaki K, Kamijo-Ikemori A, Sugaya T, Tanahashi K, Kumagai H, Sawano Y, Osuka Y, Tanaka K, Kimura K, Shibagaki Y, Maeda S. Association between muscular strength and intrarenal vascular resistance in middle-aged and older individuals. Exp Gerontol 2017; 91:72-78. [DOI: 10.1016/j.exger.2017.02.076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 02/22/2017] [Accepted: 02/27/2017] [Indexed: 10/20/2022]
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Montero D, Lundby C, Ruschitzka F, Flammer AJ. True Anemia―Red Blood Cell Volume Deficit―in Heart Failure. Circ Heart Fail 2017; 10:CIRCHEARTFAILURE.116.003610. [DOI: 10.1161/circheartfailure.116.003610] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 03/29/2017] [Indexed: 01/08/2023]
Abstract
Background—
Anemia in heart failure (HF) is commonly diagnosed according to hemoglobin concentration [Hb], hence may be the result of hemodilution or true red blood cell volume (RBCV) deficit. Whether true (nonhemodilutional) anemia in HF can or cannot be generally inferred by [Hb] measurements and clinical correlates remains unclear. The purpose of this study was to systematically review the literature and investigate the status and correlates of RBCV in patients with HF.
Methods and Results—
MEDLINE, Scopus, and Web of Science were searched since their inceptions until April 2016 for articles directly reporting or allowing the calculation of intravascular volumes (RBCV, plasma volume) in patients with HF according to the International Council for Standardization in Hematology. Eighteen studies were included after systematic review, comprising a total of 368 patients with HF (limits for mean age=49–80 years, sex=0%–92% females, left ventricular ejection fraction=26%–61%). Mean RBCV was reduced (limits=67%–88% of normal) in all studies including HF patients with anemia (low [Hb]) (7 studies, n=127), whereas only 2 of 10 studies in nonanemic patients with HF presented lower than normal mean RBCV (90% and 96%). In metaregression analyses, RBCV was positively associated with [Hb] (
B
=6.10, SE=1.44) and negatively associated with age (
B
=−1.14, SE=0.23), % females (
B
=−0.38, SE=0.04), left ventricular ejection fraction (
B
=−0.81, SE=0.20), and body mass index (
B
=−3.55, SE=0.46;
P
<0.001).
Conclusions—
Presence or absence of true anemia in patients with HF as determined by RBCV status mainly concurs with diagnosis based on [Hb] and presents negative relationships with age, female sex, left ventricular ejection fraction, and body mass index.
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Affiliation(s)
- David Montero
- From the University Heart Center, Department of Cardiology, University Hospital Zurich, Switzerland (D.M., F.R., A.J.F.); and Zurich Center for Integrative Human Physiology (ZIHP), Oxygen Transport and Utilization, Institute of Physiology, University of Zurich, Switzerland (C.L.)
| | - Carsten Lundby
- From the University Heart Center, Department of Cardiology, University Hospital Zurich, Switzerland (D.M., F.R., A.J.F.); and Zurich Center for Integrative Human Physiology (ZIHP), Oxygen Transport and Utilization, Institute of Physiology, University of Zurich, Switzerland (C.L.)
| | - Frank Ruschitzka
- From the University Heart Center, Department of Cardiology, University Hospital Zurich, Switzerland (D.M., F.R., A.J.F.); and Zurich Center for Integrative Human Physiology (ZIHP), Oxygen Transport and Utilization, Institute of Physiology, University of Zurich, Switzerland (C.L.)
| | - Andreas J. Flammer
- From the University Heart Center, Department of Cardiology, University Hospital Zurich, Switzerland (D.M., F.R., A.J.F.); and Zurich Center for Integrative Human Physiology (ZIHP), Oxygen Transport and Utilization, Institute of Physiology, University of Zurich, Switzerland (C.L.)
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Deep Phenotyping of Systemic Arterial Hemodynamics in HFpEF (Part 2): Clinical and Therapeutic Considerations. J Cardiovasc Transl Res 2017; 10:261-274. [PMID: 28401511 DOI: 10.1007/s12265-017-9736-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 01/30/2017] [Indexed: 01/09/2023]
Abstract
Multiple phase III trials over the last few decades have failed to demonstrate a clear benefit of various pharmacologic interventions in heart failure with a preserved left ventricular (LV) ejection fraction (HFpEF). Therefore, a better understanding of its pathophysiology is important. An accompanying review describes key technical and physiologic aspects regarding the deep phenotyping of arterial hemodynamics in HFpEF. This review deals with the potential of this approach to enhance our clinical, translational, and therapeutic approach to HFpEF. Specifically, the role of arterial hemodynamics is discussed in relation to (1) the pathophysiology of left ventricular diastolic dysfunction, remodeling, and fibrosis, (2) impaired oxygen delivery to peripheral skeletal muscle, which affects peripheral oxygen extraction, (3) the frequent presence of comorbidities, such as renal failure and dementia in this population, and (4) the potential to enhance precision medicine approaches. A therapeutic approach to target arterial hemodynamic abnormalities that are prevalent in this population (particularly, with inorganic nitrate/nitrite) is also discussed.
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Hashimoto J, O'Rourke MF. Inflammation and Arterial Stiffness in Chronic Kidney Disease: Cause or Consequence? Am J Hypertens 2017; 30:350-352. [PMID: 28164218 DOI: 10.1093/ajh/hpx007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 01/06/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Michael F O'Rourke
- St. Vincent's Clinic/University of New South Wales, Darlinghurst, Australia
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Choline ameliorates cardiovascular damage by improving vagal activity and inhibiting the inflammatory response in spontaneously hypertensive rats. Sci Rep 2017; 7:42553. [PMID: 28225018 PMCID: PMC5320519 DOI: 10.1038/srep42553] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 01/10/2017] [Indexed: 11/17/2022] Open
Abstract
Autonomic dysfunction and abnormal immunity lead to systemic inflammatory responses, which result in cardiovascular damage in hypertension. The aim of this report was to investigate the effects of choline on cardiovascular damage in hypertension. Eight-week-old male spontaneously hypertensive rats (SHRs) and Wistar-Kyoto rats were intraperitoneally injected with choline or vehicle (8 mg/kg/day). After 8 weeks, choline restored the cardiac function of the SHRs, as evidenced by decreased heart rate, systolic blood pressure, left ventricle systolic pressure, and ±dp/dtmax and increased ejection fraction and fractional shortening. Choline also ameliorated the cardiac hypertrophy of the SHRs, as indicated by reduced left ventricle internal dimensions and decreased cardiomyocyte cross-sectional area. Moreover, choline improved mesenteric arterial function and preserved endothelial ultrastructure in the SHRs. Notably, the protective effect of choline may be due to its anti-inflammatory effect. Choline downregulated expression of interleukin (IL)-6 and tumour necrosis factor-α and upregulated IL-10 in the mesenteric arteries of SHRs, possibly because of the inhibition of Toll-like receptor 4. Furthermore, choline restored baroreflex sensitivity and serum acetylcholine level in SHRs, thus indicating that choline improved vagal activity. This study suggests that choline elicits cardiovascular protective effects and may be useful as a potential adjunct therapeutic approach for hypertension.
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Relationship between exercise capacity and urinary liver-type fatty acid-binding protein in middle-aged and older individuals. Clin Exp Nephrol 2017; 21:810-817. [PMID: 28197733 DOI: 10.1007/s10157-017-1385-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 01/19/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND The underlying mechanism linking the decline in exercise capacity with renal dysfunction remains unclear. Urinary liver-type fatty acid-binding protein (L-FABP) levels reflect the degree of peritubular capillary blood flow, an important factor for renal dysfunction with aging. The aim of this study was to examine the relationship between exercise capacity and urinary L-FABP levels. METHODS This was a cross-sectional study of 187 middle-aged and older individuals (aged 50-83 years) without chronic kidney disease (CKD). We assessed urinary L-FABP levels, peak oxygen consumption ([Formula: see text]), and grip strength. RESULTS Urinary L-FABP levels inversely correlated with both [Formula: see text] (r s = -0.349) and grip strength (r s = -0.485). When the participants were divided into four groups according to the median values of aerobic fitness and muscular strength ([Formula: see text] and grip strength), urinary L-FABP levels were the highest in participants with lower levels of aerobic fitness and muscular strength (2.95 ± 1.43 μg/g creatinine) and the lowest in the participants with higher levels of aerobic fitness and muscular strength (1.33 ± 0.76 μg/g creatinine). The difference between the two groups was significant (P < 0.001). CONCLUSION Our results demonstrate that both [Formula: see text] and grip strength were inversely associated with urinary L-FABP levels in middle-aged and older individuals without CKD. This suggests that a decline in exercise capacity is associated with a reduction in peritubular capillary blood flow, providing a novel insight into the underlying mechanism linking the decline in exercise capacity to the development of renal dysfunction.
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Exploring the association of arterial stiffness with estimated glomerular filtration rate: another chicken-egg paradigm? J Hypertens 2017; 35:650-651. [PMID: 28121844 DOI: 10.1097/hjh.0000000000001238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Montero D, Diaz-Cañestro C, Flammer A, Lundby C. Unexplained Anemia in the Elderly: Potential Role of Arterial Stiffness. Front Physiol 2016; 7:485. [PMID: 27826252 PMCID: PMC5078728 DOI: 10.3389/fphys.2016.00485] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 10/10/2016] [Indexed: 12/02/2022] Open
Affiliation(s)
- David Montero
- Department of Cardiology, University Heart Center, University Hospital Zurich Zurich, Switzerland
| | | | - Andreas Flammer
- Department of Cardiology, University Heart Center, University Hospital Zurich Zurich, Switzerland
| | - Carsten Lundby
- Zurich Center for Integrative Human Physiology, Institute of Physiology, University of Zurich Zurich, Switzerland
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Montero D, Diaz-Cañestro C, Keiser S, Lundby C. Arterial stiffness is strongly and negatively associated with the total volume of red blood cells. Int J Cardiol 2016; 221:77-80. [PMID: 27400301 DOI: 10.1016/j.ijcard.2016.06.265] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 05/24/2016] [Accepted: 06/27/2016] [Indexed: 01/13/2023]
Abstract
BACKGROUND Erythropoiesis is partly regulated through classic feedback pathways that govern blood volume (BV) as sensed by veno-atrial but also arterial stretch receptors. Hence, the total volume of red blood cells (RBCV) could be associated with arterial stiffness (AS), although such hypothesis has not yet been tested. Therefore, we sought to investigate the association of AS with hematological variables including RBCV. METHODS Fourteen healthy physically active individuals volunteered for the study (age=23±2). RBCV, plasma volume (PV), and BV were calculated from measures of hematocrit and total hemoglobin mass (Hbmass) determined by CO-rebreathing. Carotid compliance with ultrasonography and carotid-ankle pulse wave velocity (PWV) were determined at rest and immediately after a maximal exercise test. The rationale for assessment of AS after exercise derives from the potential marked role of AS in the regulation of erythropoiesis in the setting of reduced central venous pressure. RESULTS At rest, carotid compliance was positively associated with Hbmass, RBCV, BV, but not PV, with coefficients of determination (R(2)) ranging from 0.39 to 0.57. Following exercise, closer positive associations were observed between carotid compliance and Hbmass, RBCV, or BV. Moreover, carotid-ankle PWV was negatively associated with all hematological variables after exercise except for PV, with R(2) ranging from 0.49 to 0.75. Similar results were observed when adjusted by body weight. CONCLUSIONS AS is strongly and inversely associated with RBCV in healthy individuals. These findings suggest that AS may adversely intercede in the regulation of erythropoiesis through the alteration of mechanisms that control BV.
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Affiliation(s)
- David Montero
- Zurich Center for Integrative Human Physiology (ZIHP), Institute of Physiology, University of Zurich, Zurich, Switzerland.
| | | | - Stefanie Keiser
- Zurich Center for Integrative Human Physiology (ZIHP), Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - Carsten Lundby
- Zurich Center for Integrative Human Physiology (ZIHP), Institute of Physiology, University of Zurich, Zurich, Switzerland
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Aboyans V, De Carlo M, Kownator S, Mazzolai L, Meneveau N, Ricco JB, Vlachopoulos C, Brodmann M. The year in cardiology 2015: peripheral circulation. Eur Heart J 2016; 37:676-85. [PMID: 26726049 DOI: 10.1093/eurheartj/ehv709] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Accepted: 12/03/2015] [Indexed: 11/12/2022] Open
Affiliation(s)
- Victor Aboyans
- Department of Cardiology, Dupuytren University Hospital, 2, Martin Luther King Avenue, 87042 Limoges, France Inserm 1094, Tropical Neuroepidemiology, University of Limoges, Limoges, France
| | - Marco De Carlo
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | | | - Lucia Mazzolai
- Department of Angiology, CHUV, Lausanne University Hospital, Lausanne, Switzerland
| | - Nicolas Meneveau
- Department of Cardiology, EA3920, University Hospital Jean Minjoz, Besançon, France
| | - Jean-Baptiste Ricco
- Department of Vascular Surgery, University Hospital of Poitiers, Poitiers, France
| | - Charalambos Vlachopoulos
- Peripheral Vessels and Hypertension Units, 1st Department Cardiology, Athens Medical School, Athens, Greece
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The two faces of hypertension: role of aortic stiffness. ACTA ACUST UNITED AC 2016; 10:175-83. [DOI: 10.1016/j.jash.2015.11.012] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 10/14/2015] [Accepted: 11/18/2015] [Indexed: 11/18/2022]
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49
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Iwakura Y, Ito S, Morimoto R, Kudo M, Ono Y, Nezu M, Takase K, Seiji K, Ishidoya S, Arai Y, Funamizu Y, Miki T, Nakamura Y, Sasano H, Satoh F. Renal Resistive Index Predicts Postoperative Blood Pressure Outcome in Primary Aldosteronism. Hypertension 2016; 67:654-60. [PMID: 26865201 DOI: 10.1161/hypertensionaha.115.05924] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 12/30/2015] [Indexed: 11/16/2022]
Abstract
The renal resistive index (RI) calculated by Doppler ultrasonography has been reported to be correlated with renal structural changes and outcomes in patients with essential hypertension or renal disease. However, little is known about this index in primary aldosteronism. In this prospective study, we examined the utility of this index to predict blood pressure (BP) outcome after adrenalectomy in patients with primary aldosteronism. We studied 94 patients with histopathologically proven aldosteronoma who underwent surgery. Parameters on renal function, including renal flow indices, were examined and followed up for 12 months postoperatively. The renal RI of the main, hilum, and interlobar arteries was significantly higher in patients with aldosteronoma compared with 100 control patients. BP, estimated glomerular filtration rate, and urinary albumin excretion significantly decreased after adrenalectomy. The resistive indices of all compartment arteries were significantly reduced 1 month after adrenalectomy and remained stable for 12 months. Patients whose interlobar RI was in the highest tertile at baseline had higher systolic BP after adrenalectomy than those whose RI was in the lowest tertile. Logistic regression analysis demonstrated that the RI of the interlobar and hilum arteries could be an independent predictive marker for intractable hypertension (systolic BP ≥140 mm Hg, increased BP, taking ≥3 antihypertensive agents, or increased number of agents) even after adrenalectomy. Therefore, in patients with aldosteronoma, the renal RI indicates partially reversible renal hemodynamics and renal structural damages that would influence postoperative BP outcome.
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Affiliation(s)
- Yoshitsugu Iwakura
- From the Endocrine unit of the Division of Nephrology, Endocrinology and Vascular Medicine (Y.I., S.I., R.M., M.K., Y.O., M.N., F.S.), Departments of Diagnostic Radiology (K.T., K.S.) and Urology (S.I, Y.A.), Clinical Physiology Center (Y.F., T.M.), Department of Pathology (Y.N., H.S.), Tohoku University Hospital, Sendai, Japan; and Division of Clinical Hypertension, Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Japan (F.S.)
| | - Sadayoshi Ito
- From the Endocrine unit of the Division of Nephrology, Endocrinology and Vascular Medicine (Y.I., S.I., R.M., M.K., Y.O., M.N., F.S.), Departments of Diagnostic Radiology (K.T., K.S.) and Urology (S.I, Y.A.), Clinical Physiology Center (Y.F., T.M.), Department of Pathology (Y.N., H.S.), Tohoku University Hospital, Sendai, Japan; and Division of Clinical Hypertension, Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Japan (F.S.)
| | - Ryo Morimoto
- From the Endocrine unit of the Division of Nephrology, Endocrinology and Vascular Medicine (Y.I., S.I., R.M., M.K., Y.O., M.N., F.S.), Departments of Diagnostic Radiology (K.T., K.S.) and Urology (S.I, Y.A.), Clinical Physiology Center (Y.F., T.M.), Department of Pathology (Y.N., H.S.), Tohoku University Hospital, Sendai, Japan; and Division of Clinical Hypertension, Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Japan (F.S.)
| | - Masataka Kudo
- From the Endocrine unit of the Division of Nephrology, Endocrinology and Vascular Medicine (Y.I., S.I., R.M., M.K., Y.O., M.N., F.S.), Departments of Diagnostic Radiology (K.T., K.S.) and Urology (S.I, Y.A.), Clinical Physiology Center (Y.F., T.M.), Department of Pathology (Y.N., H.S.), Tohoku University Hospital, Sendai, Japan; and Division of Clinical Hypertension, Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Japan (F.S.)
| | - Yoshikiyo Ono
- From the Endocrine unit of the Division of Nephrology, Endocrinology and Vascular Medicine (Y.I., S.I., R.M., M.K., Y.O., M.N., F.S.), Departments of Diagnostic Radiology (K.T., K.S.) and Urology (S.I, Y.A.), Clinical Physiology Center (Y.F., T.M.), Department of Pathology (Y.N., H.S.), Tohoku University Hospital, Sendai, Japan; and Division of Clinical Hypertension, Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Japan (F.S.)
| | - Masahiro Nezu
- From the Endocrine unit of the Division of Nephrology, Endocrinology and Vascular Medicine (Y.I., S.I., R.M., M.K., Y.O., M.N., F.S.), Departments of Diagnostic Radiology (K.T., K.S.) and Urology (S.I, Y.A.), Clinical Physiology Center (Y.F., T.M.), Department of Pathology (Y.N., H.S.), Tohoku University Hospital, Sendai, Japan; and Division of Clinical Hypertension, Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Japan (F.S.)
| | - Kei Takase
- From the Endocrine unit of the Division of Nephrology, Endocrinology and Vascular Medicine (Y.I., S.I., R.M., M.K., Y.O., M.N., F.S.), Departments of Diagnostic Radiology (K.T., K.S.) and Urology (S.I, Y.A.), Clinical Physiology Center (Y.F., T.M.), Department of Pathology (Y.N., H.S.), Tohoku University Hospital, Sendai, Japan; and Division of Clinical Hypertension, Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Japan (F.S.)
| | - Kazumasa Seiji
- From the Endocrine unit of the Division of Nephrology, Endocrinology and Vascular Medicine (Y.I., S.I., R.M., M.K., Y.O., M.N., F.S.), Departments of Diagnostic Radiology (K.T., K.S.) and Urology (S.I, Y.A.), Clinical Physiology Center (Y.F., T.M.), Department of Pathology (Y.N., H.S.), Tohoku University Hospital, Sendai, Japan; and Division of Clinical Hypertension, Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Japan (F.S.)
| | - Shigeto Ishidoya
- From the Endocrine unit of the Division of Nephrology, Endocrinology and Vascular Medicine (Y.I., S.I., R.M., M.K., Y.O., M.N., F.S.), Departments of Diagnostic Radiology (K.T., K.S.) and Urology (S.I, Y.A.), Clinical Physiology Center (Y.F., T.M.), Department of Pathology (Y.N., H.S.), Tohoku University Hospital, Sendai, Japan; and Division of Clinical Hypertension, Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Japan (F.S.)
| | - Yoichi Arai
- From the Endocrine unit of the Division of Nephrology, Endocrinology and Vascular Medicine (Y.I., S.I., R.M., M.K., Y.O., M.N., F.S.), Departments of Diagnostic Radiology (K.T., K.S.) and Urology (S.I, Y.A.), Clinical Physiology Center (Y.F., T.M.), Department of Pathology (Y.N., H.S.), Tohoku University Hospital, Sendai, Japan; and Division of Clinical Hypertension, Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Japan (F.S.)
| | - Yasuharu Funamizu
- From the Endocrine unit of the Division of Nephrology, Endocrinology and Vascular Medicine (Y.I., S.I., R.M., M.K., Y.O., M.N., F.S.), Departments of Diagnostic Radiology (K.T., K.S.) and Urology (S.I, Y.A.), Clinical Physiology Center (Y.F., T.M.), Department of Pathology (Y.N., H.S.), Tohoku University Hospital, Sendai, Japan; and Division of Clinical Hypertension, Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Japan (F.S.)
| | - Takashi Miki
- From the Endocrine unit of the Division of Nephrology, Endocrinology and Vascular Medicine (Y.I., S.I., R.M., M.K., Y.O., M.N., F.S.), Departments of Diagnostic Radiology (K.T., K.S.) and Urology (S.I, Y.A.), Clinical Physiology Center (Y.F., T.M.), Department of Pathology (Y.N., H.S.), Tohoku University Hospital, Sendai, Japan; and Division of Clinical Hypertension, Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Japan (F.S.)
| | - Yasuhiro Nakamura
- From the Endocrine unit of the Division of Nephrology, Endocrinology and Vascular Medicine (Y.I., S.I., R.M., M.K., Y.O., M.N., F.S.), Departments of Diagnostic Radiology (K.T., K.S.) and Urology (S.I, Y.A.), Clinical Physiology Center (Y.F., T.M.), Department of Pathology (Y.N., H.S.), Tohoku University Hospital, Sendai, Japan; and Division of Clinical Hypertension, Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Japan (F.S.)
| | - Hironobu Sasano
- From the Endocrine unit of the Division of Nephrology, Endocrinology and Vascular Medicine (Y.I., S.I., R.M., M.K., Y.O., M.N., F.S.), Departments of Diagnostic Radiology (K.T., K.S.) and Urology (S.I, Y.A.), Clinical Physiology Center (Y.F., T.M.), Department of Pathology (Y.N., H.S.), Tohoku University Hospital, Sendai, Japan; and Division of Clinical Hypertension, Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Japan (F.S.)
| | - Fumitoshi Satoh
- From the Endocrine unit of the Division of Nephrology, Endocrinology and Vascular Medicine (Y.I., S.I., R.M., M.K., Y.O., M.N., F.S.), Departments of Diagnostic Radiology (K.T., K.S.) and Urology (S.I, Y.A.), Clinical Physiology Center (Y.F., T.M.), Department of Pathology (Y.N., H.S.), Tohoku University Hospital, Sendai, Japan; and Division of Clinical Hypertension, Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Japan (F.S.).
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Laurent S, Boutouyrie P, Mousseaux E. Aortic Stiffening, Aortic Blood Flow Reversal, and Renal Blood Flow. Hypertension 2015; 66:10-2. [DOI: 10.1161/hypertensionaha.115.05357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Stéphane Laurent
- From the Department of Pharmacology (S.L., P.B.) and Department of Cardiovascular Radiology (E.M.), European Georges Pompidou Hospital, Assistance Publique-Hôpitaux de Paris, Inserm UMR 970, University Paris Descartes, Paris, France
| | - Pierre Boutouyrie
- From the Department of Pharmacology (S.L., P.B.) and Department of Cardiovascular Radiology (E.M.), European Georges Pompidou Hospital, Assistance Publique-Hôpitaux de Paris, Inserm UMR 970, University Paris Descartes, Paris, France
| | - Elie Mousseaux
- From the Department of Pharmacology (S.L., P.B.) and Department of Cardiovascular Radiology (E.M.), European Georges Pompidou Hospital, Assistance Publique-Hôpitaux de Paris, Inserm UMR 970, University Paris Descartes, Paris, France
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