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Priyadarsini N, Singh SC, Sethi P, Mohapatra S, Goyal M, Rao BN. Hemodynamic changes in pregnancy: does central blood pressure have any role? Women Health 2023; 63:150-155. [PMID: 36593559 DOI: 10.1080/03630242.2022.2164115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Pregnancy is associated with alteration in the hemodynamic state. In clinical practice, only peripheral blood pressure is measured; however, central blood pressure is a better predictor of cardiovascular events. We have investigated variations in peripheral blood pressure, central blood pressure, and augmentation index in healthy non-pregnant and pregnant women. This was a cross-sectional study of 107 pregnant women (I trimester n = 19, II trimester n = 39, and III trimester n = 49) and age-matched 53 non-pregnant women (Follicular phase n = 25 and luteal phase n = 28). The augmentation index showed a significant decrease with the progression of pregnancy. Central systolic blood pressure showed a decreasing trend (non-significant) with the progression of pregnancy. Heart rate shows a significant increase from follicular to luteal phase in non-pregnant women, which further increases with the progression of pregnancy. Longitudinal studies involving larger sample sizes might provide some insights into the significance of including central blood pressure and augmentation index for routine checkups in both non-pregnant and pregnant women.
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Affiliation(s)
- Nibedita Priyadarsini
- Department of Physiology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Sajal C Singh
- Department of Physiology, IMS & SUM Hospital, Bhubaneswar, India
| | - Pruthwiraj Sethi
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Subarna Mohapatra
- Department of Physiology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Manish Goyal
- Department of Physiology, All India Institute of Medical Sciences, Bhubaneswar, India
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Hauck AS, Buchwald I, Watz H, Trinkmann F, Söling C, Rabenstein A, Ruether T, Mortensen K, Drömann D, Franzen KF. Impact of Chewing Bags, E-Cigarettes, and Combustible Cigarettes on Arterial Stiffness and Small Airway Function in Healthy Students. TOXICS 2023; 11:77. [PMID: 36668804 PMCID: PMC9866725 DOI: 10.3390/toxics11010077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 12/26/2022] [Accepted: 01/10/2023] [Indexed: 06/17/2023]
Abstract
Several substitute products are discussed as a healthier alternative to smoking, thereunder e-cigarettes and smokeless tobacco products, e.g., chewing bags, which are increasingly used in this context. We investigated the acute effects of chewing bags compared to combustible cigarettes and e-cigarettes with and without nicotine on small airways and arterial stiffness in a head-to-head design. This single-center, four-arm cross-overstudy included 20 healthy occasional smokers (25 ± 0.6 years). On four test days, participants consumed one product per day. Before, during, and after consumption, peripheral and central hemodynamic as well as arterial stiffness parameters were measured by Mobil-O-Graph™ (I.E.M., Germany). Resistance and small airway function were assessed by tremoFlo® c-100 (THORASYS Thoracic Medical Systems Inc.). The combustible cigarette and the e-cigarettes with and without nicotine significantly increased the resistance of the small airways (p < 0.05), while chewing bags had no effect. All nicotine containing products (e-cigarette with nicotine, combustible cigarette, chewing bag) as well as the e-cigarette without nicotine significantly increased parameters of hemodynamic and arterial stiffness. Changes in blood pressure and arterial stiffness were similar after smoking, vaping, and using chewing bags. We conclude that e-cigarettes and combustible cigarettes have similar acute harmful effects on small airway dysfunction. All nicotine containing products are associated with an increased cardiovascular risk compared with no product use.
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Affiliation(s)
- Annabelle Susann Hauck
- Medical Clinic III, Site Lübeck, University Hospital Schleswig-Holstein, 23562 Luebeck, Germany
- Airway Research Center North (ARCN), German Center for Lung Research (DZL), 23562 Luebeck, Germany
| | - Isabel Buchwald
- Medical Clinic III, Site Lübeck, University Hospital Schleswig-Holstein, 23562 Luebeck, Germany
- Airway Research Center North (ARCN), German Center for Lung Research (DZL), 23562 Luebeck, Germany
| | - Henrik Watz
- Airway Research Center North (ARCN), German Center for Lung Research (DZL), 23562 Luebeck, Germany
- Pulmonary Research Institute (PRI) at LungenClinic Grosshansdorf, 22927 Grosshansdorf, Germany
| | - Frederik Trinkmann
- Thoraxklinik Heidelberg, Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), University Hospital Heidelberg, 69120 Heidelberg, Germany
- Department of Biomedical Informatics, Heinrich-Lanz-Center, University Medical Center Mannheim, Heidelberg University, 69120 Heidelberg, Germany
| | - Charlotte Söling
- Medical Clinic III, Site Lübeck, University Hospital Schleswig-Holstein, 23562 Luebeck, Germany
- Airway Research Center North (ARCN), German Center for Lung Research (DZL), 23562 Luebeck, Germany
| | - Andrea Rabenstein
- Klinik für Psychiatrie und Psychotherapie, LMU Klinikum, 80336 Munich, Germany
| | - Tobias Ruether
- Klinik für Psychiatrie und Psychotherapie, LMU Klinikum, 80336 Munich, Germany
| | - Kai Mortensen
- Cardiology Kiel, 24116 Kiel, Germany
- Clinic for Rhythmology, Campus Lübeck, University Hospital Schleswig-Holstein, 23562 Lubeck, Germany
| | - Daniel Drömann
- Medical Clinic III, Site Lübeck, University Hospital Schleswig-Holstein, 23562 Luebeck, Germany
- Airway Research Center North (ARCN), German Center for Lung Research (DZL), 23562 Luebeck, Germany
| | - Klaas Frederik Franzen
- Medical Clinic III, Site Lübeck, University Hospital Schleswig-Holstein, 23562 Luebeck, Germany
- Airway Research Center North (ARCN), German Center for Lung Research (DZL), 23562 Luebeck, Germany
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Negative Impact of the UEFA European Soccer Championship on Central Hemodynamics and Arterial Stiffness: A Multicenter Study. Life (Basel) 2022; 12:life12111696. [DOI: 10.3390/life12111696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 10/02/2022] [Accepted: 10/08/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: watching sporting events may trigger cardiovascular events by elevating emotional stress levels. The underlying reasons and specific populations at risk are not well defined. (2) Methods: we conducted a multicenter prospective trial at three German sites during the UEFA Soccer EC 2012 and 2021 comprising 52 healthy participants (noCVD) and 18 patients hospitalized with cardiovascular disease (CVD). Subjects were studied during matches of the German national team (GP) as well as corresponding matches without German participation (noGP). Peripheral and central blood pressure (BP) and parameters of arterial stiffness were measured (Mobil-O-Graph™, I.E.M., Stolberg, Germany) before, during, and after the matches. (3) Results: in terms of CVD, peripheral as well as central BP and heart rate increased significantly during GP as well as noGP matches and remained elevated beyond the end of the matches. Likewise, arterial stiffness parameters and vascular resistance were higher during the matches and remained elevated after the matches. No consistent significant differences were found between GP and noGP matches. (4) Conclusions: this is the first study on real-life changes in hemodynamics during sport-associated emotional stress, with comparison between noCVD and CVD. We found that alterations were profound in CVD and remained elevated even after the matches.
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Hinrichs T, Portegijs E, Rantanen T, Infanger D, Schmidt-Trucksäss A, Karavirta L. Association between arterial stiffness and walking capacity in older adults. Exp Gerontol 2022; 167:111925. [PMID: 35963452 DOI: 10.1016/j.exger.2022.111925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/08/2022] [Accepted: 08/08/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIM Arterial stiffening - a process that is largely due to intimal thickening, collagen disposition or elastin fragmentation - significantly contributes to cardiovascular events and mortality. There is also some evidence that it may negatively affect physical function. This study aimed to evaluate whether arterial stiffness was associated with measures of walking capacity in a large, population-based sample of highly aged older adults. METHODS A population-based sample of 910 community-dwelling adults (aged 75, 80, or 85 years) were investigated in a cross-sectional observational study. Pulse wave velocity (PWV), a surrogate marker of arterial stiffness, was estimated based on the oscillometric recording of pulse waves at the brachial artery site. Walking capacity was assessed by 10-meter habitual walking speed, 10-meter maximum walking speed, and six-minute walk distance. We used multiple linear regression models to examine possible associations between PWV and parameters of walking capacity, and we adjusted the models for sex, age, socioeconomic status, anthropometry, physician-diagnosed diseases, prescription medication, smoking history, physical activity, and mean arterial pressure. Continuous variables were modelled using restricted cubic splines to account for potential nonlinear associations. RESULTS Mean (standard deviation) 10-meter habitual walking speed, 10-meter maximum walking speed, and six-minute walk distance were 1.3 (0.2) m/s, 1.7 (0.4) m/s, and 413 (85) m, respectively. The fully adjusted regression models revealed no evidence for associations between PWV and parameters of walking capacity (all p-values >0.05). CONCLUSION Our results did not confirm previous findings suggesting a potential negative association between arterial stiffness and walking capacity in old age. Longitudinal studies, potentially taking additional confounders into account, are needed to disentangle the complex relationship between the two factors.
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Affiliation(s)
- Timo Hinrichs
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland.
| | - Erja Portegijs
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, the Netherlands
| | - Taina Rantanen
- Faculty of Sport and Health Sciences and Gerontology Research Center, University of Jyvaskyla, Jyväskylä, Finland
| | - Denis Infanger
- 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
| | - Laura Karavirta
- Faculty of Sport and Health Sciences and Gerontology Research Center, University of Jyvaskyla, Jyväskylä, Finland
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Bai Y, Wang Q, Cheng D, Hu Y, Chao H, Avolio A, Tang B, Zuo J. Comparison of Risk of Target Organ Damage in Different Phenotypes of Arterial Stiffness and Central Aortic Blood Pressure. Front Cardiovasc Med 2022; 9:839875. [PMID: 35497999 PMCID: PMC9046870 DOI: 10.3389/fcvm.2022.839875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 03/14/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives The aim of this study was to explore the risk of target organ damage (TOD) in different groups based on carotid-femoral pulse wave velocity (cfPWV) and central aortic blood pressure (CBP) in different populations. Methods The study cohort was divided into four groups according to the status of cfPWV and CBP [Group (cfPWV/CBP): high cfPWV and high CBP; Group (cfPWV): high cfPWV and normal CBP; Group (CBP): normal cfPWV and high CBP; Group (control): normal cfPWV and normal CBP]. TOD was determined by the assessment of carotid intima-media thickness (CIMT) abnormality, chronic kidney disease (CKD), microalbuminuria, and left ventricular hypertrophy (LVH). Results A total of 1,280 patients (mean age 53.14 ± 12.76 years, 64.1% male patients) were recruited in this study. Regarding Group (control) as reference, LVH was significantly higher in Group (cfPWV) and Group (CBP) [OR 2.406, 95% CI (1.301–4.452), P < 0.05; OR 2.007, 95% CI (1.335–3.017), P < 0.05]; microalbuminuria was significantly higher in Group (cfPWV/CBP) and Group (CBP) [OR 3.219, 95% CI (1.630–6.359), P < 0.05; OR 3.156, 95% CI (1.961–5.079), P < 0.05]. With age stratified by 60 years, the risk of CKD was significantly higher in Group (cfPWV/CBP) [OR 4.019, 95% CI (1.439–11.229), P < 0.05]. Conclusion Different phenotypes based on the status of cfPWV and CBP were associated with different TOD. Individuals with both cfPWV and CBP elevated have a higher risk of microalbuminuria.
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Affiliation(s)
- Yaya Bai
- Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qian Wang
- Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Di Cheng
- Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yueliang Hu
- Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huijuan Chao
- Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Alberto Avolio
- Department of Biomedical Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie (University) Medical School, Sydney, NSW, Australia
| | - Biwen Tang
- Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Biwen Tang
| | - Junli Zuo
- Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Biomedical Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie (University) Medical School, Sydney, NSW, Australia
- Junli Zuo
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Gernun S, Franzen KF, Mallock N, Benthien J, Luch A, Mortensen K, Drömann D, Pogarell O, Rüther T, Rabenstein A. Cardiovascular functions and arterial stiffness after JUUL use. Tob Induc Dis 2022; 20:34. [PMID: 35431721 PMCID: PMC8973023 DOI: 10.18332/tid/144317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 10/31/2021] [Accepted: 11/28/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION METHODS RESULTS CONCLUSIONS
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Affiliation(s)
- Solveig Gernun
- Department of Psychiatry and Psychotherapy, Klinikum der Universität München, Munich, Germany
| | - Klaas F. Franzen
- Medizinische Klinik III, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
- Airway Research Center North, Germany
| | - Nadja Mallock
- Department of Chemical and Product Safety, German Federal Institute for Risk Assessment, Berlin, Germany
- Institute of Pharmacy, Department of Biology, Chemistry and Pharmacy, Freie Universität Berlin, Berlin, Germany
| | - Julia Benthien
- Medizinische Klinik III, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
- Airway Research Center North, Germany
| | - Andreas Luch
- Department of Chemical and Product Safety, German Federal Institute for Risk Assessment, Berlin, Germany
- Institute of Pharmacy, Department of Biology, Chemistry and Pharmacy, Freie Universität Berlin, Berlin, Germany
| | | | - Daniel Drömann
- Medizinische Klinik III, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
- Airway Research Center North, Germany
| | - Oliver Pogarell
- Department of Psychiatry and Psychotherapy, Klinikum der Universität München, Munich, Germany
| | - Tobias Rüther
- Department of Psychiatry and Psychotherapy, Klinikum der Universität München, Munich, Germany
| | - Andrea Rabenstein
- Department of Psychiatry and Psychotherapy, Klinikum der Universität München, Munich, Germany
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Hu Y, Zhao J, Wang Q, Chao H, Tang B, Cheng D, Tan I, Butlin M, Avolio A, Wang W, Zuo J. Disparate Associations of 24-h Central Aortic and Brachial Cuff Blood Pressure With Hypertension-Mediated Organ Damage and Cardiovascular Risk. Front Cardiovasc Med 2022; 9:795509. [PMID: 35274011 PMCID: PMC8902413 DOI: 10.3389/fcvm.2022.795509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 01/04/2022] [Indexed: 11/27/2022] Open
Abstract
Objective Aim of this study was to evaluate the associations of non-invasive central aortic and peripheral (brachial) blood pressure (BP) for Hypertension-mediated organ damage (HMOD) and atherosclerotic cardiovascular disease (ASCVD) risk. Methods We evaluated associations of HMOD with 24-h ambulatory blood pressure monitoring (ABPM) of central aortic and peripheral BP indices in patients with primary hypertension and presence of several cardiovascular risk factors. BP measurements were performed by means of a non-invasive automated oscillometric device (Mobil-O-Graph). HMOD was defined as the presence of carotid intima-media thickness (IMT) above normal values and/or carotid plaque, left ventricular hypertrophy (LVH), and/or renal abnormalities as assessed by urine albumin/creatinine ratio above normal values and/or estimated glomerular filtration rate (eGFR) <60 ml/min per 1.73 m2. Results In the study cohort of 273 (age 55.2 ± 13.4 years, 71.8% male) patients with primary hypertension, documented HMOD was present in 180 (65.9%), LVH in 70 (25.6%), increased IMT in 129 (47.3%). Fifty-six patients (20.5%) had kidney organ damage (20.5% albuminuria and 2.6% impaired eGFR). When accounting for confounding factors (age, sex, body-mass-index, antihypertensive treatment, smoking, triacylglycerol, statin treatment, glucose, hypoglycemic therapy, or heart rate) only peripheral 24-h pulse pressure (PP) maintained statistical significance with HMOD indices (OR: 1.126, 95% CI: 1.012~1.253; p = 0.029). Using ASCVD risk score as the independent continuous variable in multiple linear regression, 24-h central systolic pressure (SBP) (β = 0.179; 95% CI:0.019~0.387; p = 0.031), daytime central PP (β = 0.114; 95% CI:0.070~0.375; p = 0.005, night-time central SBP (β = 0.411; 95% CI:0.112~0.691; p = 0.007) and night-time PP (β = 0.257; 95% CI:0.165~0.780; p = 0.003) were all positively associated with ASCVD risk. Conclusions Blood pressure obtained by 24-h ABPM was better correlated with HMOD than office BP. Whilst 24-h peripheral BP showed a stronger association with HMOD than 24-h central BP, the prognostic value of 24-h central BP for the 10-year ASCVD risk was superior to 24-h peripheral BP.
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Affiliation(s)
- Yueliang Hu
- Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiehui Zhao
- Daning Community Health Service Center, Shanghai, China
| | - Qian Wang
- Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huijuan Chao
- Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Biwen Tang
- Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Di Cheng
- Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Isabella Tan
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Mark Butlin
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Alberto Avolio
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | | | - Junli Zuo
- Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
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Argyris AA, Mouziouras D, Samara S, Zhang Y, Georgakis MK, Blacher J, Safar M, Sfikakis PP, Protogerou AD. Superiority of 24-Hour Aortic Over 24-Hour Brachial Pressure to Associate With Carotid Arterial Damage on the Basis of Pressure Amplification Variability: the SAFAR Study. Hypertension 2022; 79:648-658. [PMID: 34991345 DOI: 10.1161/hypertensionaha.121.17906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Evidence suggests marginal superiority of static aortic systolic blood pressure (aSBP) compared with brachial SBP regarding the association with organ damage and prognosis of cardiovascular disease. The noninvasive 24-hour aSBP assessment is feasible and associates better with presence of left ventricular hypertrophy compared with 24-hour brachial systolic blood pressure. We aimed at comparing the association of 24-hour aSBP and 24-hour brachial systolic blood pressure with indices of arterial damage and examining the role of 24-hour SBP amplification variability (within-subjects' SD) in this association. METHODS Consecutive subjects referred for cardiovascular disease risk assessment underwent 24-hour aortic and brachial ambulatory BP monitoring using a validated oscillometric device (Mobil-O-Graph). Arterial damage was assessed by carotid intima-media thickness and detection of carotid and femoral atheromatosis (plaque presence). RESULTS Cross-sectionally 501 individuals (aged 54±13 years, 57% men, 80% hypertensives) were examined. Multivariable analysis revealed superiority of 24-hour aSBP regarding the association with intimal-medial thickness, carotid hypertrophy and carotid-but not femoral-atheromatosis. In receiver operator characteristics analysis, 24-hour aBP displayed a higher discriminatory ability-compared to 24-hour brachial systolic blood pressure-for the detection of both carotid hypertrophy (area under the curve, 0.662 versus 0.624, P<0.05) and carotid atheromatosis (area under the curve, 0.573 versus 0.547, P<0.05). This effect was more prominent in individuals with above-median 24-hour SD of SBP amplification. CONCLUSIONS Our results suggest that 24-hour aSBP assessment may be of significant value in clinical practice to detect site-specific arterial damage on the basis of pressure amplification variability and should be prospectively examined in clinical trials.
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Affiliation(s)
- Antonios A Argyris
- Cardiovascular Prevention and Research Unit, Clinic/Laboratory of Pathophysiology, Laiko Hospital, Medical School, National and Kapodistrian University of Athens, Greece (A.A.A., D.M., S.S., A.D.P.)
| | - Dimitrios Mouziouras
- Cardiovascular Prevention and Research Unit, Clinic/Laboratory of Pathophysiology, Laiko Hospital, Medical School, National and Kapodistrian University of Athens, Greece (A.A.A., D.M., S.S., A.D.P.)
| | - Stamatia Samara
- Cardiovascular Prevention and Research Unit, Clinic/Laboratory of Pathophysiology, Laiko Hospital, Medical School, National and Kapodistrian University of Athens, Greece (A.A.A., D.M., S.S., A.D.P.)
| | - Yi Zhang
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China (Y.Z.)
| | - Marios K Georgakis
- Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Germany (M.K.G.)
| | - Jacques Blacher
- Université de Paris; AP-HP; Diagnosis and Therapeutic Center, Hôtel-Dieu, Paris, France (J.B., M.S.)
| | - Michel Safar
- Université de Paris; AP-HP; Diagnosis and Therapeutic Center, Hôtel-Dieu, Paris, France (J.B., M.S.)
| | - Petros P Sfikakis
- 1st Department of Propaedeutic Medicine, Laiko Hospital, Medical School, National and Kapodistrian University of Athens, Greece (P.P.S.)
| | - Athanase D Protogerou
- Cardiovascular Prevention and Research Unit, Clinic/Laboratory of Pathophysiology, Laiko Hospital, Medical School, National and Kapodistrian University of Athens, Greece (A.A.A., D.M., S.S., A.D.P.)
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9
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El Fol A, Ammar W, Sharaf Y, Youssef G. The central arterial stiffness parameters in decompensated versus compensated states of heart failure: a paired comparative cohort study. Egypt Heart J 2022; 74:2. [PMID: 34978636 PMCID: PMC8724513 DOI: 10.1186/s43044-021-00236-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 12/22/2021] [Indexed: 11/10/2022] Open
Abstract
Background Arterial stiffness is strongly linked to the pathogenesis of heart failure and the development of acute decompensation in patients with stable chronic heart failure. This study aimed to compare arterial stiffness indices in patients with heart failure with reduced ejection fraction (HFrEF) during the acute decompensated state, and three months later after hospital discharge during the compensated state. Results One hundred patients with acute decompensated HFrEF (NYHA class III and IV) and left ventricular ejection fraction ≤ 35% were included in the study. During the initial and follow-up visits, all patients underwent full medical history taking, clinical examination, transthoracic echocardiography, and non-invasive pulse wave analysis by the Mobil-O-Graph 24-h device for measurement of arterial stiffness. The mean age was 51.6 ± 6.1 years and 80% of the participants were males. There was a significant reduction of the central arterial stiffness indices in patients with HFrEF during the compensated state compared to the decompensated state. During the decompensated state, patients presented with NYHA FC IV (n = 64) showed higher AI (24.5 ± 10.0 vs. 16.8 ± 8.6, p < 0.001) and pulse wave velocity (9.2 ± 1.3 vs. 8.5 ± 1.2, p = 0.021) than patients with NYHA FC III, and despite the relatively smaller number of females, they showed higher stiffness indices than males. Conclusions Central arterial stiffness indices in patients with HFrEF were significantly lower in the compensated state than in the decompensated state. Patients with NYHA FC IV and female patients showed higher stiffness indices in their decompensated state of heart failure.
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Affiliation(s)
- Ahmed El Fol
- Cardiovascular Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Waleed Ammar
- Cardiovascular Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Yasser Sharaf
- Cardiovascular Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ghada Youssef
- Cardiovascular Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
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10
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Gökçay Canpolat A, Demir Ö, Şahin M, Emral R, Çorapçıoğlu D. The missing link between inflammation and arterial stiffness among different metabolic phenotypes. Int J Clin Pract 2021; 75:e14727. [PMID: 34383387 DOI: 10.1111/ijcp.14727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 07/27/2021] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES Although metabolically healthy obesity (MHO) has begun to be seen as a being benign phenomenon, this conclusion is still not completely certain. Obesity is also associated with low-grade systemic inflammation and endothelial dysfunction. Thus, we aimed to assess Pulse Wave Velocity (PWV) as a marker of arterial stiffness and CV risk among individuals with MHO, metabolically unhealthy obesity (MUO), and metabolically healthy normal-weight (MHN). METHODS 150 participants (n = 50 MHO, n = 50 MUO, n = 50 MHN) who had been admitted to our outpatient clinics were enrolled in this cross-sectional study. Demographic, anthropometric, clinical, and laboratory data, including hs-CRP and PWV, were recorded for all subjects. RESULTS hs-CRP and PWV were higher in MUO and MHO than MHN individuals (P < .05). hs-CRP showed a strong positive correlation with PWV (r = 0.85, P < .001). After adjusting for other risk factors, multivariate linear regression analysis showed that the PWV was independently associated with BMI (β = 0.08, P = .03), WC (β = 0.04, P = .04) and hs-CRP (β = 6.08, P < .001). CONCLUSIONS PWV, which is an important non-invasive marker of cardiovascular risk, is higher in MHO than in MHN as in MUO individuals. Moreover, PWV was positively correlated with the serum hs-CRP level as a conventional marker for systemic inflammation. Thus, MHO can be seen as a cardiometabolic risk marker.
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Affiliation(s)
- Asena Gökçay Canpolat
- Department of Endocrinology and Metabolism, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Özgür Demir
- Department of Endocrinology and Metabolism, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Mustafa Şahin
- Department of Endocrinology and Metabolism, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Rıfat Emral
- Department of Endocrinology and Metabolism, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Demet Çorapçıoğlu
- Department of Endocrinology and Metabolism, Ankara University Faculty of Medicine, Ankara, Turkey
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11
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Takemoto R, Uchida HA, Toda H, Okada K, Otsuka F, Ito H, Wada J. Total vascular resistance, augmentation index, and augmentation pressure increase in patients with peripheral artery disease. Medicine (Baltimore) 2021; 100:e26931. [PMID: 34397939 PMCID: PMC8360418 DOI: 10.1097/md.0000000000026931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 07/21/2021] [Indexed: 01/04/2023] Open
Abstract
Peripheral arterial disease (PAD) is one of major vascular diseases which frequently coexists with coronary arterial disease and cerebrovascular disease. The patients with PAD have a poor prognosis when it progresses. A new blood pressure testing device enables to simultaneously measure brachial blood pressure (BP), central BP, and several vascular parameters, with easy and non-invasive, in a short time. Here, we aimed to evaluate these arterial stiffness parameters in patients with PAD.In this study, 243 consecutive patients who were suspected of having PAD and referred to our hospital from September 2016 to June 2019, were registered. Several parameters, such as brachial BP, central BP, aortic pulse wave velocity (aPWV), total vascular resistance (TVR), augmentation index (AI) and augmentation pressure (AP), were determined by Mobil-O-Graph. Ankle-brachial pressure index (ABI) was used to define PAD (ABI ≤ 0.9 as PAD). The relationship between PAD and central BP, aPWV, TVR, AI, or AP were investigated.One hundred sixty-two patients (67%) were categorized as the PAD group and 81 patients (33%) as the non-PAD group. In the PAD group, the systolic brachial BP and central systolic BP were significantly higher than those in the non-PAD group (138 ± 24 mmHg vs 131 ± 19 mmHg, P < .05, 125 ± 22 mmHg vs 119 ± 18 mmHg, P < .05, respectively). TVR, AI, and AP were significantly higher in the PAD group (1785 ± 379 dyn s/cm5 vs 1661 ± 317 dyn s/cm5, P < .05, 26.2 ± 13.0% vs 22.2 ± 13.3%, P < .05, 13.5 ± 9.4 mmHg vs 10.7 ± 7.2 mmHg, P < .05, respectively). No significant differences in diastolic BP, central diastolic BP, and aPWV were found between the groups. Multivariate logistic regression analysis revealed that PAD was significantly associated with TVR, AI, and AP (P < .05, respectively).TVR/AP/AI were significantly higher in the PAD group than in the non-PAD group.
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Affiliation(s)
- Rika Takemoto
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
- Ultrasound Diagnostics Center, Okayama University Hospital, Okayama, Japan
| | - Haruhito A. Uchida
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
- Department of Chronic Kidney Disease and Cardiovascular Disease, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hironobu Toda
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Ken Okada
- Department of Medical Support, Okayama University Hospital, Okayama, Japan
| | - Fumio Otsuka
- Ultrasound Diagnostics Center, Okayama University Hospital, Okayama, Japan
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Jun Wada
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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12
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Xiong J, Qian Y, Yu S, Ji H, Teliewubai J, Chi C, Lu Y, Zhou Y, Fan X, Li J, Blacher J, Zhang Y, Xu Y. Somatotype and Its Impact on Asymptomatic Target Organ Damage in the Elderly Chinese: The Northern Shanghai Study. Clin Interv Aging 2021; 16:887-895. [PMID: 34054294 PMCID: PMC8153068 DOI: 10.2147/cia.s302468] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 04/13/2021] [Indexed: 11/23/2022] Open
Abstract
Objective To investigate the relationship between asymptomatic target organ damage (TOD) and different somatotypes in a population of elderly from Chinese community-dwelling. Methods A total of 2098 Chinese senior residents from northern Shanghai older than 65 years were recruited in the research. The following somatotype parameters were recorded and analyzed: body mass index, waist circumference, hip circumference, and waist-hip ratio were recorded and calculated. Asymptomatic TOD, including urine albumin/creatinine ratio, estimated glomerular filtration rate (eGFR), intima-media thickness (IMT), left ventricular mass index (LVMI), left ventricular diastolic function, and carotid-femoral pulse wave velocity (PWV) was recorded using the MyLab30 Gold CV system and SphygmoCor. Results Of all 2098 residents, 817 (38.9%) were overweight and 289 (13.8%) were obese. All somatotype measures were significantly correlated with TOD parameters (p<0.05). After adjustment for age and male gender, in total population, LVMI (p<0.001), cardiac diastolic function (E/Ea, p<0.001), PWV (p<0.001), eGFR (p=0.03), and urine albumin/creatinine ratio (p<0.001) changed gradually and significantly correlated with increasing BMI values. Obesity and overweight were independently related to the incidence of LVH, LVDD, artery stiffness, carotid arterial plaque, and microalbuminuria. Conclusion The incidence of asymptomatic TOD was significantly correlated with overweight and obesity, especially in women, whereas the underweight may favor in the prevention of TOD.
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Affiliation(s)
- Jing Xiong
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Yunyun Qian
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Shikai Yu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - HongWei Ji
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Jiadela Teliewubai
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Chen Chi
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - YuYan Lu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - YiWu Zhou
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - XiMin Fan
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Jue Li
- The Research Institute of Clinical Epidemiology, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Jacques Blacher
- Paris Descartes University, AP-HP, Diagnosis and Therapeutic Center, Hôtel-Dieu, Paris, France
| | - Yi Zhang
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - YaWei Xu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
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13
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Sex differences in arterial wave reflection and the role of exogenous and endogenous sex hormones: results of the Berlin Aging Study II. J Hypertens 2021; 38:1040-1046. [PMID: 32371793 DOI: 10.1097/hjh.0000000000002386] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Arterial stiffness is tightly linked to hypertension. Sex differences in hypertension and arterial stiffness have already been established, yet the role of sex hormones is not precisely defined. This study examined age and sex differences of arterial wave reflection and associations with endogenous and exogenous sex hormones in women. METHODS Pulse wave analysis was performed with an oscillometric device in 590 male and 400 female participants of the Berlin Aging Study II. Participants have been recruited from two age-strata, 22-35 years and 60-82 years. Data on exposures and potential confounders, including medication, have been collected at baseline visit. RESULTS Aumentation index (AIx) and pulse wave velocity increased with age. Mean AIx was higher in women than in men. Multivariable regression analysis showed a positive association between use of oral contraceptive pills (OCPs) and AIx controlling for confounders (age, BMI, current smoking, central blood pressure), with a significantly higher mean AIx in OCP-users compared with nonusers (mean group difference: 4.41; 95% confidence interval 1.61-7.22). Per quartile decrease in estradiol level AIx increased by 1.72 (95% confidence interval 0.43-3.00). In OCP users endogenous estradiol was largely suppressed. CONCLUSION The findings suggest important sex differences in measures of arterial wave reflection, with a higher mean AIx observed in women compared with men. OCPs may promote the development of hypertension by increasing AIx. Suppressed endogenous estradiol levels may be responsible for this increased wave reflection due to increased vasotonus of the small and medium arteries.
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14
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Mendes-Pinto D, Rodrigues-Machado MDG, Navarro TP, Dardik A. Association Between Critical Limb Ischemia, the Society for Vascular Surgery Wound, Ischemia and Foot Infection (WIfI) Classification System and Arterial Stiffness. Ann Vasc Surg 2020; 63:250-258.e2. [DOI: 10.1016/j.avsg.2019.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 07/25/2019] [Accepted: 07/29/2019] [Indexed: 12/17/2022]
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15
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Ried K. Garlic lowers blood pressure in hypertensive subjects, improves arterial stiffness and gut microbiota: A review and meta-analysis. Exp Ther Med 2019; 19:1472-1478. [PMID: 32010325 PMCID: PMC6966103 DOI: 10.3892/etm.2019.8374] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 08/09/2019] [Indexed: 01/20/2023] Open
Abstract
Garlic supplements have shown effectiveness in reducing blood pressure in hypertensive patients, similarly to first-line standard anti-hypertensive medications. Kyolic garlic has also shown promise in improving cardiovascular health by reducing arterial stiffness, elevated cholesterol levels and blood 'stickiness'. In addition, the prebiotic properties in garlic increase gut microbial richness and diversity. This article systematically reviews previously published trials investigating the effects of garlic on blood pressure, and provides an updated meta-analysis of hypertensive participants. In addition, we summarise the findings of recent clinical trials investigating the effects of Kyolic aged garlic extract on arterial stiffness, and gut microbiota in hypertensive subjects. We searched online electronic databases, including PubMed and Google Scholar for randomised controlled trials (RCTs) published between 1955 and December, 2018 examining the effects of garlic on high blood pressure. The meta-analysis of 12 trials and 553 hypertensive participants confirmed that garlic supplements lower systolic blood pressure (SBP) by an average of 8.3±1.9 mmHg and diastolic blood pressure (DBP, n=8 trials, n=374 subjects) by 5.5±1.9 mmHg, similarly to standard anti-hypertensive medications. This reduction in blood pressure was associated with a 16-40% reduction in the risk of suffering from cardiovascular events. Additionally, this review summarises new evidence for the vitamin B12 status playing an important role in the responsiveness of blood pressure to garlic. Furthermore, Kyolic aged garlic extract significantly lowered central blood pressure, pulse pressure, pulse wave velocity and arterial stiffness, and improved the gut microbiota, evidenced by higher microbial richness and diversity, with a marked increase in the numbers of Lactobacillus and Clostridia species found following 3 months of supplementation. Thus, Kyolic aged garlic extract is considered to be highly tolerable with a high safety profile either as a stand-alone or adjunctive anti-hypertensive treatment, with multiple benefits for cardiovascular health.
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Affiliation(s)
- Karin Ried
- National Institute of Integrative Medicine (NIIM), Hawthorn, Melbourne, Victoria 3122, Australia.,Department of General Practice, The University of Adelaide, South Australia 5000, Australia.,Torrens University, Melbourne, Victoria 3000, Australia
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16
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Cho EJ, Lee HY, Sung KC, Park S, Sohn IS, Park CG, Choi DJ, Ha JW, Ahn YK, Shin J, Hong SJ, Kim SK, Chung WJ, Yoo BS, Hong TJ, Youn HJ, Cho MC, Chae SC, Kim YJ, Kim CJ. Comparison of 24-Hour Ambulatory Central Blood Pressure Reduction Efficacy Between Fixed Amlodipine or Up-Titrated Hydrochlorothiazide Plus Losartan: The K-Central Study. Am J Hypertens 2019; 32:992-1002. [PMID: 31099387 PMCID: PMC6758941 DOI: 10.1093/ajh/hpz050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 03/18/2019] [Accepted: 05/10/2019] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE The main objective of this study was to evaluate non-inferiority of office mean systolic blood pressure (BP) reduction efficacy and superiority of 24-hour ambulatory central BP reduction efficacy between losartan combined with fixed dose amlodipine (L/A group) and dose up-titrated hydrochlorothiazide (L/H group) according to office BP. METHODS We conducted a prospective, randomized, double-blind multicenter trial in 231 patients with hypertensive (mean age = 59.2 ± 12.2 years). Patients received losartan 50 mg monotherapy for 4 weeks, followed by additional use of amlodipine 5 mg or hydrochlorothiazide 12.5 mg for 20 weeks after randomization. The patients who did not achieve the BP goal after 4 weeks' randomization received an increased dose of 100 mg/5 mg for the L/A group and 100 mg/25 mg for L/H group, respectively. The 24-hour ambulatory central BP was measured at baseline and after 20 weeks' treatment. RESULTS Office mean systolic BP reduction of L/A group was not inferior to L/H group after 4 weeks' treatment (-17.6 ± 13.3 vs. -14.4 ± 12.6 mm Hg, P = 0.0863) and was not significantly different after 20 weeks' treatment. (-15.7 ± 14.0 vs. -14.7 ± 15.1 mm Hg, P = 0.6130) The 24-hour ambulatory central systolic BP was significantly more reduced in the L/A group compared with that in the L/H group after 20 weeks' treatment (-9.37 ± 10.67 vs. -6.28 ± 10.50 mm Hg, P = 0.0407). The 24-hour ambulatory central systolic BP at the completion of the study and its reduction magnitude were independently associated with reductions in aortic pulse wave velocity, pulse pressure, and wave reflection magnitude. CONCLUSION Office systolic BP reduction with L/A was not inferior to L/H after 4 week's treatment. The combination of losartan and amlodipine was more favorable in 24-hour ambulatory central hemodynamics beyond BP-lowering efficacy than the combination of losartan and hydrochlorothiazide, regardless of office BP. CLINICAL TRIALS REGISTRATION NCT02294539.
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Affiliation(s)
- Eun Joo Cho
- Division of Cardiology, Department of Internal Medicine, St. Paul’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Hae Young Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Ki Chul Sung
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, Seoul, Korea
| | - Sungha Park
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University, Seoul, Korea
| | - Il-Suk Sohn
- Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Chang Gyu Park
- Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Dong-Ju Choi
- Division of Cardiology, Department of Internal Medicine, Bundang Seoul National University Hospital, Seongnam, Korea
| | - Jong Won Ha
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University, Seoul, Korea
| | - Young Keun Ahn
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Jinho Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University Hospital, Seoul, Korea
| | - Soon-Jun Hong
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Soon Kil Kim
- Division of Cardiology, Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea
| | - Wook-Jin Chung
- Division of Cardiology, Department of Internal Medicine, Gil Hospital, Gachon University, Incheon, Korea
| | - Byung Su Yoo
- Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Taek Jong Hong
- Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Pusan, Korea
| | - Ho Joong Youn
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Myeong-Chan Cho
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Shung Chull Chae
- Division of Cardiology, Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Young Jo Kim
- Division of Cardiology, Department of Internal Medicine, Yeungnam University Hospital, Daegu, Korea
| | - Chong-Jin Kim
- Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea
- Correspondence: Chong-Jin Kim ()
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Oliveira AND, Simões MM, Simões R, Malachias MVB, Rezende BA. Cardiovascular Risk in Psoriasis Patients: Clinical, Functional and Morphological Parameters. Arq Bras Cardiol 2019; 113:242-249. [PMID: 31340236 PMCID: PMC6777896 DOI: 10.5935/abc.20190123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 11/21/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Psoriasis correlates with metabolic disorders, early atheromatosis and increased cardiovascular risk. OBJECTIVES To assess markers of cardiovascular disease in psoriatic patients. METHODS Cross-sectional, observational study involving 11 psoriatic participants and 33 controls. Anthropometric, biochemical, hemodynamic and imaging parameters were evaluated. Arterial stiffness was assessed by oscillometric measurement of the brachial artery. Intima-media thickness (IMT) and left ventricular diastolic function were assessed by Doppler echography and echocardiography. Between-group comparisons of numerical variables were performed by the Student's t-test or Wilcoxon Mann-Whitney test for independent samples. Significance level was set at 5%. RESULTS Psoriatic patients showed increased pulse wave velocity (PWV) (9.1 ± 1.8 vs 8.0 ± 2 m/s, p = 0.033), IMT of the left common carotid artery (p = 0.018) and a higher percentage of patients above the 75th percentile according to the ELSA table when compared with controls (54.5 vs 18.2%, p = 0.045). Psoriatic patients also showed an increase in peripheral/central systolic blood pressure (137.1 ± 13.2 vs 122.3 ± 11.6 mmHg, p = 0.004)/(127 ± 13 vs 112.5 ± 10.4 mmHg, p = 0.005), peripheral/central diastolic blood pressure (89.9 ± 8.9 vs 82.2 ± 8, p = 0.022)/(91 ± 9.3 vs 82.2 ± 8.3, p = 0.014), total cholesterol (252 ± 43.5 vs 198 ± 39.8 mg/dL, p < 0.001), LDL cholesterol (167 ± 24 vs 118 ± 40.8 mg/dL, p < 0.001) and C-reactive protein (7.6 ± 35.4 vs 1 ± 1.2 mg/L p < 0.001) compared with controls. CONCLUSION Psoriasis patients show increased PWV, IMT, peripheral and central blood pressures, and serum cholesterol and C-reactive protein levels, denoting a higher cardiovascular risk.
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Affiliation(s)
| | - Marcela M Simões
- Faculdade de Ciências Medicas de Minas Gerais - Instituto de Pós-Graduação, Belo Horizonte, MG - Brazil
| | - Ricardo Simões
- Faculdade de Ciências Medicas de Minas Gerais - Instituto de Pós-Graduação, Belo Horizonte, MG - Brazil
| | | | - Bruno Almeida Rezende
- Faculdade de Ciências Medicas de Minas Gerais - Instituto de Pós-Graduação, Belo Horizonte, MG - Brazil
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18
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Mendes-Pinto D, Ribeiro JM, Rodrigues-Machado MDG. Association between critical limb ischemia and arterial stiffness measured by brachial artery oscillometry. J Vasc Bras 2019; 18:e20180073. [PMID: 31258553 PMCID: PMC6582766 DOI: 10.1590/1677-5449.007318] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 11/03/2018] [Indexed: 11/22/2022] Open
Abstract
Background Elevated arterial stiffness is associated with increased cardiovascular mortality. The relationship between arterial stiffness and critical limb ischemia (CLI) is not well established. Objectives The objective of this study is to analyze the relationship between arterial stiffness indices and the degree of limb ischemia measured by the ankle-brachial index (ABI). Methods A cross-sectional study comparing patients with CLI and controls. Arterial stiffness was measured using brachial artery oscillometry. The arterial stiffness indices pulse wave velocity (PWV) and augmentation index normalized to 75 beats/min (AIx@75) were determined. Multiple linear regression was applied to identify predictors of arterial stiffness indices. Results Patients in the CLI group had higher PWV (12.1±1.9 m/s vs. 10.1±1.9 m/s, p < 0.01) and AIx@75 (31.8±7.8% vs. 17.5±10.8%, p < 0.01) than controls. Central systolic pressure was higher in the CLI group (129.2±18.4 mmHg vs. 115.2±13.1 mmHg, p < 0.01). There was an inverse relationship between AIx@75 and ABI (Pearson coefficient = 0.24, p = 0.048), but there was no relationship between ABI and PWV (Pearson coefficient = 0.19, p = 0.12). In multiple regression analysis, reduced ABI was a predictor of elevated levels of AIx@75 (β = -25.02, p < 0.01). Conclusions Patients with CLI have high arterial stiffness measured by brachial artery oscillometry. The degree of limb ischemia, as measured by the ABI, is a predictor of increased AIx@75. The increased AIx@75 observed in CLI may have implications for the prognosis of this group of patients with advanced atherosclerosis.
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Affiliation(s)
- Daniel Mendes-Pinto
- Hospital Felício Rocho, Departamento de Cirurgia Vascular, Belo Horizonte, MG, Brasil.,Faculdade de Ciências Médicas de Minas Gerais - FCM-MG, Belo Horizonte, MG, Brasil
| | - José Márcio Ribeiro
- Faculdade de Ciências Médicas de Minas Gerais - FCM-MG, Belo Horizonte, MG, Brasil.,Hospital Felício Rocho, Departamento de Cardiologia, Belo Horizonte, MG, Brasil
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19
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Mendes-Pinto D, Rodrigues-Machado MDG. Applications of arterial stiffness markers in peripheral arterial disease. J Vasc Bras 2019; 18:e20180093. [PMID: 31236104 PMCID: PMC6579524 DOI: 10.1590/1677-5449.009318] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 01/04/2019] [Indexed: 11/21/2022] Open
Abstract
Arterial stiffness has been analyzed in many different population groups with the objective of identifying cardiovascular risk early and performing specific therapeutic interventions. Increased arterial stiffness affects the capacity of the aorta and elastic arteries to adapt to pressure variations during the cardiac cycle. The main markers of arterial stiffness are pulse wave velocity (PWV), augmentation index (AIx) and central aortic pressure. They can be measured noninvasively. Patients with coronary disease or on hemodialysis who have elevated PWV or AIx have increased mortality. The association with peripheral arterial disease has been studied little. The objective of this review is to demonstrate the applicability and utility of assessing measures of arterial stiffness in patients with peripheral arterial disease.
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Affiliation(s)
- Daniel Mendes-Pinto
- Departamento de Cirurgia Vascular, Hospital Felício Rocho, Belo Horizonte, MG, Brasil.,Faculdade Ciências Médicas de Minas Gerais - FCMMG, Belo Horizonte, MG, Brasil
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20
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Obayashi M, Kobayashi S, Kohno M, Nakashima T, Yano M. Cuff-Based Oscillometric Measurements of Central Hemodynamics: Factors Influencing Central Augmentation Pressure in Normotensive Japanese Individuals. Pulse (Basel) 2019; 6:161-168. [PMID: 31049316 DOI: 10.1159/000496151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 12/07/2018] [Indexed: 11/19/2022] Open
Abstract
Background Recently, new devices using oscillometric cuff have been developed to derive central blood pressure (BP) waveform from brachial BP waveform. Late systolic pressure augmentation of central BP waveform is a marker of central hemodynamics. Mobil-O-Graph, a cuff-based oscillometric device, can assess central augmentation pressure (AP) together with central BP. Central AP measurement using the Mobil-O-Graph in the European population was reported to be associated with age and sex. However, factors influencing central AP in the Asian population have not been shown. Objectives and Methods We enrolled 110 normotensive volunteers (50 men; age range, 21‒76 years). Central BP and AP were measured using the Mobil-O-Graph on the left arm with the subjects in the seated position after resting for at least 5 min. We compared central hemodynamics between the sexes. We investigated factors influencing central AP in uni- and multivariate linear regression analyses and age-related change in central AP using the Mobil-O-Graph in healthy Japanese individuals. Results Central AP were lower in men than in women (5.5 ± 2.8 vs. 11.0 ± 4.7 mm Hg, p < 0.001). The central AP in the total cohort was positively correlated with age (r = 0.325, p < 0.001) and inversely correlated with height (r = -0.601, p < 0.001) in the Pearson correlations. In multivariate regression analysis, the parameters influencing central AP (R>sup<2>/sup< = 0.467) were age (β = 0.097, p < 0.001), sex (β = -2.890, p = 0.010), and height (β = -0.153, p = 0.031). The central AP (10.0 ± 4.8 mm Hg) in the ≥50-year-old group significantly increased compared with those in the 20- to 39-year-old group (6.7 ± 4.2 mm Hg, p < 0.05). Conclusions Age, sex, and height influenced central AP, as assessed using the Mobil-O-Graph. Age-related increase in central AP was observed in normotensive Japanese individuals. Brachial cuff-based waveform recordings using the Mobil-O-Graph are feasible for the estimation of central AP in the Asian population.
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Affiliation(s)
- Masakazu Obayashi
- Department of Cardiovascular Medicine, Sanyo-Onoda City Hospital, Sanyo-Onoda, Japan
| | - Shigeki Kobayashi
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Michiaki Kohno
- Department of Cardiovascular Medicine, Sanyo-Onoda City Hospital, Sanyo-Onoda, Japan.,Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Tomoko Nakashima
- Department of Cardiovascular Medicine, Sanyo-Onoda City Hospital, Sanyo-Onoda, Japan
| | - Masafumi Yano
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
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Ried K, Travica N, Sali A. The Effect of Kyolic Aged Garlic Extract on Gut Microbiota, Inflammation, and Cardiovascular Markers in Hypertensives: The GarGIC Trial. Front Nutr 2018; 5:122. [PMID: 30619868 PMCID: PMC6297383 DOI: 10.3389/fnut.2018.00122] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 11/22/2018] [Indexed: 12/14/2022] Open
Abstract
Background: Previous research suggests Kyolic-aged-garlic-extract to be effective in reducing blood pressure in a large proportion of hypertensive patients similar to first-line standard antihypertensive medication. High blood pressure has been linked to gut dysbiosis, with a significant decrease in microbial richness and diversity in hypertensives compared to normotensives. Furthermore, gut dysbiosis has been associated with increased inflammatory status and risk of cardiovascular events. Objective: To assess the effect of Kyolic aged GARlic extract on Gut microbiota, Inflammation, and Cardiovascular markers, including blood pressure, pulse wave velocity and arterial stiffness. Methods: A total of 49 participants with uncontrolled hypertension completed a double-blind randomized placebo-controlled trial of 12-weeks, investigating the effect of daily intake of aged-garlic-extract (1.2 g containing 1.2 mg S-allylcysteine) or placebo on blood pressure, pulse wave velocity and arterial stiffness, inflammatory markers, and gut microbiota. Results: Mean blood pressure was significantly reduced by 10 ± 3.6 mmHg systolic and 5.4 ± 2.3 mmHg diastolic compared to placebo. Vitamin B12 status played a role in responsiveness to garlic on blood pressure in 17% of patients. Garlic significantly lowered central blood pressure, pulse pressure and arterial stiffness (p < 0.05). Trends observed in inflammatory markers TNF-α and IL-6 need to be confirmed in larger trials. Furthermore, aged-garlic-extract improved gut microbiota, evident by higher microbial richness and diversity with a marked increase in Lactobacillus and Clostridia species after 3 months of supplementation. Conclusions: Kyolic-aged-garlic-extract is effective in reducing blood pressure in patients with uncontrolled hypertension, and has the potential to improve arterial stiffness, inflammation, and gut microbial profile. Aged-garlic-extract is highly tolerable with a high safety profile as a stand-alone or adjunctive antihypertensive treatment, with multiple benefits for cardiovascular health. Trial Registration: Australian New Zealand Clinical Trial Registry ACTRN12616000185460 (https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370096).
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Affiliation(s)
- Karin Ried
- National Institute of Integrative Medicine, Melbourne, VIC, Australia.,Discipline of General Practice, The University of Adelaide, Adelaide, SA, Australia.,Faculty of Health Science and Medicine, Bond University, Gold Coast, QLD, Australia
| | - Nikolaj Travica
- National Institute of Integrative Medicine, Melbourne, VIC, Australia
| | - Avni Sali
- National Institute of Integrative Medicine, Melbourne, VIC, Australia
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22
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Aortic systolic pressure derived with different calibration methods: associations to brachial systolic pressure in the general population. Blood Press Monit 2018; 23:134-140. [PMID: 29608470 DOI: 10.1097/mbp.0000000000000319] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND There is increasing evidence that the method of calibration directly influences the association between brachial systolic blood pressure (bSBP) and estimated aortic systolic blood pressure (aSBP) and subsequently affects prognostic and diagnostic differentiation power of the latter. OBJECTIVE The aim of this study was to investigate associations between different methods of systolic pressure assessment in a large cohort and its comparison with recently published evidence. PARTICIPANTS AND METHODS During a public health campaign, cardiovascular hemodynamic data were assessed using a validated oscillometric device in a pharmacy setting. The device measures bSBP, mean arterial pressure, and diastolic blood pressure (DBP), and records brachial waveforms at the DBP level. aSBP1 was derived using bSBP and DBP and aSBP2 using measured mean arterial pressure and DBP for waveform calibration. In addition to pressures, age, sex, and anthropometric data were recorded. Regression analysis was carried out to investigate associations. RESULTS A total of 7409 (5133/2276, female/male) individuals with a median age of 54 years were sampled. aSBPs differed significantly from bSBP (126.0 mmHg) for aSBP1 (117.0 mmHg) and aSBP2 (127.5 mmHg, both P<0.0001). Regression analysis showed that aSBP2 (R=0.853) is significantly less associated with bSBP than aSBP1 (R=0.937) (Williams' test, P<0.001 for comparison). Subgroup analysis showed the major influence of sex and heart rate. The association between bSBP, aSBP1 (R=0.83), and aSBP2 (R=0.66), respectively, reduced significantly for borderline hypertensives (P<0.001 for comparison). CONCLUSION In contrast to aSBP1, the association between bSBP and aSBP2 is significantly less dominant and therefore aSBP2 may have potential prognostic superiority over bSBP.
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23
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Solanki JD, Mehta HB, Shah CJ. Pulse wave analyzed cardiovascular parameters in young first degree relatives of hypertensives. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2018; 23:72. [PMID: 30181754 PMCID: PMC6116665 DOI: 10.4103/jrms.jrms_581_16] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 04/03/2018] [Accepted: 06/14/2018] [Indexed: 11/07/2022]
Abstract
Background: First-degree relatives (FDRs) of hypertensive (HT) are predisposed to hypertension (HTN) which accelerates cardiovascular aging. Same can be studied noninvasively by pulse wave analysis (PWA), encompassing central hemodynamics such as central blood pressure (cBP), cardiac output, and stroke work (SW) and vascular stiffness parameters such as pulse wave velocity (PWV) and augmentation index at HR 75 (AIx@75). We studied PWA-derived cardiovascular parameters in FDRs of HT compared to controls. Materials and Methods: We conducted a case–control study in 119 FDRs of HT and 119 matched controls. Oscillometric PWA was performed by Mobil-o-Graph (IEM, Germany) and cardiovascular parameters were compared. P < 0.05 was considered statistically significant. Results: Groups were comparable with gender, age, height, weight, body mass index, and physical activity. FDRs of HT had significantly higher brachial and cBPs, SW (101.41 ± 25.44 vs. 88.31 ± 20.25, P = 0.001), rate pressure product-119.40 ± 25.34 vs. 108.34 ± 18.17, P < 0.0001), PWV (5.22 ± 0.46, P < 0.0001), and AIx@75 (31.48 ± 9.01 vs. 27.95 ± 9.4, P = 0.002) than control. Dependent study variables correlated with brachial blood pressure more in magnitude and significance level than age or anthropometric variables. PWA results of FDR with maternal inheritance did not differ significantly from those with paternal inheritance. Conclusion: PWA reveals early cardiovascular aging in young FDRs of HTs. It clues to future cardiovascular disease including HTN itself, need for primary prevention, and further study for consolidation of these results.
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Affiliation(s)
| | - Hemant B Mehta
- Department of Physiology, Government Medical College, Bhavnagar, Gujarat, India
| | - Chinmay J Shah
- Department of Physiology, Government Medical College, Bhavnagar, Gujarat, India
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24
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Franzen KF, Willig J, Cayo Talavera S, Meusel M, Sayk F, Reppel M, Dalhoff K, Mortensen K, Droemann D. E-cigarettes and cigarettes worsen peripheral and central hemodynamics as well as arterial stiffness: A randomized, double-blinded pilot study. Vasc Med 2018; 23:419-425. [PMID: 29985113 DOI: 10.1177/1358863x18779694] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The introduction of electronic cigarettes has led to widespread discussion on the cardiovascular risks compared to conventional smoking. We therefore conducted a randomized cross-over study of the acute use of three tobacco products, including a control group using a nicotine-free liquid. Fifteen active smokers were studied during and after smoking either a cigarette or an electronic cigarette with or without nicotine (eGo-T CE4 vaporizer). Subjects were blinded to the nicotine content of the electronic cigarette and were followed up for 2 hours after smoking a cigarette or vaping an electronic cigarette. Peripheral and central blood pressures as well as parameters of arterial stiffness were measured by a Mobil-O-Graph® device. The peripheral systolic blood pressure rose significantly for approximately 45 minutes after vaping nicotine-containing liquid ( p<0.05) and for approximately 15 minutes after smoking a conventional cigarette ( p<0.01), whereas nicotine-free liquids did not lead to significant changes during the first hour of follow-up. Likewise, heart rate remained elevated approximately 45 minutes after vaping an electronic cigarette with nicotine-containing liquid and over the first 30 minutes after smoking a cigarette in contrast to controls. Elevation of pulse wave velocity was independent from mean arterial pressure as well as heart rate in the electronic cigarette and cigarette groups. In this first of its kind trial, we observed changes in peripheral and central blood pressure and also in pulse wave velocity after smoking a cigarette as well as after vaping a nicotine-containing electronic cigarette. These findings may be associated with an increased long-term cardiovascular risk.
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Affiliation(s)
- Klaas Frederik Franzen
- 1 Medizinische Klinik III, Campus Luebeck, Universitätsklinikum Schleswig-Holstein, Luebeck, Germany
| | - Johannes Willig
- 1 Medizinische Klinik III, Campus Luebeck, Universitätsklinikum Schleswig-Holstein, Luebeck, Germany
| | - Silja Cayo Talavera
- 1 Medizinische Klinik III, Campus Luebeck, Universitätsklinikum Schleswig-Holstein, Luebeck, Germany
| | - Moritz Meusel
- 2 Medizinische Klinik II, Campus Luebeck, Universitätsklinikum Schleswig-Holstein, Luebeck, Germany
| | | | - Michael Reppel
- 4 Practice for Cardiology and Angiology Landsberg, Landsberg, Germany
| | - Klaus Dalhoff
- 1 Medizinische Klinik III, Campus Luebeck, Universitätsklinikum Schleswig-Holstein, Luebeck, Germany.,5 German Center for Lung Research (DZL), ARCN, Kiel/Luebeck/Großhansdorf/Borstel, Germany
| | | | - Daniel Droemann
- 1 Medizinische Klinik III, Campus Luebeck, Universitätsklinikum Schleswig-Holstein, Luebeck, Germany.,5 German Center for Lung Research (DZL), ARCN, Kiel/Luebeck/Großhansdorf/Borstel, Germany
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25
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Comparison of pulse wave velocity and pulse pressure amplification in association with target organ damage in community-dwelling elderly: The Northern Shanghai Study. Hypertens Res 2018. [PMID: 29535455 DOI: 10.1038/s41440-018-0027-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
This study aimed to investigate the discrepancy between pulse wave velocity (PWV) and pulse pressure amplification (PPA) in association with hypertensive target organ damage (TOD) in the elderly. From June 2014 to August 2015, 1599 participants aged >65 years old from communities located in northern Shanghai were recruited. Carotid-femoral pulse wave velocity (cfPWV), peripheral blood pressure (BP), central BP and other TOD indicators, including the ratio of the early ventricular filling velocity (E) to the peak velocity of the tissue Doppler velocity of septal mitral annulus (E/Ea), left ventricular mass index (LVMI), carotid intima-medium thickness (CIMT), estimated glomerular filtration rate (eGFR), and urinary albumin-creatinine ratio (ACR), were determined for each participant. PPA was defined as the peripheral-to-central pulse pressure ratio. In multivariable linear regression analysis, cfPWV was significantly associated with CIMT (β = 12.83 ± 4.28 μm per SD; P = 0.003) and eGFR (β = -1.85 ± 0.69 ml/min/1.73 m2 per SD; P = 0.007), whereas PPA was significantly associated with E/Ea (β = -0.25 ± 0.10 per SD; P = 0.01) and LVMI (β = -3.00 ± 0.78 g/m2 per SD; P < 0.001). Similarly, in multivariable logistic regression analysis, cfPWV was significantly associated with arterial plaque (odds ratio [OR], 1.21 [95% confidence interval [CI], 1.05-1.39]; P = 0.007), peripheral artery disease (OR, 1.22 [95% CI, 1.06-1.42]; P = 0.007), chronic kidney diseases (OR, 1.24 [95% CI, 1.01-1.54]; P = 0.04) and microalbuminuria (OR, 1.21 [95% CI, 1.07-1.37]; P = 0.002), while PPA was tightly associated with left ventricular hypertrophy (OR, 0.85 [95% CI, 0.72-0.99]; P = 0.04) and diastolic dysfunction (OR, 0.78 [95% CI, 0.64-0.96]; P = 0.02). In conclusion, cfPWV is a vessel-related and renal-related biomarker, while PPA is a cardiac-related biomarker in community-based elderly.
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26
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Mechanisms of pulse pressure amplification dipping pattern during sleep time: the SAFAR study. ACTA ACUST UNITED AC 2017; 12:117-127. [PMID: 29287945 DOI: 10.1016/j.jash.2017.12.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 12/07/2017] [Accepted: 12/10/2017] [Indexed: 11/20/2022]
Abstract
The difference in pulse pressure (PP) between peripheral arteries and the aorta, called pulse pressure amplification (PPamp), is a well-described physiological phenomenon independently associated with cardiovascular events. Recent studies suggest that it exhibits circadian variability. Our aim was to detect the factors associated with the circadian variability of PPamp. In 497 consecutive subjects (aged 54 years, 56.7% male, 79.7% hypertensives), we assessed the circadian pattern of peripheral and central arterial hemodynamics by 24-hour evaluation of brachial and aortic blood pressure (BP), augmentation index (AI), and pulse wave velocity (PWV) using a validated oscillometric device (Mobil-O-Graph). All parameters exhibited a circadian variation. Sleep dipping (decrease) pattern was observed for PPamp, brachial and aortic systolic BP, mean BP, and PWV, whereas a rising pattern (higher sleep than wake values) was observed for brachial PP, aortic PP, and AI. The factors independently associated with the less sleep dipping in PPamp were older age, lower height, the use of antihypertensive medication, and sleep decrease in arterial stiffness (PWV), whereas female gender, the presence of hypertension, sleep increase of pressure wave reflections (AI), sleep decrease in heart rate, and mean BP were associated with a greater sleep-dipping in PPamp. These data provide further pathophysiological understanding of the mechanisms leading to PPamp dipping. Several implications regarding the clinical use of the aortic and brachial BP, especially during sleep time, are raised that should be addressed in future research.
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27
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Martini D, Rossi S, Biasini B, Zavaroni I, Bedogni G, Musci M, Pruneti C, Passeri G, Ventura M, Di Nuzzo S, Galli D, Mirandola P, Vitale M, Dei Cas A, Bonadonna RC, Del Rio D. Claimed effects, outcome variables and methods of measurement for health claims proposed under European Community Regulation 1924/2006 in the framework of protection against oxidative damage and cardiovascular health. Nutr Metab Cardiovasc Dis 2017; 27:473-503. [PMID: 28434807 DOI: 10.1016/j.numecd.2017.01.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 01/30/2017] [Accepted: 01/31/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS The high number of negative opinions from the European Food Safety Authority (EFSA) to the requests for authorization of health claims is largely due to the design of human intervention studies, including the inappropriate choice of outcome variables (OVs) and of their methods of measurement (MMs). The present manuscript reports the results of an investigation aimed to collect, collate and critically analyse the information in relation to claimed effects, OVs and MMs, in the context of protection against oxidative damage and cardiovascular health compliant with Regulation 1924/2006. METHODS AND RESULTS Claimed effects, OVs and the related MMs were collected from EFSA Guidance documents and applications for authorization of health claims under Articles 13.5 and 14. The OVs and their MMs were evaluated only if the claimed effect was sufficiently defined and was considered beneficial by EFSA. The collection, collation and critical analysis of the relevant scientific literature consisted in the definition of the keywords, the PubMed search strategies and the creation of databases of references. The critical analysis of the OVs and their MMs was performed on the basis of the literature review and was aimed at defining the appropriateness of OVs and MMs in the context of the specific claimed effects. CONCLUSIONS The information provided in this document could serve to EFSA for the development of further guidance on the scientific requirements for health claims, as well as to the stakeholders for the proper design of human intervention studies aimed to substantiate such health claims.
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Affiliation(s)
- D Martini
- The Laboratory of Phytochemicals in Physiology, Department of Food and Drug, University of Parma, Parma, Italy
| | - S Rossi
- The Laboratory of Phytochemicals in Physiology, Department of Food and Drug, University of Parma, Parma, Italy
| | - B Biasini
- The Laboratory of Phytochemicals in Physiology, Department of Food and Drug, University of Parma, Parma, Italy
| | - I Zavaroni
- Department of Medicine and Surgery, Division of Endocrinology, University of Parma, Italy; Azienda Ospedaliera Universitaria of Parma, Parma, Italy
| | - G Bedogni
- Clinical Epidemiology Unit, Liver Research Center, Basovizza, Trieste, Italy
| | - M Musci
- Department of Food and Drug, University of Parma, Parma, Italy
| | - C Pruneti
- Department of Medicine and Surgery, Clinical Psychology Unit, University of Parma, Medical School Building, Parma, Italy
| | - G Passeri
- Department of Medicine and Surgery, Building Clinica Medica Generale, University of Parma, Parma, Italy
| | - M Ventura
- Department of Chemistry, Life Sciences and Environmental Sustainability, Laboratory of Probiogenomics, University of Parma, Parma, Italy
| | - S Di Nuzzo
- Department of Medicine and Surgery, Section of Dermatology, University of Parma, Parma, Italy
| | - D Galli
- Department of Medicine and Surgery, Sport and Exercise Medicine Centre (SEM), University of Parma, Parma, Italy
| | - P Mirandola
- Department of Medicine and Surgery, Sport and Exercise Medicine Centre (SEM), University of Parma, Parma, Italy
| | - M Vitale
- Department of Medicine and Surgery, Sport and Exercise Medicine Centre (SEM), University of Parma, Parma, Italy
| | - A Dei Cas
- Department of Medicine and Surgery, Division of Endocrinology, University of Parma, Italy; Azienda Ospedaliera Universitaria of Parma, Parma, Italy
| | - R C Bonadonna
- Department of Medicine and Surgery, Division of Endocrinology, University of Parma, Italy; Azienda Ospedaliera Universitaria of Parma, Parma, Italy
| | - D Del Rio
- The Laboratory of Phytochemicals in Physiology, Department of Food and Drug, University of Parma, Parma, Italy.
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28
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Comparison of central and peripheral hemodynamics in association with left ventricular diastolic dysfunction in the community-based elderly Chinese. ACTA ACUST UNITED AC 2017; 11:366-375. [PMID: 28528875 DOI: 10.1016/j.jash.2017.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 03/12/2017] [Accepted: 04/06/2017] [Indexed: 01/31/2023]
Abstract
The aim of the study was to investigate the association of left ventricular diastolic dysfunction (LVDD) with central and peripheral hemodynamics. A total of 1599 community-based senior residents (aged ≥ 65 years) in northern Shanghai, China, were recruited as of August 2015. Echocardiography was performed for each participant using the MyLab30 Gold CV system. According to the recommendations from the American Society of Echocardiography, the ratio of E (peak early diastolic transmitral flow velocity) to E' (early diastolic lateral mitral annulus velocity) was assessed for the evaluation of LVDD. Central blood pressure (BP) components were measured using the SphygmoCor system. In community older population (72.7 ± 6.01 years), brachial systolic BP (mm Hg) was higher than central systolic BP (141.9 ± 19.5 vs. 130.3 ± 20.1 mm Hg). A total of 214 subjects (13.4%) showed LVDD, and female showed higher prevalence of diastolic dysfunction than male (17.3% vs. 8.4%, P < .01). After adjustment for confounding variables, only central systolic BP, not brachial systolic BP, was significantly associated with E/E' in the total population. Similar result was found in the subgroup analysis (participants without antihypertensive agents treatment, man, woman). Similar findings were obtained for the pulse pressure (PP) analysis. Within central hemodynamics, only central PP, but not central systolic BP or augmentation pressure, was significantly associated with E/E' after adjustment. When LVDD was defined by E/E' and other echocardiographic parameters, our findings remained unaltered in the multivariate logistic regression with similar adjustment in the total population and subgroup analysis. In the Chinese elderly cohort, central hemodynamics, especially central PP, is superior to other BP components in identifying LVDD (NCT02368938).
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29
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Kizilirmak Yilmaz F, Babur Guler G, Kaya O, Guler E, Gunhan Demir G, Gunes HM, Olgun FE, Barutcu İ, Boztosun B. Relationship between arterial stiffness parameters and the extent and severity of coronary artery disease. COR ET VASA 2017. [DOI: 10.1016/j.crvasa.2016.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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30
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Schmaderer C, Tholen S, Hasenau AL, Hauser C, Suttmann Y, Wassertheurer S, Mayer CC, Bauer A, Rizas KD, Kemmner S, Kotliar K, Haller B, Mann J, Renders L, Heemann U, Baumann M. Rationale and study design of the prospective, longitudinal, observational cohort study "rISk strAtification in end-stage renal disease" (ISAR) study. BMC Nephrol 2016; 17:161. [PMID: 27784272 PMCID: PMC5080708 DOI: 10.1186/s12882-016-0374-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 10/15/2016] [Indexed: 01/14/2023] Open
Abstract
Background The ISAR study is a prospective, longitudinal, observational cohort study to improve the cardiovascular risk stratification in endstage renal disease (ESRD). The major goal is to characterize the cardiovascular phenotype of the study subjects, namely alterations in micro- and macrocirculation and to determine autonomic function. Methods/design We intend to recruit 500 prevalent dialysis patients in 17 centers in Munich and the surrounding area. Baseline examinations include: (1) biochemistry, (2) 24-h Holter Electrocardiography (ECG) recordings, (3) 24-h ambulatory blood pressure measurement (ABPM), (4) 24 h pulse wave analysis (PWA) and pulse wave velocity (PWV), (5) retinal vessel analysis (RVA) and (6) neurocognitive testing. After 24 months biochemistry and determination of single PWA, single PWV and neurocognitive testing are repeated. Patients will be followed up to 6 years for (1) hospitalizations, (2) cardiovascular and (3) non-cardiovascular events and (4) cardiovascular and (5) all-cause mortality. Discussion/conclusion We aim to create a complex dataset to answer questions about the insufficiently understood pathophysiology leading to excessively high cardiovascular and non-cardiovascular mortality in dialysis patients. Finally we hope to improve cardiovascular risk stratification in comparison to the use of classical and non-classical (dialysis-associated) risk factors and other models of risk stratification in ESRD patients by building a multivariable Cox-Regression model using a combination of the parameters measured in the study. Clinical trials identifier ClinicalTrials.gov NCT01152892 (June 28, 2010)
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Affiliation(s)
- Christoph Schmaderer
- Department of Nephrology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany.
| | - Susanne Tholen
- Department of Nephrology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - Anna-Lena Hasenau
- Department of Nephrology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - Christine Hauser
- Department of Nephrology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - Yana Suttmann
- Department of Nephrology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - Siegfried Wassertheurer
- Health & Environment Department, AIT Austrian Institute of Technology GmbH, Biomedical Systems, Donau-City-Str. 1, 1220, Vienna, Austria
| | - Christopher C Mayer
- Health & Environment Department, AIT Austrian Institute of Technology GmbH, Biomedical Systems, Donau-City-Str. 1, 1220, Vienna, Austria
| | - Axel Bauer
- Medizinische Klinik und Poliklinik I, Department of Cardiology, Klinikum Großhadern, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, Munich, Germany
| | - Kostantinos D Rizas
- Medizinische Klinik und Poliklinik I, Department of Cardiology, Klinikum Großhadern, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, Munich, Germany
| | - Stephan Kemmner
- Department of Nephrology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - Konstantin Kotliar
- FH Aachen, University of applied sciences, Heinrich-Mussmann-Str. 1, 52428, Jülich, Germany
| | - Bernhard Haller
- Institute of medical statistics and epidemiology (IMSE), Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - Johannes Mann
- Städtisches Klinikum Schwabing, KFH Dialysezentrum Schwabing, Kölner Platz 1, 80804, Munich, Germany
| | - Lutz Renders
- Department of Nephrology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - Uwe Heemann
- Department of Nephrology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - Marcus Baumann
- Department of Nephrology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
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Changes in Central Aortic Pressure Levels, Wave Components and Determinants Associated with High Peripheral Blood Pressure States in Childhood: Analysis of Hypertensive Phenotype. Pediatr Cardiol 2016; 37:1340-50. [PMID: 27388527 DOI: 10.1007/s00246-016-1440-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 06/23/2016] [Indexed: 12/29/2022]
Abstract
The aims were to determine whether children's high peripheral blood pressure states (HBP) are associated with increased central aortic blood pressure (BP) and to characterize hemodynamic and vascular changes associated with HBP in terms of changes in cardiac output (stroke volume, SV), arterial stiffness (aortic pulse wave velocity, PWV), peripheral vascular resistances (PVR) and net and relative contributions of reflected waves to the aortic pulse amplitude. We included 154 subjects (mean age 11; range 4-16 years) assigned to one of two groups: normal peripheral BP (NBP, n = 101), defined as systolic and diastolic BP < 90th percentile, or high BP (HBP, n = 53), defined as average systolic and/or diastolic BP levels ≥90th percentile (curves for sex, age and body height). The HBP group included children with hypertensive and pre-hypertensive BP levels. After a first analysis, groups were compared excluding obese and dyslipidemic children. Peripheral and central aortic BP, PWV and pulse wave-derived parameters (augmentation index, forward and backward wave components' amplitude) were measured using gold-standard techniques, applanation tonometry (SphygmoCor) and oscillometry (Mobil-O-Graph). Independent of the presence of dyslipidemia and/or obesity, aortic systolic and pulse BP were higher in HBP than in NBP children. The increase in central BP could not be explained by an increase in the relative contribution of reflections to the aortic pressure wave, higher PVR or by an augmented peripheral reflection coefficient. Instead, the rise in central BP would be explained by an increase in the amplitude of both incident and reflected wave components.
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32
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Hillebrand M, Nouri G, Hametner B, Parragh S, Köster J, Mortensen K, Schwarz A, von Kodolitsch Y, Wassertheurer S. Ambulatory (24 h) blood pressure and arterial stiffness measurement in Marfan syndrome patients: a case control feasibility and pilot study. BMC Cardiovasc Disord 2016; 16:81. [PMID: 27151044 PMCID: PMC4858860 DOI: 10.1186/s12872-016-0263-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 04/29/2016] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The aim of this work is the investigation of measures of ambulatory brachial and aortic blood pressure and indices of arterial stiffness and aortic wave reflection in Marfan patients. METHODS A case-control study was conducted including patients with diagnosed Marfan syndrome following Ghent2 nosology and healthy controls matched for sex, age and daytime brachial systolic blood pressure. For each subject a 24 h ambulatory blood pressure and 24 h pulse wave analysis measurement was performed. RESULTS All parameters showed a circadian pattern whereby pressure dipping was more pronounced in Marfan patients. During daytime only Marfan patients with aortic root surgery showed increased pulse wave velocity. In contrast, various nighttime measurements, wave reflection determinants and circadian patterns showed a significant difference. CONCLUSIONS The findings of our study provide evidence that ambulatory measurement of arterial stiffness parameters is feasible and that these determinants are significantly different in Marfan syndrome patients compared to controls in particular at nighttime. Further investigation is therefore indicated.
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Affiliation(s)
- Matthias Hillebrand
- Universitäres Herzzentrum Hamburg, Universitätskrankenhaus Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Ghazaleh Nouri
- Universitäres Herzzentrum Hamburg, Universitätskrankenhaus Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Bernhard Hametner
- AIT Austrian Institute of Technology, Donau-City Str. 1, 1220, Vienna, Austria
| | - Stephanie Parragh
- AIT Austrian Institute of Technology, Donau-City Str. 1, 1220, Vienna, Austria
| | - Jelena Köster
- Universitätsklinikum Schleswig-Holstein, Medizinische Klinik II, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Kai Mortensen
- Universitätsklinikum Schleswig-Holstein, Medizinische Klinik II, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Achim Schwarz
- IEM GmbH, Cockerillstr. 69, 52222, Stolberg, Germany
| | - Yskert von Kodolitsch
- Universitäres Herzzentrum Hamburg, Universitätskrankenhaus Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
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Assessment of systolic aortic pressure and its association to all cause mortality critically depends on waveform calibration. J Hypertens 2016; 33:1884-8; discussion 1889. [PMID: 26147388 DOI: 10.1097/hjh.0000000000000633] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The aim of this study is the prospective investigation of the association of brachial SBP (bSBP) and aortic SBP (aSBP) to all-cause mortality, with special emphasis on different calibration methods for central pressure estimates, in particular, brachial systolic and diastolic, as well as brachial mean and diastolic pressures. METHOD One hundred and fifty-nine patients were enrolled in a longitudinal, prospective study of arterial stiffness and cardiovascular risk in a chronic kidney disease stages 2-4 cohort. Office measurements of bSBP and aSBP were assessed by a validated oscillometric device. Prognostic factors of survival were identified by use of Cox proportional-hazards regression models. RESULTS After a mean follow-up duration of 42 months (range 30-50 months), 13 patients died. In univariate Cox analysis, bSBP and aSBP calibrated using bSBP and bDBP did not significantly predict mortality, only aSBP assessed using measured mean and diastolic pressure calibration was significantly associated with mortality (hazard ratio 1.027, P = 0.008). This remained significant in multivariate analysis after adjustment for age, sex, and anthropometric measures. More important, adding bSBP to the multivariate model (hazard ratio 0.91, P = 0.003) lead to a significantly increased prognostic power of aortic systolic pressure (hazard ratio 1.097, P < 0.001) and indicated that differences between bSBP and aSBP are of potential interest. CONCLUSION Within our cohort, only aSBP assessed with measured mean and diastolic pressure independently predicted mortality and provided additional prognostic value on top of bSBP readings. Therefore, the method of calibration plays an important role for predictive power of aSBP.
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Ried K, Travica N, Sali A. The effect of aged garlic extract on blood pressure and other cardiovascular risk factors in uncontrolled hypertensives: the AGE at Heart trial. Integr Blood Press Control 2016; 9:9-21. [PMID: 26869811 PMCID: PMC4734812 DOI: 10.2147/ibpc.s93335] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background Hypertension affects 30% of adults worldwide. Garlic supplements have shown promise in the treatment of uncontrolled hypertension, and the mechanism of action is biologically plausible. Our trial is the first to assess the effect of aged garlic extract on central blood pressure and arterial stiffness, regarded as important risk factors for cardiovascular morbidity. Subjects and methods A total of 88 general practice patients and community members with uncontrolled hypertension completed a double-blind randomized placebo-controlled trial of 12 weeks investigating the effect of daily intake of aged garlic extract (1.2 g containing 1.2 mg S-allylcysteine) or placebo on blood pressure, and secondary outcome measures of central-hemodynamics and other cardiovascular markers, including cholesterol, homocysteine, platelet function, and inflammatory markers. Results Mean blood pressure was significantly reduced by 5.0±2.1 mmHg (P=0.016) systolic, and in responders by 11.5±1.9 mmHg systolic and 6.3±1.1 mmHg diastolic compared to placebo (P<0.001). Central hemodynamic-measures tended to improve in the garlic group more than in the placebo group, including central blood pressure, central pulse pressure, mean arterial pressure, augmentation pressure, pulse-wave velocity, and arterial stiffness. While changes in other cardiovascular markers did not reach significance due to small numbers in subgroups with elevated levels, trends in beneficial effects of garlic on the inflammatory markers TNFα, total cholesterol, low-density lipid cholesterol, and apolipoproteins were observed. Aged garlic extract was highly tolerable and acceptable, and did not increase the risk of bleeding in patients on blood-thinning medication. Conclusion Our trial suggests that aged garlic extract is effective in reducing peripheral and central blood pressure in a large proportion of patients with uncontrolled hypertension, and has the potential to improve arterial stiffness, inflammation, and other cardiovascular markers in patients with elevated levels. Aged garlic extract was highly tolerable with a high safety profile as a stand-alone or adjunctive antihypertensive treatment.
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Affiliation(s)
- Karin Ried
- National Institute of Integrative Medicine, Melbourne, Australia; Faculty of Health Science and Medicine, Bond University, Gold Coast, Australia; Department of General Practice, University of Adelaide, Adelaide, Australia
| | - Nikolaj Travica
- National Institute of Integrative Medicine, Melbourne, Australia
| | - Avni Sali
- National Institute of Integrative Medicine, Melbourne, Australia
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Castro JM, García-Espinosa V, Curcio S, Arana M, Chiesa P, Giachetto G, Zócalo Y, Bia D. Childhood Obesity Associates Haemodynamic and Vascular Changes That Result in Increased Central Aortic Pressure with Augmented Incident and Reflected Wave Components, without Changes in Peripheral Amplification. Int J Vasc Med 2016; 2016:3129304. [PMID: 26881081 PMCID: PMC4737025 DOI: 10.1155/2016/3129304] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 12/20/2015] [Indexed: 11/18/2022] Open
Abstract
The aims were to determine if childhood obesity is associated with increased central aortic blood pressure (BP) and to characterize haemodynamic and vascular changes associated with BP changes in obese children and adolescents by means of analyzing changes in cardiac output (stroke volume, SV), arterial stiffness (aortic pulse wave velocity, PWV), peripheral vascular resistances (PVR), and net and relative contributions of reflected waves to the aortic pulse wave amplitude. We included 117 subjects (mean/range age: 10 (5-15) years, 49 females), who were obese (OB) or had normal weight (NW). Peripheral and central aortic BP, PWV, and pulse wave-derived parameters (augmentation index, amplitude of forward and backward components) were measured with tonometry (SphygmoCor) and oscillometry (Mobil-O-Graph). With independence of the presence of dyslipidemia, hypertension, or sedentarism, the aortic systolic and pulse BP were higher in OB than in NW subjects. The increase in central BP could not be explained by the elevation in the relative contribution of reflections to the aortic pressure wave and higher PVR or by an augmented peripheral reflection coefficient. Instead, the rise in central BP could be explained by an increase in the amplitude of both incident and reflect wave components associated to augmented SV and/or PWV.
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Affiliation(s)
- Juan M. Castro
- Physiology Department, Faculty of Medicine, CUiiDARTE, Republic University, General Flores 2125, 11800 Montevideo, Uruguay
| | - Victoria García-Espinosa
- Physiology Department, Faculty of Medicine, CUiiDARTE, Republic University, General Flores 2125, 11800 Montevideo, Uruguay
| | - Santiago Curcio
- Physiology Department, Faculty of Medicine, CUiiDARTE, Republic University, General Flores 2125, 11800 Montevideo, Uruguay
| | - Maite Arana
- Pediatric Clinic “C”, Pereira-Rossell Hospital Centre, Faculty of Medicine, Republic University, Bulevar Artigas 1550, 11600 Montevideo, Uruguay
| | - Pedro Chiesa
- Pediatric Cardiology Service, Pereira-Rossell Hospital Centre, ASSE, Bulevar Artigas 1550, 11600 Montevideo, Uruguay
| | - Gustavo Giachetto
- Pediatric Clinic “C”, Pereira-Rossell Hospital Centre, Faculty of Medicine, Republic University, Bulevar Artigas 1550, 11600 Montevideo, Uruguay
| | - Yanina Zócalo
- Physiology Department, Faculty of Medicine, CUiiDARTE, Republic University, General Flores 2125, 11800 Montevideo, Uruguay
| | - Daniel Bia
- Physiology Department, Faculty of Medicine, CUiiDARTE, Republic University, General Flores 2125, 11800 Montevideo, Uruguay
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Townsend RR, Wilkinson IB, Schiffrin EL, Avolio AP, Chirinos JA, Cockcroft JR, Heffernan KS, Lakatta EG, McEniery CM, Mitchell GF, Najjar SS, Nichols WW, Urbina EM, Weber T. Recommendations for Improving and Standardizing Vascular Research on Arterial Stiffness: A Scientific Statement From the American Heart Association. Hypertension 2015; 66:698-722. [PMID: 26160955 DOI: 10.1161/hyp.0000000000000033] [Citation(s) in RCA: 938] [Impact Index Per Article: 104.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Zhang Y, Kollias G, Argyris AA, Papaioannou TG, Tountas C, Konstantonis GD, Achimastos A, Blacher J, Safar ME, Sfikakis PP, Protogerou AD. Association of left ventricular diastolic dysfunction with 24-h aortic ambulatory blood pressure: the SAFAR study. J Hum Hypertens 2014; 29:442-8. [PMID: 25391758 DOI: 10.1038/jhh.2014.101] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 09/01/2014] [Accepted: 09/29/2014] [Indexed: 12/15/2022]
Abstract
Aortic blood pressure (BP) and 24-h ambulatory BP are both better associated with target organ damage than office brachial BP. However, it remains unclear whether a combination of these two techniques would be the optimal methodology to evaluate patients' BP in terms of left ventricular diastolic dysfunction (LVDD) prevention. In 230 participants, office brachial and aortic BPs were measured by a validated BP monitor and a tonometry-based device, respectively. 24-h ambulatory brachial and aortic BPs were measured by a validated ambulatory BP monitor (Mobil-O-Graph, Germany). Systematic assessment of patients' LVDD was performed. After adjustment for age, gender, hypertension and antihypertensive treatment, septum and lateral E/Ea were significantly associated with office aortic systolic BP (SBP) and pulse pressure (PP) and 24-h brachial and aortic SBP and PP (P ⩽ 0.04), but not with office brachial BP (P ⩾ 0.09). Similarly, 1 standard deviation in SBP was significantly associated with 97.8 ± 20.9, 86.4 ± 22.9, 74.1 ± 23.3 and 51.3 ± 22.6 in septum E/Ea and 68.6 ± 2 0.1, 54.2 ± 21.9, 37.9 ± 22.4 and 23.1 ± 21.4 in lateral E/Ea, for office and 24-h aortic and brachial SBP, respectively. In qualitative analysis, except for office brachial BP, office aortic and 24-h brachial and aortic BPs were all significantly associated with LVDD (P ⩽ 0.03), with the highest odds ratio in 24-h aortic SBP. Furthermore, aortic BP, no matter in the office or 24-h ambulatory setting, showed the largest area under receiver operating characteristic curves (P ⩽ 0.02). In conclusion, 24-h aortic BP is superior to other BPs in the association with LVDD.
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Affiliation(s)
- Y Zhang
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - G Kollias
- Hypertension Center and Cardiovascular Research Laboratory, 1st Department of Propaedeutic Medicine, Laiko Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - A A Argyris
- Hypertension Center and Cardiovascular Research Laboratory, 1st Department of Propaedeutic Medicine, Laiko Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - T G Papaioannou
- Biomedical Engineering Unit, 1st Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - C Tountas
- Hypertension Center and Cardiovascular Research Laboratory, 1st Department of Propaedeutic Medicine, Laiko Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - G D Konstantonis
- Hypertension Center and Cardiovascular Research Laboratory, 1st Department of Propaedeutic Medicine, Laiko Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - A Achimastos
- Hypertension Center, 3rd University Department of Medicine, Sotiria Hospital, Athens, Greece
| | - J Blacher
- Paris Descartes University; AP-HP; Diagnosis and Therapeutic Center, Hôtel-Dieu, Paris, France
| | - M E Safar
- Paris Descartes University; AP-HP; Diagnosis and Therapeutic Center, Hôtel-Dieu, Paris, France
| | - P P Sfikakis
- Hypertension Center and Cardiovascular Research Laboratory, 1st Department of Propaedeutic Medicine, Laiko Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - A D Protogerou
- Hypertension Center and Cardiovascular Research Laboratory, 1st Department of Propaedeutic Medicine, Laiko Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Left-ventricular hypertrophy is associated better with 24-h aortic pressure than 24-h brachial pressure in hypertensive patients. J Hypertens 2014; 32:1805-14. [DOI: 10.1097/hjh.0000000000000263] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Williams B, Cockcroft JR, Kario K, Zappe DH, Cardenas P, Hester A, Brunel P, Zhang J. Rationale and study design of the Prospective comparison of Angiotensin Receptor neprilysin inhibitor with Angiotensin receptor blocker MEasuring arterial sTiffness in the eldERly (PARAMETER) study. BMJ Open 2014; 4:e004254. [PMID: 24496699 PMCID: PMC3918996 DOI: 10.1136/bmjopen-2013-004254] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Hypertension in elderly people is characterised by elevated systolic blood pressure (SBP) and increased pulse pressure (PP), which indicate large artery ageing and stiffness. LCZ696, a first-in-class angiotensin receptor neprilysin inhibitor (ARNI), is being developed to treat hypertension and heart failure. The Prospective comparison of Angiotensin Receptor neprilysin inhibitor with Angiotensin receptor blocker MEasuring arterial sTiffness in the eldERly (PARAMETER) study will assess the efficacy of LCZ696 versus olmesartan on aortic stiffness and central aortic haemodynamics. METHODS AND ANALYSIS In this 52-week multicentre study, patients with hypertension aged ≥60 years with a mean sitting (ms) SBP ≥150 to <180 and a PP>60 mm Hg will be randomised to once daily LCZ696 200 mg or olmesartan 20 mg for 4 weeks, followed by a forced-titration to double the initial doses for the next 8 weeks. At 12-24 weeks, if the BP target has not been attained (msSBP <140 and ms diastolic BP <90 mm Hg), amlodipine (2.5-5 mg) and subsequently hydrochlorothiazide (6.25-25 mg) can be added. The primary and secondary endpoints are changes from baseline in central aortic systolic pressure (CASP) and central aortic PP (CAPP) at week 12, respectively. Other secondary endpoints are the changes in CASP and CAPP at week 52. A sample size of 432 randomised patients is estimated to ensure a power of 90% to assess the superiority of LCZ696 over olmesartan at week 12 in the change from baseline of mean CASP, assuming an SD of 19 mm Hg, the difference of 6.5 mm Hg and a 15% dropout rate. The primary variable will be analysed using a two-way analysis of covariance. ETHICS AND DISSEMINATION The study was initiated in December 2012 and final results are expected in 2015. The results of this study will impact the design of future phase III studies assessing cardiovascular protection. CLINICAL TRIALS IDENTIFIER EUDract number 2012-002899-14 and ClinicalTrials.gov NCT01692301.
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Affiliation(s)
- Bryan Williams
- Department of Cardiovascular Sciences and National Institute for Health Research (NIHR) University College London (UCL) Hospitals Biomedical Research Centre, University College London, London, UK
| | | | | | - Dion H Zappe
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | - Pamela Cardenas
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | - Allen Hester
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | | | - Jack Zhang
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
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Papaioannou TG, Argyris A, Protogerou AD, Vrachatis D, Nasothimiou EG, Sfikakis PP, Stergiou GS, Stefanadis CI. Non-invasive 24hour ambulatory monitoring of aortic wave reflection and arterial stiffness by a novel oscillometric device: The first feasibility and reproducibility study. Int J Cardiol 2013; 169:57-61. [DOI: 10.1016/j.ijcard.2013.08.079] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 06/29/2013] [Accepted: 08/28/2013] [Indexed: 11/16/2022]
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