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Gavish B, Bursztyn M, Thijs L, Wei DM, Melgarejo JD, Zhang ZY, Boggia J, Hansen TW, Asayama K, Ohkubo T, Kikuya M, Yang WY, Stolarz-Skrzypek K, Malyutina S, Casiglia E, Lind L, Li Y, Kawecka-Jaszcz K, Filipovský J, Tikhonoff V, Gilis-Malinowska N, Dolan E, Sandoya E, Narkiewicz K, Wang JG, Imai Y, Maestre GE, O’Brien E, Staessen JA. Predictive power of 24-h ambulatory pulse pressure and its components for mortality and cardiovascular outcomes in 11 848 participants recruited from 13 populations. J Hypertens 2022; 40:2245-2255. [PMID: 35950994 PMCID: PMC10366954 DOI: 10.1097/hjh.0000000000003258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND The role of pulse pressure (PP) 'widening' at older and younger age as a cardiovascular risk factor is still controversial. Mean PP, as determined from repeated blood pressure (BP) readings, can be expressed as a sum of two components: 'elastic PP' (elPP) and 'stiffening PP' (stPP) associated, respectively, with stiffness at the diastole and its relative change during the systole. We investigated the association of 24-h ambulatory PP, elPP, and stPP ('PP variables') with mortality and composite cardiovascular events in different age classes. METHOD Longitudinal population-based cohort study of adults with baseline observations that included 24-h ambulatory BP. Age classes were age 40 or less, 40-50, 50-60, 60-70, and over 70 years. Co-primary endpoints were total mortality and composite cardiovascular events. The relative risk expressed by hazard ratio per 1SD increase for each of the PP variables was calculated from multivariable-adjusted Cox regression models. RESULTS The 11 848 participants from 13 cohorts (age 53 ± 16 years, 50% men) were followed for up for 13.7 ± 6.7 years. A total of 2946 participants died (18.1 per 1000 person-years) and 2093 experienced a fatal or nonfatal cardiovascular event (12.9 per 1000 person-years). Mean PP, elPP, and stPP were, respectively, 49.7, 43.5, and 6.2 mmHg, and elPP and stPP were uncorrelated ( r = -0.07). At age 50-60 years, all PP variables displayed association with risk for almost all outcomes. From age over 60 years to age over 70 years, hazard ratios of of PP and elPP were similar and decreased gradually but differently for pulse rate lower than or higher than 70 bpm, whereas stPP lacked predictive power in most cases. For age 40 years or less, elPP showed protective power for coronary events, whereas stPP and PP predicted stroke events. Adjusted and unadjusted hazard ratio variations were similar over the entire age range. CONCLUSION This study provides a new basis for associating PP components with outcome and arterial properties in different age groups and at different pulse rates for both old and young age. The similarity between adjusted and unadjusted hazard ratios supports the clinical usefulness of PP components but further studies are needed to assess the prognostic significance of the PP components, especially at the young age.
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Affiliation(s)
| | - Michael Bursztyn
- Faculty of Medicine Hebrew University, Jerusalem, Hypertension Clinic Hadassah Medical Center Mount-Scopus, Jerusalem and Department of Medicine D, Beilinson Hospital, Petach-Tikva, Israel
| | - Lutgarde Thijs
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Dong-Mei Wei
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Jesus D. Melgarejo
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
- Laboratory of Neurosciences, Faculty of Medicine, University of Zulia, Maracaibo, Zulia, Venezuela
| | - Zhen-Yu Zhang
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Jose Boggia
- Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - Tine W. Hansen
- Steno Diabetes Center Copenhagen, Gentofte and Research Centre for Prevention and Health, Capital Region of Denmark, Denmark
| | - Kei Asayama
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo
- Tohoku Institute for Management of Blood Pressure, Sendai, Japan
| | - Takayoshi Ohkubo
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo
- Tohoku Institute for Management of Blood Pressure, Sendai, Japan
| | - Masahiro Kikuya
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo
| | - Wen-Yi Yang
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Katarzyna Stolarz-Skrzypek
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Sofia Malyutina
- Institute of Internal and Preventive Medicine, Internal and Preventive Medicine - Branch of the Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Science, Novosibirsk, Russian Federation
| | | | - Lars Lind
- Section of Geriatrics, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Yan Li
- Department of Cardiovascular Medicine, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, China
| | - Kalina Kawecka-Jaszcz
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Jan Filipovský
- Faculty of Medicine, Charles University, Pilsen, Czech Republic
| | | | | | - Eamon Dolan
- Conway Institute, University College Dublin, Dublin, Ireland
- Stroke and Hypertension Unit, Blanchardstown, Dublin, Ireland
| | - Edgardo Sandoya
- Asociación Española Primera de Socorros Mutuos, Montevideo, Uruguay
| | | | - Ji-Guang Wang
- Department of Cardiovascular Medicine, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, China
| | - Yutaka Imai
- Tohoku Institute for Management of Blood Pressure, Sendai, Japan
| | - Gladys E. Maestre
- Department of Neurosciences and Department of Human Genetics, University of Texas Rio Grande Valley School of Medicine, Brownsville, Texas, USA
| | - Eoin O’Brien
- Conway Institute, University College Dublin, Dublin, Ireland
| | - Jan A. Staessen
- Research Institute Alliance for the Promotion of Preventive Medicine, Mechelen
- Biomedical Science Group, University of Leuven, Leuven, Belgium
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Niestrawska JA, Ch Haspinger D, Holzapfel GA. The influence of fiber dispersion on the mechanical response of aortic tissues in health and disease: a computational study. Comput Methods Biomech Biomed Engin 2018; 21:99-112. [PMID: 29436874 DOI: 10.1080/10255842.2017.1418862] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Changes in the structural components of aortic tissues have been shown to play a significant role in the pathogenesis of aortic degeneration. Therefore, reliable stress analyses require a suitable and meaningful constitutive model that captures micro-structural changes. As recent data show, in-plane and out-of-plane collagen fiber dispersions vary significantly between healthy and aneurysmatic aortic walls. The aim of this study is to computationally investigate the influence of fiber dispersion on the mechanical response of aortic tissues in health and disease. In particular, the influence of three different fiber dispersions is studied: (i) non-rotationally symmetric dispersion, the most realistic assumption for aortic tissues; (ii) transversely isotropic dispersion, a special case; (iii) perfectly aligned fibers (no dispersion in either plane), another special case. Explicit expressions for the stress and elasticity tensors as needed for the implementation in a finite element code are provided. Three representative numerical examples are studied: planar biaxial extension, inflation of residually stressed and pre-stretched aortic segments and inflation of an idealized abdominal aortic aneurysm (AAA) geometry. For the AAA geometry the case of isotropic dispersion is additionally analyzed. Documented structural and mechanical parameters are taken from human aortas (healthy media/adventitia and AAA). The influence of fiber dispersions upon magnitudes and distributions of stresses and deformations are presented and analyzed. Stresses vary significantly, especially in the AAA case, where material stiffening is significantly influenced by fiber dispersion. The results highlight the need to incorporate the structural differences into finite element simulations to obtain more accurate stress predictions. Additionally, results show the capability of one constitutive model to represent different scenarios of aortic micro-structures allowing future studies of collagen reorientation during disease progression.
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Affiliation(s)
| | - Daniel Ch Haspinger
- a Institute of Biomechanics , Graz University of Technology , Graz , Austria
| | - Gerhard A Holzapfel
- a Institute of Biomechanics , Graz University of Technology , Graz , Austria .,b Faculty of Engineering Science and Technology , Norwegian University of Science and Technology (NTNU) , Trondheim , Norway
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Piechna A, Lombarski L, Ciszek B, Cieslicki K. Experimental determination of rupture pressure and stress of adventitia of human middle cerebral arteries. Int J Stroke 2017; 12:636-640. [PMID: 28067614 DOI: 10.1177/1747493016685715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Intracranial arterial dissections might be attributed to the particular biomechanical properties of their specific layers. Also, knowledge of adventitia properties would be crucial in the context of intracranial balloon angioplasty. Aims The purpose of this work was to determine the rupture pressure of separated adventitia and compare it to intact cerebral arterial segments. Methods Brain specimens were harvested from 14 autopsy subjects (age range from 23 to 86 years). Pressure-inflation tests were conducted on proximal segments of middle cerebral arteries and separated adventitia layers from contralateral arteries to assess the rupture pressure values. Results The averaged rupture pressure of adventitia layers was 1.41 SD 0.25 atm (1072 SD 190 mmHg), whereas for intact arterial segments it was 2.32 SD 0.70 atm (1763 SD 532 mmHg) and diminished with age according to nonlinear regression trends. The difference beetween the aformentioned rupture pressures was positively correlated with rupture pressure of intact arterial segments ( R2 = 0.88; p < 0.001). Conclusions The obtained experimental results indicate a leading role of adventitia in building arterial strength under supraphysiological pressure conditions. The greater the rupture pressure of complete cerebral arteries, the smaller the contribution of adventitia in overall wall resistance.
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Affiliation(s)
- Adam Piechna
- 1 Warsaw University of Technology, Warsaw, Poland
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Holzapfel GA, Niestrawska JA, Ogden RW, Reinisch AJ, Schriefl AJ. Modelling non-symmetric collagen fibre dispersion in arterial walls. J R Soc Interface 2016; 12:rsif.2015.0188. [PMID: 25878125 DOI: 10.1098/rsif.2015.0188] [Citation(s) in RCA: 119] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
New experimental results on collagen fibre dispersion in human arterial layers have shown that the dispersion in the tangential plane is more significant than that out of plane. A rotationally symmetric dispersion model is not able to capture this distinction. For this reason, we introduce a new non-symmetric dispersion model, based on the bivariate von Mises distribution, which is used to construct a new structure tensor. The latter is incorporated in a strain-energy function that accommodates both the mechanical and structural features of the material, extending our rotationally symmetric dispersion model (Gasser et al. 2006 J. R. Soc. Interface 3, 15-35. (doi:10.1098/rsif.2005.0073)). We provide specific ranges for the dispersion parameters and show how previous models can be deduced as special cases. We also provide explicit expressions for the stress and elasticity tensors in the Lagrangian description that are needed for a finite-element implementation. Material and structural parameters were obtained by fitting predictions of the model to experimental data obtained from human abdominal aortic adventitia. In a finite-element example, we analyse the influence of the fibre dispersion on the homogeneous biaxial mechanical response of aortic strips, and in a final example the non-homogeneous stress distribution is obtained for circumferential and axial strips under fixed extension. It has recently become apparent that this more general model is needed for describing the mechanical behaviour of a variety of fibrous tissues.
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Affiliation(s)
- Gerhard A Holzapfel
- Institute of Biomechanics, Graz University of Technology, Kronesgasse 5-I, 8010 Graz, Austria
| | - Justyna A Niestrawska
- Institute of Biomechanics, Graz University of Technology, Kronesgasse 5-I, 8010 Graz, Austria
| | - Ray W Ogden
- School of Mathematics and Statistics, University of Glasgow, University Gardens, Glasgow G12 8QW, UK
| | - Andreas J Reinisch
- Institute of Biomechanics, Graz University of Technology, Kronesgasse 5-I, 8010 Graz, Austria
| | - Andreas J Schriefl
- Institute of Biomechanics, Graz University of Technology, Kronesgasse 5-I, 8010 Graz, Austria
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