1
|
Hamur H, Alper Onk O, Coskun R, Cosgun MS, Salcan I, Emir I. Evaluation of aortic stiffness by echocardiography in tympanosclerosis patients. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2023; 167:347-351. [PMID: 35775357 DOI: 10.5507/bp.2022.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/21/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND AIMS Tympanosclerosis (TS) is a scarring process that may occur during otitis media. Aortic stiffness (AS) is a significant predictor for the development of heart diseases due to its close relationship with atherosclerosis. Similar pathophysiological processes based on inflammation may explain both TS and AS formation. This study aimed to determine echocardiographically whether aortic elasticity is impaired in TS-detected patients and to correlate blood inflammatory parameters with TS and aortic elasticity. METHODS Ninety-eight participants diagnosed with chronic otitis media were enrolled in the study. TS-detected 42 participants were assigned to the study group, while 56 without TS constituted the control group. The two groups' demographic, clinical, echocardiographic, and laboratory characteristics were comparable. RESULTS Demographic, clinical, and laboratory parameter differences were insignificant. Hs-CRP, neutrophil-to-lymphocyte ratio, and systemic immune-inflammation index were significantly higher in the study group than in the control group (P=0.018, P=0.003, P=0.019, respectively). The study group had significantly lower aortic strain (11.80 ± 4.84 vs. 16.30 ± 3.91; P<0.001) and distensibility (5.23 ± 2.68 vs. 7.24 ± 2.89; P=0.001) values than the control group. The AS index was significantly higher in the study group than in the control group (4.81 ± 2.41 vs. 3.12 ± 1.02; P<0.001). CONCLUSION In TS-detected patients, AS parameters were found to be impaired. Aortic elasticity parameters measured by echocardiography, a non-invasive and easily accessible method, may signify early cardiovascular involvement in TS-developed patients.
Collapse
Affiliation(s)
- Hikmet Hamur
- Department of Cardiology, Faculty of Medicine, Erzincan Binali Yildirim University, Erzincan, Turkey
| | - Oruc Alper Onk
- Department of Cardiovascular Surgery, Faculty of Medicine, Erzincan Binali Yildirim University, Erzincan,Turkey
| | - Resit Coskun
- Department of Cardiology, Faculty of Medicine, Erzincan Binali Yildirim University, Erzincan, Turkey
| | - Muharrem Said Cosgun
- Department of Cardiology, Faculty of Medicine, Erzincan Binali Yildirim University, Erzincan, Turkey
| | - Ismail Salcan
- Department of Otorhinolaryngology, Faculty of Medicine , Erzincan Binali Yildirim University, Erzincan, Turkey
| | - Izzet Emir
- Department of Cardiovascular Surgery, Faculty of Medicine, Erzincan Binali Yildirim University, Erzincan,Turkey
| |
Collapse
|
2
|
Tunedal K, Viola F, Garcia BC, Bolger A, Nyström FH, Östgren CJ, Engvall J, Lundberg P, Dyverfeldt P, Carlhäll CJ, Cedersund G, Ebbers T. Haemodynamic effects of hypertension and type 2 diabetes: Insights from a 4D flow MRI-based personalized cardiovascular mathematical model. J Physiol 2023; 601:3765-3787. [PMID: 37485733 DOI: 10.1113/jp284652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/29/2023] [Indexed: 07/25/2023] Open
Abstract
Type 2 diabetes (T2D) and hypertension increase the risk of cardiovascular diseases mediated by whole-body changes to metabolism, cardiovascular structure and haemodynamics. The haemodynamic changes related to hypertension and T2D are complex and subject-specific, however, and not fully understood. We aimed to investigate the haemodynamic mechanisms in T2D and hypertension by comparing the haemodynamics between healthy controls and subjects with T2D, hypertension, or both. For all subjects, we combined 4D flow magnetic resonance imaging data, brachial blood pressure and a cardiovascular mathematical model to create a comprehensive subject-specific analysis of central haemodynamics. When comparing the subject-specific haemodynamic parameters between the four groups, the predominant haemodynamic difference is impaired left ventricular relaxation in subjects with both T2D and hypertension compared to subjects with only T2D, only hypertension and controls. The impaired relaxation indicates that, in this cohort, the long-term changes in haemodynamic load of co-existing T2D and hypertension cause diastolic dysfunction demonstrable at rest, whereas either disease on its own does not. However, through subject-specific predictions of impaired relaxation, we show that altered relaxation alone is not enough to explain the subject-specific and group-related differences; instead, a combination of parameters is affected in T2D and hypertension. These results confirm previous studies that reported more adverse effects from the combination of T2D and hypertension compared to either disease on its own. Furthermore, this shows the potential of personalized cardiovascular models in providing haemodynamic mechanistic insights and subject-specific predictions that could aid in the understanding and treatment planning of patients with T2D and hypertension. KEY POINTS: The combination of 4D flow magnetic resonance imaging data and a cardiovascular mathematical model allows for a comprehensive analysis of subject-specific haemodynamic parameters that otherwise cannot be derived non-invasively. Using this combination, we show that diastolic dysfunction in subjects with both type 2 diabetes (T2D) and hypertension is the main group-level difference between controls, subjects with T2D, subjects with hypertension, and subjects with both T2D and hypertension. These results suggest that, in this relatively healthy population, the additional load of both hypertension and T2D affects the haemodynamic function of the left ventricle, whereas each disease on its own is not enough to cause significant effects under resting conditions. Finally, using the subject-specific model, we show that the haemodynamic effects of diastolic dysfunction alone are not sufficient to explain all the observed haemodynamic differences. Instead, additional subject-specific variations in cardiac and vascular function combine to explain the complex haemodynamics of subjects affected by hypertension and/or T2D.
Collapse
Affiliation(s)
- Kajsa Tunedal
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Federica Viola
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Belén Casas Garcia
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
| | - Ann Bolger
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Fredrik H Nyström
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Carl Johan Östgren
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Division of Prevention, Rehabilitation and Community Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Jan Engvall
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Clinical Physiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Peter Lundberg
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Department of Radiation Physics, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Petter Dyverfeldt
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Carl-Johan Carlhäll
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Clinical Physiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Gunnar Cedersund
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Tino Ebbers
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| |
Collapse
|
3
|
Stäuber A, Piper C, Köster M, Dörr M, Richter S, Ohlow MA, Eckert S, Baulmann J. Invasive validation of the Antares algorithm for determining central blood pressure based on upper arm oscillometric pulse waves in patients with type 2 diabetes. BMJ Open Diabetes Res Care 2023; 11:11/1/e003119. [PMID: 36707104 PMCID: PMC9884863 DOI: 10.1136/bmjdrc-2022-003119] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 01/18/2023] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Antares is a pulse wave analysis (PWA) algorithm designed to allow a non-invasive estimation of central (aortic) blood pressure (cBP) using automated oscillometric blood pressure (BP) devices. Diabetes may affect elastic and muscular arteries differently, resulting in disparate pulse wave characteristics in central and peripheral arteries, which may limit the accuracy of PWA devices. The aim of our study was to evaluate the accuracy of Antares for estimating cBP as compared with invasively measured cBP in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS In this study, consecutive patients undergoing elective coronary angiography were recruited between November 2017 and September 2020. In 119 patients with type 2 diabetes, cBP was measured invasively and simultaneously determined non-invasively using the custo screen 400 device with the integrated Antares algorithm. RESULTS The mean difference between the estimated and invasively measured cBP was 1.2±6.3 mmHg for central systolic BP (cSBP), 1.0±4.3 mmHg for central mean arterial pressure (cMAP) and 3.6±5.7 mmHg for central diastolic BP (cDBP). High correlations were found between estimated cBP and invasively measured cBP (cSBP: r=0.916; cMAP: r=0.882; cDBP: r=0.791; all p<0.001). CONCLUSIONS The present study suggests that the Antares algorithm incorporated into the custo screen 400 device can estimate cBP with high accuracy turning a conventional oscillometric BP device into a type II device for the non-invasive estimation of cBP, which is applicable in patients with type 2 diabetes. Integration of Antares into commercially available BP devices could facilitate the introduction of cBP into routine clinical practice as a part of disease and risk management.
Collapse
Affiliation(s)
- Alexander Stäuber
- Department of Movement and Training Science, Leipzig University, Leipzig, Sachsen, Germany
| | - Cornelia Piper
- Klinik für Allgemeine und Interventionelle Kardiologie/Angiologie, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Marco Köster
- Klinik für Allgemeine und Interventionelle Kardiologie/Angiologie, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Marcus Dörr
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany
| | - Stefan Richter
- Department of Cardiology, Zentralklinik Bad Berka GmbH, Bad Berka, Thüringen, Germany
- Department of Cardiology, SRH Klinikum Burgenlandkreis GmbH, Naumburg, Germany
| | | | - Siegfried Eckert
- Klinik für Allgemeine und Interventionelle Kardiologie/Angiologie, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Johannes Baulmann
- Praxis Dres. Gille/Baulmann, Rheinbach, Germany
- Division of Cardiology, Medical University of Graz, Graz, Steiermark, Austria
| |
Collapse
|
4
|
Monteiro CI, Simões RP, Goulart CL, da Silva CD, Borghi-Silva A, Mendes RG. Arterial stiffness in type 2 diabetes: determinants and indication of a discriminative value. Clinics (Sao Paulo) 2021; 76:e2172. [PMID: 33624706 PMCID: PMC7885854 DOI: 10.6061/clinics/2021/e2172] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 12/16/2020] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES To identify the clinical discriminative value and determinants of arterial stiffness in individuals with type 2 diabetes mellitus (T2DM). METHODS This prospective cohort study included 51 individuals (53.57±9.35 years) diagnosed with T2DM (stage glucose≥126 mg/dL; diagnostic time: 87.4±69.8 months). All participants underwent an initial evaluation of personal habits, medications, and history; arterial stiffness assessment by carotid-femoral pulse wave velocity (cfPWV) using SphygmoCor; and blood laboratory analysis. A statistical analysis was performed using SPSS software, and values of p≤0.05 were considered significant. RESULTS A cut-off cfPWV value of 7.9 m/s was identified for T2DM [Sensitivity (SE): 90% and Specificity (SP): 80%]. A subgroup analysis revealed higher glycated hemoglobin (Hb1Ac) (p=0.006), obesity (p=0.036), and dyslipidemia (p=0.013) than those with cfPWV ≥7.9 m/s. Multivariate analysis identified higher stage glucose (p=0.04), Hb1Ac (p=0.04), hypertension (p=0.001), and dyslipidemia (p=0.01) as determinant factors of cfPWV; positive and significant correlation between cfPWV and glucose (r=0.62; p=0.0003) and Hb1Ac (r=0.55; p=0.0031). CONCLUSIONS In T2DM, an indicator of the discriminative value of arterial stiffness was cfPWV of 7.9 m/s. Clinical findings and comorbidities, such as hypertension, glucose, poor glycemic control, and dyslipidemia, were associated with and were determinants of arterial stiffness in T2DM. Reinforcement of monitoring risk factors, such as hypertension, dyslipidemia, and glycemic control, seems to be essential to the process of arterial stiffening. Confirmation of this discriminative value in larger populations is recommended.
Collapse
Affiliation(s)
- Clara Italiano Monteiro
- Laboratorio de Fisioterapia Cardiopulmunar (LACAP), Departamento de Fisioterapia, Universidade Federal de Sao Carlos, Sao Carlos, SP, BR
| | - Rodrigo Polaquini Simões
- Laboratorio de Fisioterapia Cardiopulmunar (LACAP), Departamento de Fisioterapia, Universidade Federal de Sao Carlos, Sao Carlos, SP, BR
- Programa de Pos-Graduacao em Ciencias da Reabilitacao, Universidade Federal de Alfenas, Alfenas, MG, BR
| | - Cássia Luz Goulart
- Laboratorio de Fisioterapia Cardiopulmunar (LACAP), Departamento de Fisioterapia, Universidade Federal de Sao Carlos, Sao Carlos, SP, BR
| | - Claudio Donisete da Silva
- Laboratorio de Fisioterapia Cardiopulmunar (LACAP), Departamento de Fisioterapia, Universidade Federal de Sao Carlos, Sao Carlos, SP, BR
| | - Audrey Borghi-Silva
- Laboratorio de Fisioterapia Cardiopulmunar (LACAP), Departamento de Fisioterapia, Universidade Federal de Sao Carlos, Sao Carlos, SP, BR
| | - Renata Gonçalves Mendes
- Laboratorio de Fisioterapia Cardiopulmunar (LACAP), Departamento de Fisioterapia, Universidade Federal de Sao Carlos, Sao Carlos, SP, BR
- *Corresponding author. E-mail:
| |
Collapse
|
5
|
Nuamchit T, Siriwittayawan D, Thitiwuthikiat P. The Relationship Between Glycemic Control and Concomitant Hypertension on Arterial Stiffness in Type II Diabetes. Vasc Health Risk Manag 2020; 16:343-352. [PMID: 32943869 PMCID: PMC7459141 DOI: 10.2147/vhrm.s265157] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 08/03/2020] [Indexed: 12/27/2022] Open
Abstract
Purpose The impact of glycemic control on macrovascular complications and arterial stiffness in type II diabetes (T2D), as well as the extent of additive effect of hypertension, is unclear. The aims of this study were to investigate the impact of glycemic control on the cardio-ankle vascular index (CAVI), an indicator of arterial stiffness, and to determine the relative risk of concomitant diabetes and hypertension with arterial stiffness. Methods One hundred and nine participants were enrolled and classified as non-diabetes (n= 37) and diabetes (n=72); the diabetic group was further identified as controllable and uncontrollable T2D depending on their hemoglobin A1c (HbA1c) levels. Univariate and multiple regression analyses were used to assess the association between CAVI and glycemic control status and hypertension. Relative risk analysis for abnormal CAVI with exposure to diabetes and hypertension was investigated. Results In all participants, age, systolic blood pressure, body mass index, and fasting blood sugar were independent predictors of CAVI. In diabetic participants, glycemic control status or HbA1c levels did not significantly correlate with CAVI. Systolic blood pressure was an independent predictor for CAVI with β = 0.26. In addition, the coexistence of diabetes together with hypertension was significantly associated with a 2.4-fold increase in the risk of abnormal CAVI (95% CI, 1.410-4.184; p <0.001). Conclusion This study demonstrates that HbA1c as well as fasting blood sugar levels in diabetic participants do not correlate with arterial stiffness. Concomitant diabetes and hypertension significantly increase the risk of arterial stiffness.
Collapse
Affiliation(s)
- Teonchit Nuamchit
- Department of Cardiothoracic Technology, Faculty of Allied Health Sciences, Naresuan University, Phitsanulok, Thailand
| | - Duangduan Siriwittayawan
- Department of Cardiothoracic Technology, Faculty of Allied Health Sciences, Naresuan University, Phitsanulok, Thailand
| | - Piyanuch Thitiwuthikiat
- Department of Cardiothoracic Technology, Faculty of Allied Health Sciences, Naresuan University, Phitsanulok, Thailand
| |
Collapse
|
6
|
Galvão RDV, Pereira CDS, Freitas EGB, Lima DRART, Santos WAM, Souza DF, Nomelini QSS, Ferreira-Filho SR. Association between diabetes mellitus and central arterial stiffness in elderly patients with systemic arterial hypertension. Clin Exp Hypertens 2020; 42:728-732. [DOI: 10.1080/10641963.2020.1783547] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
| | - Cristiane de Sousa Pereira
- Internal Medicine Department, Federal University of Uberlândia (Universidade Federal De Uberlândia), Uberlândia, Brazil
| | | | | | | | - Denis Fabiano Souza
- Internal Medicine Department, Federal University of Uberlândia (Universidade Federal De Uberlândia), Uberlândia, Brazil
| | | | | |
Collapse
|
7
|
Nedogoda SV, Barykina IN, Salasyuk AS, Sanina TN, Smirnova VO, Popova EA. The effect of various classes of glucose-lowering medications on the blood vessel elasticity in patients with type 2 diabetes. ACTA ACUST UNITED AC 2020. [DOI: 10.15829/1560-4071-2020-3766] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Aim. To study the effect of various classes of glucose-lowering agents (dipeptidyl peptidase-4 (DPP-4) and sodium-glucose cotransporter-2 (SGLT-2) inhibitors) on the vascular stiffness in patients with type 2 diabetes (T2D) and high cardiovascular risk.Material and methods. The open-label, prospective 24-week study included 120 patients with T2D and high cardiovascular risk. We evaluated the effect of modern glucose-lowering medications, empagliflozin at a dose of 25 mg/day (SGLT-2 inhibitor) and sitagliptin at a dose of 100 mg/day (DPP-4 inhibitor), on vascular elasticity, central hemodynamic and laboratory parameters.Results. After 24-week therapy, the target glycated hemoglobin level reached 71% and 80% of patients in the sitagliptin and empagliflozin groups, respectively. In both groups, vascular stiffness and central hemodynamic parameters were improved. However, significant changes were recorded only in the empagliflozin (carotid-femoral pulse wave velocity decreased by 14,4%, augmentation index — by 6%, central pulse pressure — by 7,8%) (p<0,05). Use of sitagliptin was associated with significant improvements in the lipid profile (total cholesterol decreased by 9,5%, triglycerides — by 21%, low density lipoproteins — by 15,1%; high density lipoproteins increased by 15,7%) (p<0,05). In the empagliflozin group, anthropometric parameters were improved (body mass index decreased by 9,1%, waist circumference — by 4,1%) (p<0,05). Patients in both groups had a significant decrease in HOMA-IR index and highly sensitive C-reactive protein: by 34% and 51,6% in the empagliflozin group and by 31,8% and 22,1% in the sitagliptin group, respectively (p<0,05).Conclusion. The use of empagliflozin is more associated with arterial stiffness decrease in T2D patients with high cardiovascular risk compared with sitagliptin.
Collapse
|
8
|
Song XT, Fan L, Yan ZN, Rui YF. Evaluation of the Effect of Essential Hypertension on Elasticity of Ascending Aorta in Type 2 Diabetic Mellitus Patients by Echocardiography. Angiology 2020; 71:536-543. [DOI: 10.1177/0003319720911572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Both essential hypertension (EH) and type 2 diabetes mellitus (T2DM) can impair the elasticity of the ascending aorta. We prospectively enrolled 42 patients with T2DM, 44 patients with EH, 45 patients with T2DM and EH (T2DM + EH), and 41 healthy subjects (HS). They all underwent transthoracic echocardiography to measure ascending aorta inner diameters and a brachial blood pressure measurement to calculate aortic elastic parameters (ie, compliance, distensibility, strain, stiffness index, and Peterson elastic modulus). We found that there were no significant differences as regard with age, sex, body mass index, blood lipids and glucose, carotid atherosclerosis, and ascending aorta inner diameters among the 4 groups. The aortic elastic properties were significantly impaired in T2DM, EH, and T2DM + EH patients compared with the HS, and more impaired in EH and T2DM + EH patients than T2DM patients; there were no significant differences between EH and T2DM + EH patients. Our findings suggest that both T2DM and EH can impair aortic elastic properties. Essential hypertension may play a more important role in the process of ascending aorta sclerosis in patients with T2DM + EH.
Collapse
Affiliation(s)
- Xiang-Ting Song
- Department of Echocardiography, Nanjing Medical University, Changzhou, China
| | - Li Fan
- Department of Echocardiography, Nanjing Medical University, Changzhou, China
| | - Zi-Ning Yan
- Department of Echocardiography, Nanjing Medical University, Changzhou, China
| | - Yi-Fei Rui
- Department of Echocardiography, Nanjing Medical University, Changzhou, China
| |
Collapse
|
9
|
Alsharari R, Lip GYH, Shantsila A. Assessment of Arterial Stiffness in Patients With Resistant Hypertension: Additional Insights Into the Pathophysiology of This Condition? Am J Hypertens 2020; 33:107-115. [PMID: 31608357 DOI: 10.1093/ajh/hpz169] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 09/24/2019] [Accepted: 10/10/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Good understanding of the pathophysiological mechanism(s) of resistant hypertension (RH) and the relationship to vascular dysfunction is important for optimal blood pressure control. METHODS AND RESULTS The aim of this review article is to summarize the available data on the methods of arterial stiffness assessment, and their usefulness in RH. Several studies that provide information on the noninvasive methods of evaluation of arterial stiffness have been discussed; specifically, pulse wave velocity (PWV) and augmentation index (AIx) tests. Increased arterial stiffness, elevated AIx, and impaired endothelial function all act as indicators and predictors of cardiovascular events in patients with hypertension (HTN). CONCLUSION Our review suggests that PWV and AIx are impaired in patients with severe HTN. Early assessment of these characteristics can potentially be of value in patients with RH.
Collapse
Affiliation(s)
- Reem Alsharari
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
- Cardiovascular technology department, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Alena Shantsila
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| |
Collapse
|
10
|
Nesnawy S, Tolba K, Roshdy I, Abdel Kader M. Ankle pulse pressure to diastole ratio as a novel non-invasive costless screening tool for subclinical atherosclerosis. Med Hypotheses 2019; 135:109449. [PMID: 31678820 DOI: 10.1016/j.mehy.2019.109449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/04/2019] [Accepted: 10/22/2019] [Indexed: 10/25/2022]
Abstract
Atherosclerosis develops gradually as a subclinical condition and eventually becomes clinically apparent as heart disease or stroke. The degree of decreased arterial compliance affects both pulse pressure (PP) and diastolic blood pressure (DBP). These relations would be clear in the distal periphery. We propose that the ankle PP/ankle DBP ratio (APPD) can uncover the ongoing subclinical vascular risk. Based on the elastic chamber theory, APPD = (Cs-Cd)/(Cd-C0) in which Cs, Cd, and C0 represent arterial compliance at systolic pressure, diastolic pressure, and zero-pressure. For a given ventricular ejection, the value of Cs-Cd (i.e. PP) positively differs in the same person from brachium to ankle based on the distance from the heart, degree of arterial stiffness, and the local arterial function. On the other hand, the decreased arterial compliance increases the speed of reflected pulse waves to the heart resulting in earlier ventricular ejection by which the value of Cd-C0 (i.e. DBP) decreases over the arterial tree. In the same person, studies of ankle-brachial blood pressure (BP) differences revealed that PP greatly differed from brachium to ankle while DBPs were of minimal change or almost equivalent. However, DBP would be lower in those with arterial stiffness compared to others of the same age. Accordingly, APPD increases as arterial compliance decreases. Moreover, decreased APPD after a certain limit would reflect either local arterial stenosis or a compromised left ventricular function. When we divided ankle PP by ankle DBP, we could control the diversity of ankle PP as being not related to the BP level and possibly fluctuates in the same person. Additionally, APPD will indicate the extra rapid reflected pulse wave given in decreased DBP. Since increased common carotid artery intima-media thickness (CIMT) is a well-established marker of atherosclerosis, we initially studied 115 subjects apparently free form vascular diseases and had not taken a drug that can affect BP on the day of the study, aged 40-60 years, without a history of stroke, coronary heart disease or peripheral vascular disease to evaluate the relation between APPD and CIMT. The association was statistically significant even after adjusting for age, sex and important covariates and the area under the receiver operating characteristic curve was 0.902 ± 0.031. Therefore, the potential applicability of APPD as a tool for subclinical atherosclerosis was greatly proven.
Collapse
Affiliation(s)
- Sherif Nesnawy
- Department of Medical Surgical Nursing, Faculty of Nursing, Minia University, Minia, Egypt.
| | - Kawther Tolba
- Department of Medical Surgical Nursing, Faculty of Nursing, Alexandria University, Alexandria, Egypt
| | - Inshrah Roshdy
- Department of Medical Surgical Nursing, Faculty of Nursing, Minia University, Minia, Egypt
| | - Mostafa Abdel Kader
- Department of Radiology, Faculty of Medicine, Minia University, Minia, Egypt
| |
Collapse
|
11
|
Deiseroth A, Streese L, Köchli S, Wüst RS, Infanger D, Schmidt-Trucksäss A, Hanssen H. Exercise and Arterial Stiffness in the Elderly: A Combined Cross-Sectional and Randomized Controlled Trial (EXAMIN AGE). Front Physiol 2019; 10:1119. [PMID: 31551805 PMCID: PMC6738015 DOI: 10.3389/fphys.2019.01119] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 08/13/2019] [Indexed: 01/10/2023] Open
Abstract
Introduction: Arterial stiffness (AST) is a main determinant of cardiovascular (CV) mortality. Long-term physical activity (PA) is considered to decrease age-related progression of AST but effects of short-term exercise interventions on AST remain unclear. Methods: In a combined cross-sectional and interventional study approach, we investigated the effects of long-term PA and short-term high-intensity interval training (HIIT) on AST in an older population. 147 older individuals (mean age 59 ± 7 years) were assigned to three groups according to their PA and CV risk profile and compared: healthy active (HA, n = 35), healthy sedentary (HS, n = 33) and sedentary at risk (SR, n = 79). In addition, SR were randomized to either 12 weeks of HIIT or standard recommendations. Pulse wave velocity (PWV) was measured by applanation tonometry. Cardiorespiratory fitness (CRF) was performed by symptom-limited spiroergometry to determine maximal oxygen uptake (VO2max). Results: Higher CRF was associated with lower PWV (p < 0.001) and VO2max explained 18% of PWV variance. PWV was higher in SR (8.2 ± 1.4 m/s) compared to HS (7.5 ± 1.6 m/s) and HA (7.0 ± 1.1 m/s; p < 0.001). 12 weeks of HIIT did not change PWV in SR. HIIT-induced reduction in systolic BP was associated with a reduction in PWV (p < 0.05). Discussion: SR show higher PWV compared to HS and long-term PA is associated with lower PWV. Reduction of AST following short-term HIIT seems to depend on a concomitant decrease in blood pressure. Our study puts into perspective the effects of long- and short-term exercise on arterial wall integrity as treatment options for CV prevention in an older population. Clinical Trial Registration: ClinicalTrials.gov: NCT02796976 (https://clinicaltrials.gov/ct2/show/NCT02796976).
Collapse
Affiliation(s)
- Arne Deiseroth
- Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Basel, Switzerland
| | - Lukas Streese
- Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Basel, Switzerland
| | - Sabrina Köchli
- Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Basel, Switzerland
| | - Romy Sandra Wüst
- Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Basel, Switzerland
| | - Denis Infanger
- Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Basel, Switzerland
| | - Arno Schmidt-Trucksäss
- Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Basel, Switzerland
| | - Henner Hanssen
- Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Basel, Switzerland
| |
Collapse
|
12
|
Climie RE, van Sloten TT, Bruno RM, Taddei S, Empana JP, Stehouwer CD, Sharman JE, Boutouyrie P, Laurent S. Macrovasculature and Microvasculature at the Crossroads Between Type 2 Diabetes Mellitus and Hypertension. Hypertension 2019; 73:1138-1149. [DOI: 10.1161/hypertensionaha.118.11769] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Rachel E. Climie
- From the INSERM, U970, Paris Cardiovascular Research Center (PARCC), France (R.E.C., T.T.v.S., R.-M.B., J.-P.E.)
- Baker Heart and Diabetes Institute, Melbourne, Australia (R.E.C.)
- Menzies Institute for Medical Research, University of Tasmanian, Hobart, Australia (R.E.C., J.E.S.)
| | - Thomas T. van Sloten
- From the INSERM, U970, Paris Cardiovascular Research Center (PARCC), France (R.E.C., T.T.v.S., R.-M.B., J.-P.E.)
- Department of Internal Medicine, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, the Netherlands (T.T.v.S., C.D.A.S.)
| | - Rosa-Maria Bruno
- From the INSERM, U970, Paris Cardiovascular Research Center (PARCC), France (R.E.C., T.T.v.S., R.-M.B., J.-P.E.)
- Department of Clinical and Experimental Medicine, University of Pisa, Italy (R.-M.B., S.T.)
| | - Stefano Taddei
- Department of Clinical and Experimental Medicine, University of Pisa, Italy (R.-M.B., S.T.)
| | - Jean-Philippe Empana
- From the INSERM, U970, Paris Cardiovascular Research Center (PARCC), France (R.E.C., T.T.v.S., R.-M.B., J.-P.E.)
| | - Coen D.A. Stehouwer
- Department of Internal Medicine, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, the Netherlands (T.T.v.S., C.D.A.S.)
| | - James E. Sharman
- Menzies Institute for Medical Research, University of Tasmanian, Hobart, Australia (R.E.C., J.E.S.)
| | - Pierre Boutouyrie
- INSERM, U970, APHP. Paris Descartes University, Paris, France (P.B., S.L.)
| | - Stéphane Laurent
- INSERM, U970, APHP. Paris Descartes University, Paris, France (P.B., S.L.)
| |
Collapse
|
13
|
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.
Collapse
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.
| |
Collapse
|
14
|
Determinants of the aortic pulse wave velocity index in hypertensive and diabetic patients. J Hypertens 2018; 36:2324-2332. [DOI: 10.1097/hjh.0000000000001828] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
15
|
Cosenso-Martin LN, Giollo-Júnior LT, Fernandes LAB, Cesarino CB, Nakazone MA, Machado MDN, Yugar-Toledo JC, Vilela-Martin JF. Effect of vildagliptin versus glibenclamide on endothelial function and arterial stiffness in patients with type 2 diabetes and hypertension: a randomized controlled trial. Acta Diabetol 2018; 55:1237-1245. [PMID: 30094725 DOI: 10.1007/s00592-018-1204-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 08/02/2018] [Indexed: 12/11/2022]
Abstract
AIMS Several trials have reported that dipeptidyl peptidase-4 (DPP-4) inhibitors, used to treat type 2 diabetes (T2DM), improve endothelial function. The current study investigated the effects of vildagliptin, a DPP-4 inhibitor, compared to glibenclamide on endothelial function, arterial stiffness, and blood pressure in patients with T2DM and hypertension. METHODS Patients aged over 35 years with T2DM and hypertension, but without cardiovascular disease, were randomly allocated to treatment with vildagliptin (n = 25) or glibenclamide (n = 25). Both groups took metformin. Endothelial function was evaluated by peripheral artery tonometry (Endo-PAT 2000) to calculate the reactive hyperemia index (RHI) and arterial stiffness. Primary outcome was change in the RHI after 12 weeks of treatment. Twenty-four-hour non-invasive ambulatory blood pressure monitoring was performed using a Mobil-O-Graph® 24-h PWA monitor. Arterial stiffness was assessed using the augmentation index corrected for 75 bpm (AIx75), pulse wave velocity (PWV) and central systolic blood pressure (cSBP). RESULTS There were no changes in the RHI in the vildagliptin group (before 2.35 ± 0.59; after 2.24 ± 0.60; p value = NS) or in the glibenclamide group (before 2.36 ± 0.52; after 2.34 ± 0.50; p value = NS), with no differences between groups (p value = NS). There was also no difference between vildagliptin and glibenclamide treatment in respect to AIx75 (p value = NS), cSBP (p value = NS) or PWV (p value = NS). CONCLUSIONS Vildagliptin and glibenclamide similarly do not change the endothelial function and arterial stiffness after 12 weeks of treatment in diabetic and hypertensive patients without cardiovascular disease. Thus, vildagliptin has a neutral effect on vascular function. TRIAL REGISTRATION ClinicalTrials.gov: NCT02145611, registered on 11 Jun 2013.
Collapse
Affiliation(s)
- Luciana Neves Cosenso-Martin
- Internal Medicine Division, Hospital de Base, State Medical School at São José do Rio Preto (FAMERP), São José do Rio Preto, São Paulo, Brazil
| | - Luiz Tadeu Giollo-Júnior
- Hypertension Clinic, State Medical School at São José do Rio Preto (FAMERP), São José do Rio Preto, São Paulo, Brazil
| | | | - Cláudia Bernardi Cesarino
- Hypertension Clinic, State Nursing School at São José do Rio Preto (FAMERP), São José do Rio Preto, São Paulo, Brazil
| | - Marcelo Arruda Nakazone
- Cardiology Department, Hospital de Base, State Medical School at São José do Rio Preto (FAMERP), São José do Rio Preto, São Paulo, Brazil
| | - Maurício de Nassau Machado
- Cardiology Department, Hospital de Base, State Medical School at São José do Rio Preto (FAMERP), São José do Rio Preto, São Paulo, Brazil
| | - Juan Carlos Yugar-Toledo
- Hypertension Clinic, State Medical School at São José do Rio Preto (FAMERP), São José do Rio Preto, São Paulo, Brazil
| | - José Fernando Vilela-Martin
- Hypertension Clinic, Internal Medicine Department, Hospital de Base, State Medical School at São José do Rio Preto (FAMERP), Ave Brig. Faria Lima 5416, São José do Rio Preto, 15090-000, São Paulo, Brazil.
| |
Collapse
|
16
|
|
17
|
Streese L, Deiseroth A, Schäfer J, Schmidt-Trucksäss A, Hanssen H. Exercise, Arterial Crosstalk-Modulation, and Inflammation in an Aging Population: The ExAMIN AGE Study. Front Physiol 2018. [PMID: 29515458 PMCID: PMC5826378 DOI: 10.3389/fphys.2018.00116] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background: Age is a key determinant for the development of cardiovascular disease and higher age coincides with an increased prevalence of obesity and physical inactivity. The study examines the influence of physical activity on aging processes of physiological systems focusing on the mechanisms of vascular aging. Methods/Design: The study consists of two parts. The cross-sectional approach aims at examining the association of physical fitness and cardiovascular risk with large and small artery function in healthy older active (HOA, n = 40) and sedentary (HOS, n = 40) persons as well as older sedentary individuals with increased cardiovascular risk (OSR, n = 80) aged 50–80 years. In the interventional approach, the OSR group is randomized into a 12-week walking-based high intensity interval training (HIIT) group or a control condition, aiming at examining the effects of HIIT on arterial function in diseased older adults. Active lifestyle is defined as >9 metabolic equivalent of task (MET) per week and sedentary as ≤3 MET/week. Inclusion criteria for OSR are overweight or obesity (body mass index ≥30 kg/m2) plus at least one additional cardiovascular risk factor. The primary outcome is arterial stiffness as determined by aortic pulse wave velocity (PWV). The secondary outcomes are retinal arterial and venous diameters. Further cardiovascular assessments include peripheral PWV, central haemodynamics, retinal endothelial function, carotid intima media thickness, cardiac strain and diastolic function as well as autonomic function and inflammation. Physical fitness is measured by a treadmill-based spiroergometry to determine peak oxygen uptake. Discussion: The aim of the study is to demonstrate the importance of and need for specific physical activity programs for seniors to achieve healthier aging as a long-term goal. Vascular function defines disease- and age-related end organ damage and represents the potential to contain health at older age. This research will identify cardiovascular biomarkers that best resemble underlying cardiovascular risk in age and disease. The integrated approach will help define new recommendations for treatment guidance of exercise therapy in an aging population. ClinicalTrials. gov: NCT02796976; registered 02 June 2016 (retrospectively registered).
Collapse
Affiliation(s)
- Lukas Streese
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Arne Deiseroth
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Juliane Schäfer
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Arno Schmidt-Trucksäss
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Henner Hanssen
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| |
Collapse
|
18
|
Ji L, Liu C, Li P, Wang X, Liu C, Hou Y. Increased pulse wave transit time after percutaneous coronary intervention procedure in CAD patients. Sci Rep 2018; 8:115. [PMID: 29311630 PMCID: PMC5758522 DOI: 10.1038/s41598-017-18520-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 12/13/2017] [Indexed: 11/17/2022] Open
Abstract
Pulse wave transit time (PWTT) has been widely used as an index in assessing arterial stiffness. Percutaneous coronary intervention (PCI) is usually applied to the treatment of coronary artery disease (CAD). Research on the changes in PWTT caused by PCI is helpful for understanding the impact of the PCI procedure. In addition, effects of stent sites and access sites on the changes in PWTT have not been explored. Consequently, this study aimed to provide this information. The results showed that PWTT significantly increased after PCI (p < 0.01) while the standard deviation (SD) of PWTT time series had no statistically significant changes (p = 0.60) between before and after PCI. Significantly increased PWTT was found in the radial access group (p < 0.01), while there were no significant changes in the femoral access group (p > 0.4). Additionally, PWTT in the left anterior descending (LAD) group significantly increased after PCI (p < 0.01), but the increase that was found in the right coronary artery (RCA) group was not significant (p > 0.1). Our study indicates that arterial elasticity and left ventricular functions can benefit from a successful PCI procedure, and the increase of peripheral PWTT after PCI can help to better understand the effectiveness of the procedure.
Collapse
Affiliation(s)
- Lizhen Ji
- School of Control Science and Engineering, Shandong University, Jinan, 250061, China.,Institute of Environment and Ecology, College of Geography and Environment, Shandong Normal University, Jinan, 250014, China
| | - Chengyu Liu
- School of Control Science and Engineering, Shandong University, Jinan, 250061, China
| | - Peng Li
- School of Control Science and Engineering, Shandong University, Jinan, 250061, China
| | - Xinpei Wang
- School of Control Science and Engineering, Shandong University, Jinan, 250061, China
| | - Changchun Liu
- School of Control Science and Engineering, Shandong University, Jinan, 250061, China.
| | - Yinglong Hou
- Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, 250014, China
| |
Collapse
|
19
|
Fasting blood soluble RAGE may be causally implicated in impaired glucose metabolism in Chinese patients with primary hypertension. Gene 2018; 639:11-17. [DOI: 10.1016/j.gene.2017.09.066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 09/27/2017] [Accepted: 09/29/2017] [Indexed: 11/22/2022]
|
20
|
Chang S, Kim J, Sohn T, Son H, Lee J. Effects of glucose control on arterial stiffness in patients with type 2 diabetes mellitus and hypertension: An observational study. J Int Med Res 2017; 46:284-292. [PMID: 28835148 PMCID: PMC6011304 DOI: 10.1177/0300060517722697] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objective We evaluated the association of glucose control with changes in arterial stiffness, inflammatory markers, and oxidative stress markers. Methods Sixty-four patients with uncontrolled type 2 diabetes mellitus (glycated hemoglobin [HbA1c] ≥ 9%) and hypertension were enrolled in this study. The patients were divided into two groups based on their post-treatment HbA1c level: HbA1c ≤ 7% (well-controlled group, n = 28) and HbA1c > 7% (uncontrolled group, n = 36). The pulse wave velocity, augmentation index, and markers of inflammation and oxidative stress were measured and analyzed. Results The patients’ mean baseline HbA1c level was 11.7%. There were no differences in any baseline parameters between the two groups except the duration of diabetes. The mean HbA1c level was significantly lower at 12 weeks in the well-controlled than uncontrolled group (6.1% vs. 9.0%, respectively), but there were no significant differences in the pulse wave velocity (0.33 ± 0.95 vs. 0.36 ± 1.44 m/s), aortic augmentation index (5.1 ± 8.3 vs. 0.7 ± 11.6), or markers of inflammation and oxidative stress. Conclusions Short-term glycemic control did not influence the arterial stiffness in patients with type 2 diabetes mellitus and hypertension.
Collapse
Affiliation(s)
- Sangah Chang
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jihyun Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Taeseo Sohn
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyunshik Son
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jungmin Lee
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| |
Collapse
|
21
|
|
22
|
Duvnjak L, Blaslov K. Dipeptidyl peptidase-4 inhibitors improve arterial stiffness, blood pressure, lipid profile and inflammation parameters in patients with type 2 diabetes mellitus. Diabetol Metab Syndr 2016; 8:26. [PMID: 27006706 PMCID: PMC4802883 DOI: 10.1186/s13098-016-0144-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 03/09/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND This uncontrolled open label study evaluated the effect of dipeptidyl peptidase-4 inhibitors (DPP-4i): sitagliptin and vildagliptin on augmentation index standardized for 75 beats per minute (cAiX@75), blood pressure (BP), lipid profile and high-sensitivity C-reactive protein (hsCRP) in patients with type 2 diabetes mellitus (T2DM). METHODS Fifty-one well-regulated T2DM patients were randomly assigned to either sitagliptin or vildagliptin (100 mg/day) for 3 months continuing their previous treatment. Lipid profile, cAiX@75, hsCRP, glycated hemoglobin (HbA1c) were measured at baseline at 4, 8 and 12th week were accessed. cAiX@75 and pulse wave velocity (PWV) were determined by SphygmoCor device. RESULTS Following DPP-4 treatment there was a significant reduction in total serum cholesterol (5.18 vs 4.62 mmol/L), low-density lipoprotein (2.89 vs 2.54 mmol/L), hsCRP (3.21 vs 1.95 mg/L), cAiX@75 (24.5 vs 22.3) and central systolic BP (131.8 vs 119.5 mmHg). The sitagliptin treated group reached cAiX@75 reduction earlier in the study period while neither sitagliptin or vildagliptin use resulted in the significant HbA1c reduction. CONCLUSION The treatment with DPP-4i: sitagliptin and vildagliptin provides favorable metabolic and vascular effects beyond glucose-control. Further studies are required to elucidate their implication in metabolic pathways.
Collapse
Affiliation(s)
- Lea Duvnjak
- />Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic diseases, Merkur University hospital, Dugi dol 4a, Zagreb, Croatia
- />School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Kristina Blaslov
- />Vuk Vrhovac Clinic for Diabetes, Endocrinology and Metabolic diseases, Merkur University hospital, Dugi dol 4a, Zagreb, Croatia
| |
Collapse
|
23
|
Yeboah K, Antwi DA, Gyan B. Arterial Stiffness in Nonhypertensive Type 2 Diabetes Patients in Ghana. Int J Endocrinol 2016; 2016:6107572. [PMID: 27774104 PMCID: PMC5059649 DOI: 10.1155/2016/6107572] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 05/31/2016] [Accepted: 06/26/2016] [Indexed: 12/03/2022] Open
Abstract
Background. Increased arterial stiffness is an independent cardiovascular risk factor in diabetes patients and general population. However, the contribution of diabetes to arterial stiffness is often masked by coexistent obesity and hypertension. In this study, we assessed arterial stiffness in nonhypertensive, nonobese type 2 diabetes (T2DM) patients in Ghana. Methods. In case-control design, 166 nonhypertensive, nonobese participants, comprising 96 T2DM patients and 70 nondiabetes controls, were recruited. Peripheral and central blood pressure (BP) indices were measured, and arterial stiffness was assessed as aortic pulse wave velocity (PWVao), augmentation index (AIx), cardioankle vascular index (CAVI), and heart-ankle pulse wave velocity (haPWV). Results. With similar peripheral and central BP indices, T2DM patients had higher PWVao (8.3 ± 1 versus 7.8 ± 1.3, p = 0.044) and CAVI (7.9 ± 1.2 versus 6.9 ± 0.7, p = 0.021) than nondiabetic control. AIx and haPWV were similar between T2DM and nondiabetic controls. Multiple regression models showed that, in the entire study participants, the major determinants of PWVao were diabetes status, age, gender, systolic BP, and previous smoking status (β = 0.22, 0.36, 0.48, 0.21, and 0.25, resp.; all p < 0.05); the determinants of CAVI were diabetes status, age, BMI, heart rate, HbA1c, total cholesterol, HDL cholesterol, and previous smoking status (β = 0.21, 0.38, 0.2, 0.18, 0.24. 0.2, -0.19, and 0.2, resp.; all p < 0.05). Conclusion. Our findings suggest that nonhypertensive, nonobese T2DM patients have increased arterial stiffness without appreciable increase in peripheral and central pressure indices.
Collapse
Affiliation(s)
- Kwame Yeboah
- Department of Physiology, School of Allied & Biomedical Sciences, University of Ghana, Accra, Ghana
- *Kwame Yeboah:
| | - Daniel A. Antwi
- Department of Physiology, School of Allied & Biomedical Sciences, University of Ghana, Accra, Ghana
| | - Ben Gyan
- Department of Immunology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| |
Collapse
|
24
|
Cosenso-Martin LN, Giollo-Júnior LT, Martineli DD, Cesarino CB, Nakazone MA, Cipullo JP, Vilela-Martin JF. Twelve-week randomized study to compare the effect of vildagliptin vs. glibenclamide both added-on to metformin on endothelium function in patients with type 2 diabetes and hypertension. Diabetol Metab Syndr 2015; 7:70. [PMID: 26312070 PMCID: PMC4550051 DOI: 10.1186/s13098-015-0062-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 08/07/2015] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Vildagliptin, a DPP-4 inhibitor widely used for the treatment of type 2 diabetes mellitus (T2DM), shows beneficial effects on endothelial function. This study aims to evaluate the effect of vildagliptin on endothelial function and arterial stiffness in patients with T2DM and hypertension. METHODS Fifty over 35-year-old patients with T2DM and hypertension, without cardiovascular disease, will be randomly allocated to two groups: group 1 will receive vildagliptin added-on to metformin and group 2, glibenclamide added-on to metformin. Biochemical tests (glycemia, glycated hemoglobin, total cholesterol, high-density lipoprotein cholesterol, triglycerides, creatinine, alanine aminotransferase, ultrasensitive C-reactive protein, and microalbuminuria), 24-h non-invasive ambulatory blood pressure monitoring, and assessment of endothelial function and arterial stiffness will be performed in both groups before and after 12 weeks of treatment. The endothelial function will be assessed by peripheral arterial tonometry, which measures the reactive hyperemia index (vasodilation), and arterial stiffness will be evaluated by applanation tonometry. All analysis will be performed using SPSS Statistical Software. For all analysis, a 2-sided P < 0.05 will be considered statistically significant. RESULTS The study started in December 2013 and patient recruitment is programed until October 2015. The expected results are that vildagliptin will improve the endothelial function in patients with T2DM and hypertension compared to glibenclamide treatment, independently of glycemic control. CONCLUSIONS It is expected that this DPP-4 inhibitor will improve endothelial function in patients with T2 DM. TRIAL REGISTRATION Clinical Trials NCT02145611, registered on 11 Jun 2013.
Collapse
Affiliation(s)
- Luciana Neves Cosenso-Martin
- />Hospital de Base/Centro Integrado de Pesquisa da Fundação Faculdade Regional de Medicina de São José do Rio Preto (FUNFARME), São José do Rio Preto, Brazil
- />Internal Medicine Department and Hypertension Clinic, State Medical School in São José do Rio Preto (FAMERP), Ave Brig. Faria Lima 5416, São José do Rio Preto, SP 15090-000 Brazil
| | - Luiz Tadeu Giollo-Júnior
- />Hospital de Base/Centro Integrado de Pesquisa da Fundação Faculdade Regional de Medicina de São José do Rio Preto (FUNFARME), São José do Rio Preto, Brazil
- />Internal Medicine Department and Hypertension Clinic, State Medical School in São José do Rio Preto (FAMERP), Ave Brig. Faria Lima 5416, São José do Rio Preto, SP 15090-000 Brazil
| | - Débora Dada Martineli
- />Hospital de Base/Centro Integrado de Pesquisa da Fundação Faculdade Regional de Medicina de São José do Rio Preto (FUNFARME), São José do Rio Preto, Brazil
- />Internal Medicine Department and Hypertension Clinic, State Medical School in São José do Rio Preto (FAMERP), Ave Brig. Faria Lima 5416, São José do Rio Preto, SP 15090-000 Brazil
| | - Cláudia Bernardi Cesarino
- />Hospital de Base/Centro Integrado de Pesquisa da Fundação Faculdade Regional de Medicina de São José do Rio Preto (FUNFARME), São José do Rio Preto, Brazil
- />Internal Medicine Department and Hypertension Clinic, State Medical School in São José do Rio Preto (FAMERP), Ave Brig. Faria Lima 5416, São José do Rio Preto, SP 15090-000 Brazil
| | - Marcelo Arruda Nakazone
- />Hospital de Base/Centro Integrado de Pesquisa da Fundação Faculdade Regional de Medicina de São José do Rio Preto (FUNFARME), São José do Rio Preto, Brazil
- />Internal Medicine Department and Hypertension Clinic, State Medical School in São José do Rio Preto (FAMERP), Ave Brig. Faria Lima 5416, São José do Rio Preto, SP 15090-000 Brazil
| | - José Paulo Cipullo
- />Hospital de Base/Centro Integrado de Pesquisa da Fundação Faculdade Regional de Medicina de São José do Rio Preto (FUNFARME), São José do Rio Preto, Brazil
- />Internal Medicine Department and Hypertension Clinic, State Medical School in São José do Rio Preto (FAMERP), Ave Brig. Faria Lima 5416, São José do Rio Preto, SP 15090-000 Brazil
| | - José Fernando Vilela-Martin
- />Hospital de Base/Centro Integrado de Pesquisa da Fundação Faculdade Regional de Medicina de São José do Rio Preto (FUNFARME), São José do Rio Preto, Brazil
- />Internal Medicine Department and Hypertension Clinic, State Medical School in São José do Rio Preto (FAMERP), Ave Brig. Faria Lima 5416, São José do Rio Preto, SP 15090-000 Brazil
| |
Collapse
|
25
|
Inci S, Nar G, Erol MK, Demirelli S, Duman H, Serdar S, Erol F. The Effects of Successful Percutaneous Mitral Balloon Valvuloplasty on Acute and Intermediate Term Aortic Stiffness. Echocardiography 2014; 32:813-8. [DOI: 10.1111/echo.12799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Sinan Inci
- Department of Cardiology; State Hospital Aksaray; Aksaray Turkey
| | - Gökay Nar
- Department of Cardiology; State Hospital Aksaray; Aksaray Turkey
| | - Mustafa Kemal Erol
- Department of Cardiology; Ataturk University Medical Faculty; Erzurum Turkey
| | - Selami Demirelli
- Department of Cardiology; Ataturk University Medical Faculty; Erzurum Turkey
| | - Hakan Duman
- Department of Cardiology; Ataturk University Medical Faculty; Erzurum Turkey
| | - Serkan Serdar
- Department of Cardiology; Ataturk University Medical Faculty; Erzurum Turkey
| | - Fatih Erol
- Department of Cardiology; Ataturk University Medical Faculty; Erzurum Turkey
| |
Collapse
|
26
|
Chantler PD, Frisbee JC. Arterial function in cardio-metabolic diseases: from the microcirculation to the large conduits. Prog Cardiovasc Dis 2014; 57:489-96. [PMID: 25220256 DOI: 10.1016/j.pcad.2014.09.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The metabolic syndrome (MetS) is characterized as a constellation of metabolic risk factors such as obesity, hypertension, dyslipidemia, and hyperglycemia that co-occur within a given individual. This consultation of risk factors exposes MetS to a 3-fold increased risk of cardiovascular disease and an even higher risk of developing type 2 diabetes compared to healthy individuals. The pathophysiological mechanisms underlying this increased cardiovascular risk are incompletely understood but likely include alterations to macro- and micro-vasculature. The vasculature plays an important role not only in delivery and adjusting the quantity of blood delivered to the tissues, but the dynamic changes in structure and compliance significantly alter the hemodynamic stress imposed on the heart and end-organs. This review will give an overview of the pathophysiological changes to the vasculature that accompany MetS in both human and animal models, as well as the possible mechanistic pathways.
Collapse
Affiliation(s)
- Paul D Chantler
- Division of Exercise Physiology, School of Medicine, West Virginia University, Morgantown, WV, USA; Center for Cardiovascular and Respiratory Sciences, School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Jefferson C Frisbee
- Center for Cardiovascular and Respiratory Sciences, School of Medicine, West Virginia University, Morgantown, WV, USA; Department of Physiology and Pharmacology, School of Medicine, West Virginia University, Morgantown, WV, USA.
| |
Collapse
|
27
|
|
28
|
Pozzobon CR, Gismondi RAOC, Bedirian R, Ladeira MC, Neves MF, Oigman W. Functional vascular study in hypertensive subjects with type 2 diabetes using losartan or amlodipine. Arq Bras Cardiol 2014; 103:51-9. [PMID: 25014057 PMCID: PMC4126761 DOI: 10.5935/abc.20140089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 03/14/2014] [Indexed: 12/24/2022] Open
Abstract
Background Antihypertensive drugs are used to control blood pressure (BP) and reduce
macro- and microvascular complications in hypertensive patients with
diabetes. Objectives The present study aimed to compare the functional vascular changes in
hypertensive patients with type 2 diabetes mellitus after 6 weeks of
treatment with amlodipine or losartan. Methods Patients with a previous diagnosis of hypertension and type 2 diabetes
mellitus were randomly divided into 2 groups and evaluated after 6 weeks of
treatment with amlodipine (5 mg/day) or losartan (100 mg/day). Patient
evaluation included BP measurement, ambulatory BP monitoring, and assessment
of vascular parameters using applanation tonometry, pulse wave velocity
(PWV), and flow-mediated dilation (FMD) of the brachial artery. Results A total of 42 patients were evaluated (21 in each group), with a predominance
of women (71%) in both groups. The mean age of the patients in both groups
was similar (amlodipine group: 54.9 ± 4.5 years; losartan group: 54.0 ± 6.9
years), with no significant difference in the mean BP [amlodipine group: 145
± 14 mmHg (systolic) and 84 ± 8 mmHg (diastolic); losartan group: 153 ± 19
mmHg (systolic) and 90 ± 9 mmHg (diastolic)]. The augmentation index (30% ±
9% and 36% ± 8%, p = 0.025) and augmentation pressure (16 ± 6 mmHg and 20 ±
8 mmHg, p = 0.045) were lower in the amlodipine group when compared with the
losartan group. PWV and FMD were similar in both groups. Conclusions Hypertensive patients with type 2 diabetes mellitus treated with amlodipine
exhibited an improved pattern of pulse wave reflection in comparison with
those treated with losartan. However, the use of losartan may be associated
with independent vascular reactivity to the pressor effect.
Collapse
Affiliation(s)
| | | | - Ricardo Bedirian
- Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | | | - Wille Oigman
- Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| |
Collapse
|
29
|
Liu X, Song P. Is the association of diabetes with uncontrolled blood pressure stronger in Mexican Americans and blacks than in whites among diagnosed hypertensive patients? Am J Hypertens 2013; 26:1328-34. [PMID: 23864584 DOI: 10.1093/ajh/hpt109] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Clinical evidence shows that diabetes may provoke uncontrolled blood pressure (BP) in hypertensive patients. However, racial differences in the associations of diabetes with uncontrolled BP outcomes among diagnosed hypertensive patients have not been evaluated. METHODS A total of 6,134 diagnosed hypertensive subjects aged ≥ 20 years were collected from the National Health and Nutrition Examination Survey 1999-2008 with a stratified multistage design. Odds ratios (ORs) and relative ORs of uncontrolled BP and effect differences in continuous BP for diabetes over race/ethnicity were derived using weighted logistic regression and linear regression models. RESULTS Compared with participants who did not have diabetes, non-Hispanic black participants with diabetes had a 138% higher chance of having uncontrolled BP, Mexican participants with diabetes had a 60% higher chance of having uncontrolled BP, and non-Hispanic white participants with diabetes had a 161% higher chances of having uncontrolled BP. The association of diabetes with uncontrolled BP was lower in Mexican Americans than in non-Hispanic blacks and whites (Mexican Americans vs. non-Hispanic blacks: relative OR = 0.55, 95% confidence interval (CI) = 0.37-0.82; Mexican Americans vs. non-Hispanic whites: relative OR = 0.53, 95% CI = 0.35-0.80) and the association of diabetes with isolated uncontrolled systolic BP was lower in Mexican Americans than in non-Hispanic whites (Mexican Americans vs. non-Hispanic whites: relative OR = 0.62, 95% CI = 0.40-0.96). Mexican Americans have a stronger association of diabetes with decreased systolic BP and diastolic BP than non-Hispanic whites, and a stronger association of diabetes with decreased diastolic BP than non-Hispanic blacks. CONCLUSIONS The association of diabetes with uncontrolled BP outcomes is lower despite higher prevalence of diabetes in Mexican Americans than in non-Hispanic whites. The stronger association of diabetes with BP outcomes in whites should be of clinical concern, considering they account for the majority of the hypertensive population in the United States.
Collapse
Affiliation(s)
- Xuefeng Liu
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, Tennessee
| | - Ping Song
- Department of Internal Medicine, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| |
Collapse
|
30
|
de Oliveira Alvim R, Santos PCJL, Musso MM, de Sá Cunha R, Krieger JE, Mill JG, Pereira AC. Impact of diabetes mellitus on arterial stiffness in a representative sample of an urban Brazilian population. Diabetol Metab Syndr 2013; 5:45. [PMID: 23965633 PMCID: PMC3765236 DOI: 10.1186/1758-5996-5-45] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 08/19/2013] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Independent of other cardiovascular (CV) risk factors, increased arterial stiffness has been established as a predictor of morbidity and mortality. The main aim of this study was to investigate the impact of diabetes on arterial stiffness in a representative sample of an urban Brazilian population plus Amerindians. METHODS A total of 1,415 individuals from the general population were randomly selected plus 588 Amerindians from a native community in Brazil. In addition, a sub-sample of 380 individuals from the general population had 5-year follow-up data. Pulse wave velocity (PWV) was measured with a non-invasive automatic device (Complior, Colson; Garges les Gonesses, France) and increased arterial stiffness was defined as PWV ≥ 12 m/s. RESULTS In the overall group, diabetic individuals had higher frequencies of increased arterial stiffness and hypertension. They also had higher values of PWV, body mass index, total cholesterol, triglycerides, systolic and diastolic blood pressures compared to non-diabetic individuals (p < 0.01). In an analysis stratified by hypertension, PWV values and increased arterial stiffness frequency were higher in diabetic individuals in both groups (hypertensive and non-hypertensive) (p < 0.05). Furthermore, higher risk for increased arterial stiffness was observed in the diabetic individuals from the overall group (OR = 2.27; CI = 1.47-3.52, p < 0.001) and from the hypertensive group (OR = 2.70; CI = 1.58-4.75, p < 0.001), adjusted for covariates. Regarding the ethnic stratification, diabetic individuals from Amerindian, White, and Mulatto (mixed-race) groups had higher PWV values and a greater frequency of increased arterial stiffness compared to non-diabetic individuals. Both diabetic and non-diabetic individuals had higher PWV values after 5 years. There was no significant difference in the 5-year PWV progression in diabetic compared to non-diabetic individuals. CONCLUSIONS These results confirm, in a sample of Brazilian population, that the presence of diabetes is associated with increased arterial stiffness and it may contribute in part to increased cardiovascular risk in diabetic patients.
Collapse
Affiliation(s)
- Rafael de Oliveira Alvim
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 44 Cerqueira César, São Paulo, SP CEP 05403-000, Brazil
| | - Paulo Caleb Junior Lima Santos
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 44 Cerqueira César, São Paulo, SP CEP 05403-000, Brazil
| | - Mariane Manso Musso
- Department of Medicine, Juiz de Fora Federal University, Juiz de Fora, MG, Brazil
| | - Roberto de Sá Cunha
- Department of Physiology, Espirito Santo Federal University, Espirito Santo, ES, Brazil
| | - José Eduardo Krieger
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 44 Cerqueira César, São Paulo, SP CEP 05403-000, Brazil
| | - José Geraldo Mill
- Department of Physiology, Espirito Santo Federal University, Espirito Santo, ES, Brazil
| | - Alexandre Costa Pereira
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 44 Cerqueira César, São Paulo, SP CEP 05403-000, Brazil
| |
Collapse
|
31
|
Central hemodynamic modifications in diabetes mellitus. Atherosclerosis 2013; 230:315-21. [PMID: 24075763 DOI: 10.1016/j.atherosclerosis.2013.07.054] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 07/02/2013] [Accepted: 07/29/2013] [Indexed: 11/23/2022]
Abstract
Arterial stiffness in hypertension is markedly influenced by age, mean arterial pressure (MAP) and heart rate, whereas factors influencing this parameter in diabetes mellitus are not yet fully understood. The aim of our study was to compare central hemodynamics in diabetics (n = 126) versus non-diabetic controls (n = 203), most of whom were hypertensive, and with similar MAP. Anthropometric, laboratory and clinical measurements were collected. Hemodynamic parameters (central blood pressure, aortic pulse wave velocity [PWV], augmentation index [AIx] and pulse pressure amplification [PPA]) were measured using applanation tonometry. PWV and AIx were significantly higher in diabetics, after adjustment for age, gender, MAP, and heart rate. After further adjustment for metabolic syndrome, only the difference in PWV persisted (P < 0.0001). PPA was marginally altered though not significantly. In diabetics, PWV did not correlate with MAP, suggesting that other structural alterations, resulting from insulin resistance, may account for diabetic arterial stiffening to a greater extent than, and independently of, blood pressure. Chronic treatment with insulin was associated with increased PWV, independently of blood pressure, diabetes control and duration, or other common confounding variables. In conclusion, hypertensive diabetics had greater arterial stiffness than hypertensive controls. In diabetes, multiple factors affect arterial stiffening independently of hemodynamic status. Notably, insulin therapy (IT) is associated with more severe arterial stiffness, suggesting a consistent relationship between these parameters. It remains to be determined whether IT should be considered as a marker of diabetes severity that leads to increased arterial stiffness, or whether it has a direct/indirect effect on arterial wall modifications.
Collapse
|
32
|
Abstract
Exercise interventions are recommended in most guidelines for the treatment of type 2 diabetes. Although most guidelines suggest a combination of both aerobic and resistance training, the exact benefits of these interventions remain unclear. Although either modality alone or in combination seems to have an identical impact on glycated hemoglobin levels, resistance training and aerobic training have independent effects on other parameters of cardio-metabolic risk. This review examines the current evidence for aerobic and resistance training on glycemic control, lipid profile, body composition, vascular health, and mental health in patients with type 2 diabetes. The uncertainties surrounding exercise modality, volume and intensity are also addressed.
Collapse
Affiliation(s)
- Kenneth M Madden
- VITALiTY (Vancouver Initiative to Add Life to Years) Research Laboratory, Division of Geriatric Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
33
|
Meng C, Sun M, Wang Z, Fu Q, Cao M, Zhu Z, Mao J, Shi Y, Tang W, Huang X, Duan Y, Yang T. Insulin Sensitivity and Beta-Cell Function Are Associated with Arterial Stiffness in Individuals without Hypertension. J Diabetes Res 2013; 2013:151675. [PMID: 23671853 PMCID: PMC3647586 DOI: 10.1155/2013/151675] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Accepted: 01/04/2013] [Indexed: 11/17/2022] Open
Abstract
Aim. We investigated the relationship between brachial-ankle pulse wave velocity (baPWV) and glucose levels, insulin sensitivity, and beta-cell function in Chinese individuals with or without hypertension. Methods. We recruited 3137 nondiabetic individuals whose age, body mass index (BMI), glucose levels, blood pressure (BP), lipids, hemoglobin A1C (HbA1c), baPWV, and insulin levels were measured. Results. In normotensive group, 2 h glucose levels (β = 0.046, P < 0.001) associated with baPWV, showed a significant increase in patients with NG as compared to those with DM (P = 0.032). The hypertensive group showed no such differences. The Matsuda index (β = 0.114, P < 0.001) and HOMA- β (β = 0.045, P < 0.001) were negatively correlated with baPWV while lnHOMA-IR (β = 0.196, P = 0.076) and the Quantitative Insulin Sensitivity Check Index (QUICKI) (β = 0.226, P = 0.046) showed a borderline negative correlation. BaPWV significantly decreased (P = 0.032) with an increase in insulin sensitivity in individuals with both normal BP and glucose tolerance. Conclusions. BaPWV was significantly associated with 2 h glucose levels, insulin sensitivity and beta-cell function in normotensive population, whereas in hypertensive individuals, BP was the dominant factor influencing arterial stiffness. Individuals with abnormal insulin sensitivity in the absence of diabetes and hypertension are also at an increased risk of arterial stiffness.
Collapse
Affiliation(s)
- Chuchen Meng
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu 210029, China
| | - Min Sun
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu 210029, China
| | - Zhixiao Wang
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu 210029, China
| | - Qi Fu
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu 210029, China
| | - Mengdie Cao
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu 210029, China
| | - Zhenxin Zhu
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu 210029, China
| | - Jia Mao
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu 210029, China
| | - Yun Shi
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu 210029, China
| | - Wei Tang
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu 210029, China
| | - Xiaoping Huang
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu 210029, China
| | - Yu Duan
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu 210029, China
- *Yu Duan: and
| | - Tao Yang
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu 210029, China
- *Tao Yang:
| |
Collapse
|
34
|
Wang JW, Zhou ZQ, Hu DY. Prevalence of arterial stiffness in North China, and associations with risk factors of cardiovascular disease: a community-based study. BMC Cardiovasc Disord 2012; 12:119. [PMID: 23217203 PMCID: PMC3523088 DOI: 10.1186/1471-2261-12-119] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 11/30/2012] [Indexed: 11/10/2022] Open
Abstract
Background Brachial-ankle pulse wave velocity (baPWV), which reflects the stiffness of both central and peripheral muscular arteries, has been frequently used as a simple index for assessing arterial stiffness. The aim of the present study was to investigate the prevalence of arterial stiffness in North China based on baPWV measurements, and explore the associations between increased arterial stiffness and risk factors of cardiovascular diseases (CVD). Methods Twenty-three community populations were established in North China. For each participant, parameters for calculating baPWV, including blood pressures and pressure waveforms, were measured using a non-invasive automatic device. All participants were required to respond to an interviewer-led questionnaire including medical histories and demographic data, and to receive blood tests on biochemical indictors. Results A total of 2,852 participants were finally investigated. Among them, 1,201 people with low burden of CVD risk factors were chosen to be the healthy reference sample. The cut-off point of high baPWV was defined as age-specific 90th percentile of the reference sample. Thus, the prevalence of high baPWV was found to be 22.3% and 26.4% in men and women respectively. After adjusted for age, heart rate (HR), systolic blood pressure (SBP), fasting glucose level, and smoking were significantly associated with high baPWV in men; while level of serum total cholesterol (TC), HR, SBP, and diabetes were significantly associated with high baPWV in women. Conclusions Based on the age-specific cut-off points, the middle-aged population has a higher prevalence of high baPWV in North China. There exists a difference between men and women in terms of the potential risk factors associated with arterial stiffness.
Collapse
Affiliation(s)
- Jin-Wen Wang
- Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, 100029, People's Republic of China.
| | | | | |
Collapse
|
35
|
Bruno RM, Penno G, Daniele G, Pucci L, Lucchesi D, Stea F, Landini L, Cartoni G, Taddei S, Ghiadoni L, Del Prato S. Type 2 diabetes mellitus worsens arterial stiffness in hypertensive patients through endothelial dysfunction. Diabetologia 2012; 55:1847-55. [PMID: 22411135 DOI: 10.1007/s00125-012-2517-1] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Accepted: 02/09/2012] [Indexed: 02/07/2023]
Abstract
AIMS/HYPOTHESIS Endothelium-derived factors are thought to be physiological modulators of large artery stiffness. The aim of the study was to investigate whether endothelial function could be a determinant of arterial stiffness in essential hypertensive patients, in relation with the concomitant presence of type 2 diabetes mellitus. METHODS The study included 341 participants (84 hypertensive patients with and 175 without type 2 diabetes mellitus, 82 matched controls). Brachial artery endothelium-dependent flow-mediated dilation (FMD) was determined by high-resolution ultrasound and computerised edge detection system. Applanation tonometry was used to measure carotid-femoral pulse wave velocity (PWV). RESULTS Hypertensive patients with diabetes had higher PWV (10.1 ± 2.3 m/s vs 8.6 ± 1.4 m/s, p < 0.001) and lower FMD (3.51 ± 2.07 vs 5.16 ± 2.96%, p < 0.001) than non-diabetic hypertensive patients, who showed impaired vascular function when compared with healthy participants (7.9 ± 1.6 m/s and 6.68 ± 3.67%). FMD was significantly and negatively correlated to PWV only in hypertensive diabetic patients (r = -0.456, p < 0.001), but not in hypertensive normoglycaemic patients (r = -0.088, p = 0.248) or in healthy participants (r = 0.008, p = 0.946). Multivariate analysis demonstrated that, in the diabetic group, FMD remained an independent predictor of PWV after adjustment for confounders (r(2) = 0.083, p = 0.003). Subgroup analysis performed in non-diabetic hypertensive patients revealed that neither obesity nor the metabolic syndrome affected the relationship between FMD and PWV. CONCLUSIONS/INTERPRETATION Endothelial dysfunction is a determinant of aortic stiffness in hypertensive diabetic patients but not in hypertensive patients without diabetes. These results suggest that type 2 diabetes mellitus on top of hypertension might worsen arterial compliance by endothelium-related mechanisms.
Collapse
Affiliation(s)
- R M Bruno
- Department of Internal Medicine, University of Pisa, Via Roma 67, 56126, Pisa, Italy
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Soender TK, Møller JE, Løgstrup BB, Lambrechtsen J, Hangaard J, Egstrup K. Vascular characteristics in patients with resistant hypertension and type-II-diabetes mellitus. Artery Res 2012. [DOI: 10.1016/j.artres.2012.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
37
|
Kim JH, Oh SJ, Lee JM, Hong EG, Yu JM, Han KA, Min KW, Son HS, Chang SA. The effect of an Angiotensin receptor blocker on arterial stiffness in type 2 diabetes mellitus patients with hypertension. Diabetes Metab J 2011; 35:236-42. [PMID: 21785743 PMCID: PMC3138103 DOI: 10.4093/dmj.2011.35.3.236] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2011] [Accepted: 06/01/2011] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Hypertension and type 2 diabetes mellitus are major risk factors for cardiovascular disease. This study analyzed the changes in central aortic waveforms and pulse wave velocity as well as related parameters after treatment with valsartan, an angiotensin II type 1 receptor blocker, in patients with type 2 diabetes and hypertension. METHODS We used pulse wave analysis to measure central aortic waveform in a total of 98 subjects. In 47 of these patients, pulse wave velocity measurements were obtained before and after 12 weeks of treatment with valsartan. RESULTS In the central aortic waveform analysis, the aortic pulse pressure and augmentation index were significantly decreased after valsartan treatment, as was the aortic pulse wave velocity. Factors contributing to the improvement in pulse wave velocity were the fasting blood glucose and haemoglobin A1c levels. CONCLUSION Short-term treatment with valsartan improves arterial stiffness in patients with type 2 diabetes and hypertension, and the glucose status at baseline was associated with this effect.
Collapse
Affiliation(s)
- Ji Hyun Kim
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Su Jin Oh
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Jung Min Lee
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Eun Gyoung Hong
- Department of Internal Medicine, Hallym University College of Medicine, Seoul, Korea
| | - Jae Myung Yu
- Department of Internal Medicine, Hallym University College of Medicine, Seoul, Korea
| | - Kyung Ah Han
- Department of Internal Medicine, Eulji University School of Medicine, Seoul, Korea
| | - Kyung Wan Min
- Department of Internal Medicine, Eulji University School of Medicine, Seoul, Korea
| | - Hyun Shik Son
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Sang Ah Chang
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| |
Collapse
|
38
|
Aortic Augmentation Index is not a Useful Index of Cardiovascular Risk in Type 2 Diabetes. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.jecm.2011.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
39
|
Gong W, Lu B, Yang Z, Ye W, Du Y, Wang M, Li Q, Zhang W, Pan Y, Feng X, Zhou W, Zhang Y, Yang Z, Yang Y, Zhu X, Hu R. Early-stage atherosclerosis in newly diagnosed, untreated type 2 diabetes mellitus and impaired glucose tolerance. DIABETES & METABOLISM 2009; 35:458-62. [DOI: 10.1016/j.diabet.2009.05.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2009] [Revised: 05/18/2009] [Accepted: 05/18/2009] [Indexed: 10/20/2022]
|
40
|
Kalaitzidis R, Bakris G. Management of hypertension in patients with diabetes: the place of angiotensin-II receptor blockers. Diabetes Obes Metab 2009; 11:757-69. [PMID: 19519867 DOI: 10.1111/j.1463-1326.2009.01052.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Hypertension is an important cardiovascular (CV) risk factor in patients with diabetes mellitus. In this setting, tight control of blood pressure (BP) significantly reduces CV morbidity and mortality. In the UK Prospective Diabetes Study, a 10 mmHg reduction in systolic blood pressure (SBP) was superior to a 0.7% decrease in glycosylated haemoglobin A1c (HbA1c) as far as reducing morbidity and mortality was concerned. In the Hypertension Optimal Treatment study, the risk of CV events decreased by 51% among patients with type 2 diabetes randomized to the lower BP level. Based on these findings, contemporary treatment guidelines recommend a target SBP/diastolic blood pressure of <130/80 mmHg for patients with diabetes.
Collapse
Affiliation(s)
- Rigas Kalaitzidis
- Hypertensive Diseases Unit, Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, Pritzker School of Medicine, University of Chicago, Chicago, IL 60637, USA
| | | |
Collapse
|
41
|
Madden KM, Lockhart C, Cuff D, Potter TF, Meneilly GS. Short-term aerobic exercise reduces arterial stiffness in older adults with type 2 diabetes, hypertension, and hypercholesterolemia. Diabetes Care 2009; 32:1531-5. [PMID: 19509011 PMCID: PMC2713633 DOI: 10.2337/dc09-0149] [Citation(s) in RCA: 123] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The relationship between increased arterial stiffness and cardiovascular mortality is well established in type 2 diabetes. We examined whether aerobic exercise could reduce arterial stiffness in older adults with type 2 diabetes complicated by comorbid hypertension and hyperlipidemia. RESEARCH DESIGN AND METHODS A total of 36 older adults (mean age 71.4 +/- 0.7 years) with diet-controlled or oral hypoglycemic-controlled type 2 diabetes, hypertension, and hypercholesterolemia were recruited. Subjects were randomly assigned to one of two groups: an aerobic group (3 months vigorous aerobic exercise) and a nonaerobic group (no aerobic exercise). Exercise sessions were supervised by a certified exercise trainer three times per week, and a combination of cycle ergometers and treadmills was used. Arterial stiffness was measured using the Complior device. RESULTS When the two groups were compared, aerobic training resulted in a decrease in measures of both radial (-20.7 +/- 6.3 vs. +8.5 +/- 6.6%, P = 0.005) and femoral (-13.9 +/- 6.7 vs. +4.4 +/- 3.3%, P = 0.015) pulse-wave velocity despite the fact that aerobic fitness as assessed by Vo(2max) did not demonstrate an improvement with training (P = 0.026). CONCLUSIONS Our findings indicate that a relatively short aerobic exercise intervention in older adults can reduce multifactorial arterial stiffness (type 2 diabetes, aging, hypertension, and hypercholesterolemia).
Collapse
Affiliation(s)
- Kenneth M Madden
- VITALiTY (Vancouver Initiative to Add Life to Years) Research Laboratory, Division of Geriatric Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
| | | | | | | | | |
Collapse
|
42
|
Franjic B, Marwick TH. The diabetic, hypertensive heart: epidemiology and mechanisms of a very high-risk situation. J Hum Hypertens 2009; 23:709-17. [DOI: 10.1038/jhh.2009.43] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
|
43
|
Abstract
This article discusses the following: (1) factors modulating central and peripheral SBP and PP in hypertensive subjects; (2) mechanisms enhancing PP variations in this population; (3) Analysis of pulsatile arterial hemodynamics as predictors of CV risk; and (4) Pulsatile hemodynamics and strategies lowering CV risk in the treatment of hypertension.
Collapse
Affiliation(s)
- Michel E Safar
- Assistance Publique-Hôpitaux de Paris, Hôtel-Dieu, Centre de Diagnostic et de Thérapeutique, Université Paris Descartes, Paris Cedex 04, Paris, France.
| |
Collapse
|
44
|
Kuo HK, Chen CY, Liu HM, Yen CJ, Chang KJ, Chang CC, Yu YH, Lin LY, Hwang JJ. Metabolic risks, white matter hyperintensities, and arterial stiffness in high-functioning healthy adults. Int J Cardiol 2009; 143:184-91. [PMID: 19261342 DOI: 10.1016/j.ijcard.2009.02.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2008] [Revised: 01/05/2009] [Accepted: 02/08/2009] [Indexed: 10/21/2022]
Abstract
BACKGROUND Arterial stiffness, an age-related feature and measured noninvasively by pulse wave velocity (PWV), is associated with a variety of cardiovascular diseases. Although white matter lesion (WML), representing cerebrovascular micro-angiopathy, is typically considered as a preclinical cardiovascular disease, little is know about the association between PWV and WML. The aim of this study is to examine the association between PWV and WML. METHOD We examined the extent of white matter lesion on cranial magnetic resonance imaging of 93 participants (mean 72.46 years) from the annual Health Examination for the Elderly Program in the National Taiwan University Hospital. Two subtypes of WML including periventricular hyperintensity (PVH) and deep white matter hyperintensity (DWMH) were graded according to Fazekas et al. The brachial-ankle PWV (baPWV) and heart-ankle PWV (haPWV) were measured using an automatic waveform analyzer. RESULTS PVH and DWHM were found in 71 (76%) and 58 (62%) participants. Various degree of WML was observed in 80 (86%) participants. Hypertension, use of anti-hypertensive medications, and elevated blood pressure were identified as risk factors of WML. The baPWV and haPWV were correlated with many metabolic risks, including systolic blood pressure, pulse pressure, and serum triglycerides. The baPWV and haPWV were greater in participants with higher grades of WML in the multivariate analyses. The receiver operating characteristics analyses demonstrated that area under curves for haPWV to identify moderate-to-severe PVH and DWMH were 0.78 (95% confidence interval [CI] 0.66-0.91) and 0.72 (95% CI 0.59-0.85), respectively. CONCLUSION Greater PWV is associated with higher grades of WML among high-functioning older adults. Our findings support the notion that measurement of arterial stiffness is useful in clinical practice for detection of preclinical cerebrovascular disease.
Collapse
Affiliation(s)
- Hsu-Ko Kuo
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan
| | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Kim EY, Yi JH, Han SW, Shin J, Lee JU, Kim SG, Kim HJ. Clinical factors associated with brachial-ankle pulse wave velocity in patients on maintenance hemodialysis. Electrolyte Blood Press 2008; 6:61-7. [PMID: 24459524 PMCID: PMC3894478 DOI: 10.5049/ebp.2008.6.2.61] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2008] [Accepted: 11/27/2008] [Indexed: 01/20/2023] Open
Abstract
Pulse wave velocity (PWV) is a main parameter for arterial stiffness. In patients with end-stage renal disease (ESRD), PWV is known to be associated with increased mortality. But factors related to the increased PWV in ESRD patients are not well defined. In addition, the carotid-femoral PWV (cfPWV) measurement, which traditionally has been used to evaluate arterial stiffness, has low reproducibility. Recently, brachial-ankle PWV (baPWV) measurement, which can be performed more easily than cfPWV measurement, has become available as a means of measuring PWV. The aim of this study is to investigate the clinical factors associated with increased baPWV in ESRD patients. BaPWV was examined for 65 ESRD patients on maintenance hemodialysis during the period between the 7(th) to the 11(th) of February in 2005 using VP-1000. The clinical factors included age, sex, smoking history, blood pressure, diabetes, body mass index, interdialytic weight gain, duration of dialysis, lipid profile, uric acid, albumin, creatinine, C-reactive protein, calcium, phosphate, intact parathyroid hormone, and hematocrit were analyzed regarding associations (or to determine associations) with baPWV. The median age was 53.8±12.0, 31 males and 34 females. BaPWV was 18.9±5.2 m/s and there was no significant difference between gender (18.1±4.4 m/s vs 19.4±5.9 m/s, p=NS). In multiple regression models, age, predialysis systolic blood pressure, and diabetes were independent variables. In conclusion, age, systolic blood pressure, and diabetes were correlated with baPWV in ESRD patients. Thus baPWV measured by simple, noninvasive methods may become available for screening high risk groups in ESRD patients, although further longitudinal studies are necessary.
Collapse
Affiliation(s)
- Eun-Young Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Joo-Hark Yi
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Sang-Woong Han
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Jinho Shin
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Jae Ung Lee
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Soon Gil Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Ho-Jung Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| |
Collapse
|
46
|
Bakris G, Molitch M, Zhou Q, Sarafidis P, Champion A, Bacher P, Sowers JR. Reversal of Diuretic-Associated Impaired Glucose Tolerance and New-Onset Diabetes: Results of the STAR-LET Study. ACTA ACUST UNITED AC 2008; 3:18-25. [DOI: 10.1111/j.1559-4572.2008.07819.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
47
|
Wong MCS, Jiang JY, Fung H, Griffiths S, Mercer S. Antihypertensive drug class and impaired fasting glucose: a risk association study among Chinese patients with uncomplicated hypertension. BMC CLINICAL PHARMACOLOGY 2008; 8:6. [PMID: 18783618 PMCID: PMC2551584 DOI: 10.1186/1472-6904-8-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/29/2008] [Accepted: 09/10/2008] [Indexed: 01/13/2023]
Abstract
Background There is a scarcity of studies addressing the factors associated with impaired fasting glucose in Chinese patients with uncomplicated hypertension. We included 1,218 patients newly prescribed a single antihypertensive drug in the public primary healthcare setting in Hong Kong, where their fasting glucose levels were measured 6–7 weeks after the first-ever antihypertensive prescription. Methods The odds ratios of having above borderline (≥ 6.1 mmol/l) and adverse (≥ 7.0 mmol/l) glucose levels, respectively, were studied according to patient age, gender, socioeconomic status, clinic types and antihypertensive drug classes by multivariable regression analyses. Results The fasting glucose levels were statistically similar (p = 0.786) among patients prescribed thiazide diuretics (5.48 mmol/l, 95%, 5.38, 5.59), calcium channel blockers (5.46 mmol/l, 95% C.I. 5.37, 5.54), β-blockers (5.42 mmol/l, 95% C.I. 5.34, 5.51) and drugs acting on the renin angiotensin system (RAS) [5.41 mmol/l, 95% C.I. 5.20, 5.61]. Multivariate analyses reported no significant associations between antihypertensive drug class and impaired fasting glucose. Elderly patients and male gender were significantly more likely to present with above borderline and adverse readings respectively. Conclusion Clinicians should be aware of the increased risk of impaired fasting glucose in these groups, and use of thiazides should not in itself deter its use as a first-line antihypertensive agent among ethnic Chinese patients.
Collapse
Affiliation(s)
- Martin C S Wong
- School of Public Health and Department of Community and Family Medicine, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong China.
| | | | | | | | | |
Collapse
|
48
|
Rahman S, Ismail AAS, Ismail SB, Naing NN, Rahman ARA. Early manifestation of macrovasculopathy in newly diagnosed never treated type II diabetic patients with no traditional CVD risk factors. Diabetes Res Clin Pract 2008; 80:253-8. [PMID: 18249457 DOI: 10.1016/j.diabres.2007.12.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2007] [Accepted: 12/10/2007] [Indexed: 11/28/2022]
Abstract
Type II diabetes patients have increased risk of macrovascular complications compared with the general population. Arterial stiffness is considered as an independent predictor of macrovascular events. This study investigated arterial stiffness in newly diagnosed never treated diabetes and impaired glucose tolerance (IGT) patients without any traditional cardiovascular diseases (CVD) risk factors. After preliminary screening of 1620 individuals, 30 diabetic and 30 IGT patients were recruited and compared with age- and sex-matched 30 normoglycaemic subjects. The subjects were newly diagnosed, never treated, normotensive, non-obese, non-hyperlipidaemic and non-smoker. Haemodynamic variables, pulse wave velocity (PWV) and augmentation index (AI) were measured. The PWV was significantly higher in diabetic patients (10.37+/-2.64m/s vs. 8.70+/-1.29m/s; p=0.035) and was of borderline significant in IGT subjects (9.54+/-1.56m/s vs.8.70+/-1.29m/s, p=0.078) compared to normoglycaemic individuals. Augmentation index was higher of borderline significant in diabetic (134.53+/-17.32% vs. 129.17+/-11.18%, p=0.055) and IGT patients (132.02+/-16.11% vs. 129.17+/-11.18%, p=0.059) compared to normoglycaemic individuals. The study demonstrated that newly diagnosed never treated diabetic patients without any CV complications had early manifestation of macrovascular diseases as evident by increased arterial stiffness. The findings also revealed early manifestations of preclinical vasculopathy and potentially increased risk for development of macrovascular diseases at an early age in diabetic patients.
Collapse
Affiliation(s)
- Sayeeda Rahman
- Department of Pharmacology, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | | | | | | | | |
Collapse
|
49
|
Stehouwer CDA, Henry RMA, Ferreira I. Arterial stiffness in diabetes and the metabolic syndrome: a pathway to cardiovascular disease. Diabetologia 2008; 51:527-39. [PMID: 18239908 DOI: 10.1007/s00125-007-0918-3] [Citation(s) in RCA: 395] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2007] [Accepted: 11/08/2007] [Indexed: 02/07/2023]
Abstract
Increased arterial stiffness associated with diabetes and the metabolic syndrome may in part explain the increased cardiovascular disease risk observed in these conditions. Arterial stiffness can be estimated by quantifying pulse pressure but is better described by distensibility and compliance coefficients, pulse wave velocity and wave reflection. The most common non-invasive methodologies used to quantify these estimates of arterial stiffness (e.g. ultrasonography and applanation tonometry) are also described. We then review and summarise the current data on the associations between diabetes, the metabolic syndrome and insulin resistance on the one hand and greater arterial stiffness on the other, and identify and discuss some unresolved issues such as differential stiffening of central vs peripheral arterial segments, the impact of sex, and the pathobiology of increased arterial stiffness in diabetes and the metabolic syndrome. Finally, some considerations with regard to treatment options are presented. At present the most powerful therapy available for reducing arterial stiffness is to vigorously treat hypertension using pharmacological agents. New pharmacological strategies to reduce arterial stiffness are likely to be especially relevant to individuals with diabetes.
Collapse
Affiliation(s)
- C D A Stehouwer
- Department of Internal Medicine, University Hospital Maastricht, P. Debyelaan 25, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.
| | | | | |
Collapse
|
50
|
Abstract
Decreased arterial compliance (increased stiffness) correlates with cardiovascular events, possibly due to increased cardiac afterload caused by more rapidly reflected pulse waves. Endothelium-derived mediators regulate vascular tone and structure, both of which can markedly influence arterial stiffness. Thus, increased arterial stiffness may be a mechanism by which endothelial dysfunction predisposes to complications of atherosclerosis. Conversely, therapeutic manipulation of endothelial mediators could reduce arterial stiffness and cardiovascular events. Techniques have been developed that use measures of arterial stiffness as an index of endothelial dilator function; these may provide unique prognostic information to identify high-risk subjects.
Collapse
Affiliation(s)
- Marcelo L G Correia
- General Clinical Research Center (157 MRF), 200 Hawkins Drive, University of Iowa, Iowa City, IA 52242, USA.
| | | |
Collapse
|