Assessment of outcomes other than systolic and diastolic blood pressure: pulse pressure, arterial stiffness and heart rate

The Effect of Dipping Tobacco on Pulse Wave Analysis among Adult Males

BACKGROUND

The current study investigated the effect of dipping tobacco (DT) use on arterial wall stiffness which is a known marker of increased risk of cardiovascular events.

METHODS

A case-control study which included 101 adult males was carried out in Al-Shaab Teaching Hospital. Blood pressure and pulse wave analysis parameters were recorded in 51 DT users (study group) before and after 30 minutes of placing tobacco and in 50 nontobacco users (control group). Anthropometric measurements were collected using data collection sheet. Data were entered into a computer and analyzed by using the software Statistical Package for the Social Sciences (SPSS) version 20 (SPSS Inc., Chicago, IL, USA).

RESULTS

At baseline measurements, heart rate (HR) was significantly lower in the study group compared to the control group (66.15 ± 9.21 vs. 72.87 ± 10.13 beats/min; P value ≤ 0.001). Subendocardial viability ratio (SEVR) was significantly higher in the study group compared to the control group (203.44 ± 30.34 vs. 179.11 ± 30.51%; P value ≤ 0.001). Acute effects of DT compared to pretobacco dipping showed significant increase in HR (72.50 ± 10.89 vs. 66.15 ± 9.21 beats/min; P value ≤ 0.001) and significant decrease in augmentation pressure (AP) (4.30 (2.30-8.00) vs. 3.30 (0.60-6.3) mmHg; P value ≤ 0.001), ejection duration (ED) (271.65 ± 19.42 vs. 279.53 ± 20.47 ms; P value ≤ 0.001), and SEVR (187.11 ± 29.81 vs. 203.44 ± 30.34; P value ≤ 0.001). Linear regression analysis for AP predictor showed that only HR and AIx@75 affect and predict the values of AP (Beta ± SE; -0.242 ± 0.019, P value ≤ 0.001; 0.685 ± 0.014, P value ≤ 0.001).

CONCLUSIONS

Long-term use of DT was not associated with permanent changes in heart rate and blood pressure. Acute tobacco dipping caused an acute increase in heart rate and oxygen demands of myocardium.

Associations between vascular risk factors and subsequent Alzheimer's disease in older adults

Background

The clinical guidelines related to the primary prevention of Alzheimer’s disease (AD) have focused on the management of vascular risk factors. However, the link between vascular risk factors and AD in older adults remains unclear. This study aimed to determine the association between vascular risk factors and subsequent AD in 178,586 older adults (age ≥ 65 years).

Methods

Participants were recruited from 2009 through 2010 and followed up for 6 years. We assessed various vascular risk factors (total cholesterol [TC], low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], triglycerides [TG], fasting glucose [FG], systolic blood pressure [SBP], diastolic blood pressure [DBP], pulse pressure [PP], and body mass index [BMI]) and their association with AD incidence, categorizing each vascular factor using current clinical guidelines.

Results

AD was observed in 6.0% of participants at follow-up. All lipid profiles (TC, LDL-C, HDL-C and TG) were positively associated with the risk of AD. SBP and PP were in negative associations with AD, and DBP was positively associated with AD. BMI exhibited a negative association with AD incidence. We found no significant association between FG and AD risk. The sex difference was observed to have effects on vascular risk factors.

Conclusions

In this study, we comprehensively investigated the association between eight vascular risk factors and the risk of incident AD. Our findings suggest that multiple vascular risk factors are related to the development of AD in older adults. These results can help inform future guidelines for reducing AD risk.

Central haemodynamics in normal pregnancy: a prospective longitudinal study

OBJECTIVE

To conduct a longitudinal evaluation of the central haemodynamic adaptations of normal pregnancy.

METHODS

This was a prospective longitudinal study involving healthy, normotensive women who were having an uncomplicated, singleton pregnancy. Brachial and central SBP, DBP, mean arterial pressure (MAP), brachial and central pulse pressure (PP), aorta-to-brachial pulse pressure amplification (AMPA-B), heart rate (HR), augmentation index adjusted for HR (AIx75), carotid-femoral pulse wave velocity (cfPWV) and cardiac output (CO) were measured at a mean gestational age of 14, 24 and 36 weeks.

RESULTS

One hundred women were followed prospectively throughout pregnancy. Brachial and central SBP, DBP and MAP decreased slightly in early gestation, followed by a significant increase in late gestation (P < 0.05). Brachial PP was lowest in the final trimester (P = 0.011) whereas central PP remained unchanged, resulting in a significant decrease in AMPA-B (P < 0.001). HR and AIx75 rose continuously throughout pregnancy (P < 0.001). A significant fall in cfPWV was observed mid-pregnancy, which remained significant after adjustment for MAP and HR (P < 0.05). CO rose mid-pregnancy, before returning to baseline values by week 36 of gestation (P < 0.05).

CONCLUSION

To our knowledge, this is the largest prospective study to evaluate several central haemodynamic parameters in normotensive pregnancies, including adjusted-AIx and the gold-standard cfPWV. These data are a necessary foundation for the establishment of pregnancy-specific reference values and provide reference data for future trial design.

Peripheral arterial stiffness is independently associated with a rapid decline in estimated glomerular filtration rate in patients with type 2 diabetes

Introduction. Diabetes and its vascular complications are main noncommunicable chronic diseases and major global health issues. Peripheral arterial disease (PAD) is highly prevalent in diabetes with nephropathy. We evaluated the associations of variables of arterial stiffness and the decline in estimated glomerular filtration rate (eGFR) in patients with type 2 diabetes. Materials and Methods. A total of 577 type 2 diabetic patients (mean ± SD: age, 63 ± 11 years) were enrolled. A rapid decline in eGFR was defined as progressively lower eGFR detected at both the 6- and 12-month follow-up visits, plus a reduction in eGFR more than 3 mL·min⁻¹per 1.73 m² per year. Results. Higher glycated hemoglobin (HbA1c), systolic blood pressure (SBP), pulse pressure (PP), and brachial-ankle pulse wave velocity (ba-PWV) at baseline were independently associated with a rapid decline in eGFR. The adjusted odds ratios (95% confidence intervals) for a rapid decline in eGFR for ba-PWV, SBP, and PP were 1.072 (1.011–1.136), 1.014 (1.004–1.025), and 1.025 (1.008–1.041), respectively, after adjustment for gender, age, body mass index, smoking, HbA1c, and baseline eGFR in separated models. Conclusions. Ba-PWV may serve as a simple and noninvasive predictor of rapid renal function progression in type 2 diabetic patients.

Education, household wealth and blood pressure in Albania, Armenia, Azerbaijan and Ukraine: findings from the Demographic Health Surveys, 2005-2009

BACKGROUND

While socioeconomic gradients in cardiovascular disease have been well established in high-income countries, this relationship is not well understood in middle-income countries.

METHODS

Data from Demographic Health Surveys collected in Albania (2008-09), Armenia (2005), Azerbaijan (2006) and Ukraine (2007) were used to estimate age-adjusted differences in systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), hypertension (HTN), elevated blood pressure, and optimal blood pressure across a standardized wealth index, level of educational attainment, and urban versus rural residence.

RESULTS

The wealthiest Albanian females had lower average SBP, DBP, PP (all p<0.01) and HTN status (odds ratio [OR]=0.3, CI: 0.2-0.5, p<0.001) compared to the poorest; similar education gradients were also found. Such disparities also existed for Albanian men. Among Armenian women, urban (OR=1.4, 1.1-1.8, p<0.01), more educated (OR=0.7, CI: 0.6-0.9, p<0.01), and wealthier (OR=1.8, 1.4-2.4, p<0.001) women were more likely to have optimal blood pressure. Urban Armenian men were also more likely to have optimal blood pressure (OR=1.8, 1.2-2.9, p<0.01). Wealthier and urban Azerbaijani had lower risk of elevated blood pressure and Azerbaijani women displayed strong wealth gradients with higher quintiles of wealth associated with lower continuous blood pressure measures. There were no socioeconomic gradients for Ukrainian males or females.

CONCLUSIONS

There is compelling evidence that wealth and education gradients affect the probability of HTN for women in Albania, Armenia, and Azerbaijan, and for men in Albania.

Increased arterial stiffness in HIV-infected children: risk factors and antiretroviral therapy

BACKGROUND

Recent evidence suggests that both the HIV virus and antiretroviral therapy (ART) are associated with premature atherosclerosis in adults. Increased arterial stiffness as assessed by pulse wave velocity (PWV) has been associated with adverse cardiovascular outcome in adults. The relationship between HIV infection and treatment and arterial stiffness has not been evaluated in children.

METHODS

We studied 83 HIV-infected children with a mean +/-sd age of 11.0 +/-3.1 years and 59 controls aged 12.2 +/-2.8 years. Among the HIV-infected children, 48 were receiving ART (23 including a protease inhibitor). Arterial stiffness was assessed non-invasively by carotid-radial PWV. Disease severity was defined according to the CDC classification.

RESULTS

PWV was significantly increased in HIV-infected children compared with controls (P<0.05). A significant association between age and PWV was noted in HIV-infected children but not in controls. HIV-infected children receiving ART had significantly increased total cholesterol levels and PWV compared with non-treated children (P<0.001 and P<0.05, respectively). CDC stage was greater in ART-treated compared with non-treated HIV-infected children (P<0.001). No differences in other cardiovascular risk factors were noted in the two groups. After multivariable analysis, ART, systolic blood pressure, disease severity and total cholesterol remained independent predictors of PWV.

CONCLUSIONS

HIV-infected children have increased arterial stiffness compared with healthy children. These changes were more pronounced with increasing age in HIV-infected children particularly in those who were receiving ART.

Relation between the estimated glomerular filtration rate and pulse wave velocity in Japanese

OBJECTIVE

We investigated the link between renal function as evaluated by estimated glomerular filtration rate (eGFR) and pulse wave velocity (PWV) in Japanese without medications.

METHODS

A total of 1,244 Japanese subjects, aged 20-79 years, were recruited in a cross-sectional clinical investigation study. They received no medications. eGFR was calculated using serum creatinine (Cr), age and sex. Peripheral arterial stiffness was evaluated by brachial-ankle PWV (baPWV).

RESULTS

eGFR and baPWV were significantly correlated with age. eGFR was negatively correlated with baPWV (men: r=-0.308, p<0.0001, women: r=-0.293, p<0.0001). Twenty-six men (5.6%) and 35 women (4.5%) were diagnosed as reduced eGFR (eGFR <60 mL/min/1.73 m(2)). We compared clinical parameters between subjects with reduced eGFR (Group R) and without such reduction (Group N). baPWV in Group R was significantly higher than that in Group N even after adjusting for age. In women, systolic blood pressure in Group R was also significantly higher than that in Group N.

CONCLUSION

eGFR was closely associated with peripheral arterial stiffness in Japanese.

Ambulatory cardiovascular activity and hostility ratings in women with chronic posttraumatic stress disorder

BACKGROUND

The objective of the current study is to evaluate the relationship between hostility and ambulatory cardiovascular activity in women with and without posttraumatic stress disorder (PTSD).

METHODS

One hundred and one women completed 24 hours of ambulatory monitoring and standardized diagnostic and hostility measures. Generalized estimating equations analysis was used to examine the effects of group and hostility factor scores (hostile beliefs, overt hostility, and covert hostility) on ambulatory heart rate (AHR) and ambulatory systolic (ASBP) and diastolic (ADBP) blood pressure.

RESULTS

After controlling for covariates, there was an interaction between PTSD and both hostile beliefs and overt hostility for AHR. Increases in hostility were associated with greater increases in heart rate among women with PTSD relative to those without PTSD. There was a similar interaction between hostile beliefs and group for ADBP.

CONCLUSIONS

Increased AHR and blood pressure have been linked to poor cardiovascular outcomes in nonpsychiatric populations. Individuals with PTSD display increased hostility, a construct that has also been linked to poorer cardiovascular outcomes. Increases in hostile beliefs were associated with a greater increase in ADBP among women with PTSD as compared with control subjects. These data suggest that PTSD might in part moderate the relationship between hostility and cardiovascular outcomes.

Arterial Elasticity Measurement in Renal Transplant Patients Under Anticalcineurin Immunosuppression

INTRODUCTION

Calcineurin inhibitors may be associated with decreased arterial elasticity and increased vascular risk. We measured pulse wave velocity (PWV) in large or small arteries as an index of elasticity. The aim of our study was to determine aortic and radial arterial elasticity in 30 stable kidney transplant patients treated with calcineurin inhibitor immunosuppression.

PATIENTS AND METHODS

In stable kidney transplant patients we determined the usual biochemical parameters as well as lipid profiles, 24-hour blood pressure (BP) monitoring (CBPM) using a chronobiological program (Garapa), and PWV with a HDI-PWV CR-2000 monitor.

RESULTS

Sixteen patients received cyclosporine (CsA, G-1) and 14 tacrolimus (G-2) immunosuppression. There were no baseline differences regarding age (G-1: 56 +/- 12 years, G-2: 56 +/- 14 years), renal transplant follow-up (G-1: 7 +/- 3 years, G-2: 7.5 +/- 3 years), Systolic BP, pulse pressure or plasma creatinine (G-1: 163 +/- 35 umol/L, G-2: 173 +/- 26 umol/L). Patients in the G-1 showed higher diastolic BP (79 +/- 11 vs 74 +/- 8 mm Hg), greater proteinuria (1.26 +/- 0.4 vs 0.6 +/- 0.2 g/d, P < .05), total cholesterol (5.51 +/- 1.2 mmol/L) and low-density lipoprotein (3.08 +/- 0.3 vs 2.99 +/- 0.3 mmol/L, P = NS). Aortic arterial elasticity was decreased in G-1 patients (10.4 +/- 6 vs 14.3 +/- 2 mL/mm Hg x10, P < .05) as well as that in the radial artery (G-1: 5.52 +/- 1 vs 5.57 +/- 1.2 mL/mm Hg x100, P = NS). Almost 100% of the patients presented normal diurnal BP with high nocturnal BP in a nondipper pattern in both groups.

CONCLUSION

Calcineurin immunosuppression may contribute to arterial stiffness in kidney transplant patients. No differences between CsA or tacrolimus were observed in our study. CBPM and PWV are useful tools to evaluate subclinical atherosclerosis in renal transplant patients.

Comparative clinical science: The medicine of the future

This review explores the emergence of Comparative Medicine in the late 19th Century as 'the medicine of the future', its failure to realise these expectations during the 20th century as it became increasingly equated with laboratory animal models of human disease, and explains why there is now an unprecedented opportunity for this latent potential to be fully realised. Comparative medicine no longer rests on apparent similarities between disease mechanisms in different species but on the rapidly maturing ability to relate these similarities to a remarkably rich shared genetic heritage. In the United Kingdom, the creation of the new Medical Research Council Comparative Clinical Science Panel, once securely funded, will provide the infrastructure and strategic focus to foster comparative clinical research, encouraging collaboration between veterinary and human medicine and between investigators in institutes and in practice. This will generate the necessary evidence base for veterinary practice, raise the standard of veterinary research, broaden the horizons of human medicine and create real opportunities for veterinary surgeons to reconcile research with practice. The review explores the broad scope of the science which will flourish in this new environment and examines specific areas in greater depth as examples, notably multifactorial disease such as hypertension and diarrhoea, also aspects of comparative endocrinology and oncology, with emphasis on the growing power conferred by comparative molecular genetics.

Brachial-ankle pulse wave velocity in Japanese university students

OBJECTIVE

Pulse wave velocity (PWV) correlates well with arterial distensibility and stiffness and is a useful non-invasive index to assess arteriosclerosis. The present study was conducted to evaluate the validity of noninvasive brachial-ankle PWV (baPWV) measurements in overweight young adults.

METHODS

Three hundred and fifty-three students were voluntarily enrolled (mean age: 20+/-2, 93 women and 260 men). The subjects were divided into three groups: normal (18.5 < or = body mass index (BMI) <25 n = 120), overweight (25 < or = BMI <30 n = 164) and obese (BMI > or = 30, n = 69). The baPWV was measured using volume-plethymographic apparatus.

RESULTS

Hypertension and hyperlipidemia were diagnosed in one-third of the subjects of the obese group and nonalcoholic fatty liver disease (NAFLD) was diagnosed in 64% of the obese group. The baPWV in male subjects was significantly higher in the obese group than in the overweight group and in the males with NAFLD than in those without NAFLD. The stepwise linear regression analysis showed that PWV was significantly associated with mean blood pressure (p < 0.001) and gamma-GTP (p = 0.03).

CONCLUSION

Mean blood pressure was a powerful determination for baPWV in the university students. BaPWV may be useful to predict the initial stage of arteriosclerosis and conceivably NAFLD including nonalcoholic steatohepatitis (NASH) in obese young adults.