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Yuenyongchaiwat K, Sermsinsathong N, Songsorn P, Charususin N, Buranapuntalug S, Buekban C, Thanawattano C. Development and feasibility assessment of a virtual reality-based aerobic exercise program with real-time pulse rate monitoring on hemodynamic and arterial stiffness in healthy people: a pilot study. Front Digit Health 2024; 6:1356837. [PMID: 38650665 PMCID: PMC11034385 DOI: 10.3389/fdgth.2024.1356837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 03/25/2024] [Indexed: 04/25/2024] Open
Abstract
Introduction Virtual reality (VR) exercises are reportedly beneficial as a physical activity tool for health promotion and rehabilitation, and can also help individuals exercise under professional supervision. We developed and investigated the potential feasibility of a VR-based aerobic exercise program using the XBOX ONE console and Kinect sensor with real-time pulse rate monitoring. The VR setting consisted of two-dimensional (2D) environments via computer, laptop, or television screens. In addition, the study investigated the potential feasibility of the VR-based exercise program on hemodynamic response and arterial stiffness in healthy participants of various ages. Methods Healthy participants (n = 30) aged > 18 years were enrolled in the VR exercise-based program. All participants were required to wear a polar heart rate (HR) monitor set for moderate-intensity exercise, targeting 40%-59% of their HR reserve. Hemodynamic and arterial stiffness (pulse wave velocity) were noninvasively measured. The Borg scale rate of perceived exertion (RPE) was also assessed. Results Following a VR-guided exercise routine, all participants performed moderate-intensity exercise with no adverse health outcomes during or after the exercise. The effects of VR-based aerobic exercise extended beyond enhanced central hemodynamic and arterial stiffness. However, neither hemodynamic nor arterial stiffness showed significant differences before and after the VR exercise, except for a higher RPE response following the exercise program. Conclusion VR-based aerobic exercise with pulse rate monitoring is a promising physical activity tool to induce physiological changes and impact dyspnea scales and is also feasible for administration to healthy populations.
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Affiliation(s)
- Kornanong Yuenyongchaiwat
- Physiotherapy Department, Faculty of Allied Health Sciences, Thammasat University, Pathumthani, Thailand
- Thammasat University Research Unit for Physical Therapy in Respiratory and Cardiovascular Systems, Thammasat University, Pathumthani, Thailand
| | - Natsinee Sermsinsathong
- Physiotherapy Department, Faculty of Allied Health Sciences, Thammasat University, Pathumthani, Thailand
| | - Preeyaphorn Songsorn
- Physiotherapy Department, Faculty of Allied Health Sciences, Thammasat University, Pathumthani, Thailand
- Thammasat University Research Unit for Physical Therapy in Respiratory and Cardiovascular Systems, Thammasat University, Pathumthani, Thailand
| | - Noppawan Charususin
- Physiotherapy Department, Faculty of Allied Health Sciences, Thammasat University, Pathumthani, Thailand
- Thammasat University Research Unit for Physical Therapy in Respiratory and Cardiovascular Systems, Thammasat University, Pathumthani, Thailand
| | - Sasipa Buranapuntalug
- Physiotherapy Department, Faculty of Allied Health Sciences, Thammasat University, Pathumthani, Thailand
- Thammasat University Research Unit for Physical Therapy in Respiratory and Cardiovascular Systems, Thammasat University, Pathumthani, Thailand
| | - Chatchai Buekban
- Biomedical Electronics and Systems Research Team Assistive Technology and Medical Devices Research Group, National Electronics and Computer Technology Center (NECTEC), Pathumthani, Thailand
| | - Chusak Thanawattano
- Biomedical Electronics and Systems Research Team Assistive Technology and Medical Devices Research Group, National Electronics and Computer Technology Center (NECTEC), Pathumthani, Thailand
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2
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Staef M, Ott C, Kannenkeril D, Striepe K, Schiffer M, Schmieder RE, Bosch A. Determinants of arterial stiffness in patients with type 2 diabetes mellitus: a cross sectional analysis. Sci Rep 2023; 13:8944. [PMID: 37268640 DOI: 10.1038/s41598-023-35589-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 05/20/2023] [Indexed: 06/04/2023] Open
Abstract
In patients with type 2 diabetes mellitus (T2DM) arterial stiffness is associated with increased cardiovascular and total mortality. Little is known about determinants of arterial stiffness in clinical routine. Identification of potential determinants of arterial stiffness will help to address treatment targets for patients in the early state of T2DM. This is a cross-sectional analysis of arterial stiffness in 266 patients in the early stage of T2DM who did not have cardiovascular or renal complications. Parameters of arterial stiffness such as central systolic blood pressure (cSBP), central pulse pressure (cPP) and pulse wave velocity (PWV) were measured with the SphygmoCor System (AtCor Medical). We investigated the influence of parameters of glucose metabolism, lipid status, body constitution, blood pressure (BP) and inflammation on the stiffness parameters using multivariate regression analysis. The study cohort consisted of male and female patients aged 61 ± 8 years with mean diabetes duration of 6.4 ± 5.1 years, mean HbA1c 7.1 ± 0.9%, mean cSBP 121 ± 12 mmHg, mean cPP 44 ± 10 mmHg and mean PWV 8.9 ± 1.8 m/s. Multiple regression analysis identified waist circumference (WC) (beta = 0.411, p = 0.026), LDL-cholesterol (beta = 0.106, p = 0.006), systolic office BP (beta = 0.936, p < 0.001) and diabetes duration (beta = 0.233, p = 0.043) as potential determinants of cSBP. cPP was determined by sex (beta = 0.330, p = 0.008), age (beta = 0.383, p < 0.001), systolic office BP (beta = 0.370, p < 0.001) and diabetes duration (beta = 0.231, p = 0.028) whereas for PWV the following determinants could be identified: age (beta = 0.405, p < 0.001), systolic office BP (beta = 0.421, p < 0.001) and diabetes duration (beta = 0.073, p = 0.038). In addition to the known parameters age, sex and systolic office BP serum LDL-cholesterol, WC and diabetes duration have been identified as determinants of arterial stiffness in patients with T2DM. Treatment of patients in the early stage of T2DM should focus on these clinical parameters to prevent progression of arterial stiffness and as a consequence reduce cardiovascular mortality.Trial registration: The patients included in the analysis participated in one of the following clinical trials NCT02752113 (registered 26.4.2016), NCT02383238 (09.03.2015), NCT02471963 (15.06.2015), NCT01319357 (21.03.2011) ( http://www.clinicaltrials.gov ).
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Affiliation(s)
- Mawadah Staef
- Department of Nephrology and Hypertension, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054, Erlangen, Germany
| | - Christian Ott
- Department of Nephrology and Hypertension, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054, Erlangen, Germany
- Paracelsus Medical School Nuremberg, Nuremberg, Germany
| | - Dennis Kannenkeril
- Department of Nephrology and Hypertension, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054, Erlangen, Germany
| | - Kristina Striepe
- Department of Nephrology and Hypertension, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054, Erlangen, Germany
| | - Mario Schiffer
- Department of Nephrology and Hypertension, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054, Erlangen, Germany
| | - Roland E Schmieder
- Department of Nephrology and Hypertension, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054, Erlangen, Germany
| | - Agnes Bosch
- Department of Nephrology and Hypertension, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054, Erlangen, Germany.
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The Role of Heart Rate Variability (HRV) in Different Hypertensive Syndromes. Diagnostics (Basel) 2023; 13:diagnostics13040785. [PMID: 36832273 PMCID: PMC9955360 DOI: 10.3390/diagnostics13040785] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/05/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open
Abstract
Cardiac innervation by the parasympathetic nervous system (PNS) and the sympathetic nervous system (SNS) modulates the heart rate (HR) (chronotropic activity) and the contraction of the cardiac muscle (inotropic activity). The peripheral vasculature is controlled only by the SNS, which is responsible for peripheral vascular resistance. This also mediates the baroreceptor reflex (BR), which in turn mediates blood pressure (BP). Hypertension (HTN) and the autonomic nervous system (ANS) are closely related, such that derangements can lead to vasomotor impairments and several comorbidities, including obesity, hypertension, resistant hypertension, and chronic kidney disease. Autonomic dysfunction is also associated with functional and structural changes in target organs (heart, brain, kidneys, and blood vessels), increasing cardiovascular risk. Heart rate variability (HRV) is a method of assessing cardiac autonomic modulation. This tool has been used for clinical evaluation and to address the effect of therapeutic interventions. The present review aims (a) to approach the heart rate (HR) as a CV risk factor in hypertensive patients; (b) to analyze the heart rate variability (HRV) as a "tool" to estimate the individual risk stratum for Pre-HTN (P-HTN), Controlled-HTN (C-HTN), Resistant and Refractory HTN (R-HTN and Rf-HTN, respectively), and hypertensive patients with chronic renal disease (HTN+CKD).
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Battillo DJ, Malin SK. Relation of Aortic Waveforms with Gut Hormones following Continuous and Interval Exercise among Older Adults with Prediabetes. Metabolites 2023; 13:137. [PMID: 36837756 PMCID: PMC9967213 DOI: 10.3390/metabo13020137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 01/13/2023] [Indexed: 01/19/2023] Open
Abstract
Prediabetes raises cardiovascular disease risk, in part through elevated aortic waveforms. While insulin is a vasodilatory hormone, the gut hormone relation to aortic waveforms is less clear. We hypothesized that exercise, independent of intensity, would favor aortic waveforms in relation to gut hormones. Older adults (61.3 ± 1.5 yr; 33.2 ± 1.1 kg/m2) with prediabetes (ADA criteria) were randomized to undertake 60 min of work-matched continuous (CONT, n = 14) or interval (INT, n = 14) exercise for 2 wks. During a 180 min 75-g OGTT, a number of aortic waveforms (applanation tonometry) were assessed: the augmentation pressure (AP) and index (AIx75), brachial (bBP) and central blood pressure (cBP), pulse pressure (bPP and cPP), pulse pressure amplification (PPA), and forward (Pf) and backward pressure (Pb) waveforms. Acylated-ghrelin (AG), des-acylated ghrelin (dAG), GIP, and GLP-1active were measured, and correlations were co-varied for insulin. Independent of intensity, exercise increased VO2peak (p = 0.01) and PPA120min (p = 0.01) and reduced weight (p < 0.01), as well as AP120min (p = 0.02) and AIx75120min (p < 0.01). CONT lowered bSBP (p < 0.02) and bDBP (p < 0.02) tAUC180min more than INT. There were decreases dAG0min related to Pb120min (r = 0.47, p = 0.03), cPP120min (r = 0.48, p = 0.02), and AP120min (r = 0.46, p = 0.02). Declines in AG tAUC60min correlated with lower Pb120min (r = 0.47, p = 0.03) and cPP120min (r = 0.49, p = 0.02) were also found. GLP-1active 0min was reduced associated with lowered AP180min (r = 0.49, p = 0.02). Thus, while CONT exercise favored blood pressure, both intensities of exercise improved aortic waveforms in relation to gut hormones after controlling for insulin.
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Affiliation(s)
- Daniel J. Battillo
- Department of Kinesiology and Health, Rutgers University, New Brunswick, NJ 08901, USA
| | - Steven K. Malin
- Department of Kinesiology and Health, Rutgers University, New Brunswick, NJ 08901, USA
- Department of Kinesiology, University of Virginia, Charlottesville, VA 22903, USA
- Division of Endocrinology, Metabolism & Nutrition, Rutgers University, New Brunswick, NJ 08901, USA
- New Jersey Institute for Food, Nutrition and Health, Rutgers University, New Brunswick, NJ 08901, USA
- Institute of Translational Medicine and Science, Rutgers University, New Brunswick, NJ 08901, USA
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5
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Vilela-Martin JF, Forcada PJ. Editorial: The importance of the central hemodynamic in the cardiovascular diseases development. Front Cardiovasc Med 2022; 9:1036440. [PMID: 36299871 PMCID: PMC9589445 DOI: 10.3389/fcvm.2022.1036440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 09/20/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Jose Fernando Vilela-Martin
- Internal Medicine Department, State Medical School in São José Do Rio Preto (FAMERP), São Paulo, Brazil,*Correspondence: Jose Fernando Vilela-Martin
| | - Pedro Jose Forcada
- University of Buenos Aires, Buenos Aires, Argentina,Non-Invasive Vascular Laboratory of CardioArenales, Universidad Austral, Buenos Aires, Argentina
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Rooprai J, Boodhwani M, Beauchesne L, Chan KL, Dennie C, Wells GA, Coutinho T. Central Hypertension in Patients With Thoracic Aortic Aneurysms: Prevalence and Association With Aneurysm Size and Growth. Am J Hypertens 2022; 35:79-86. [PMID: 33759993 DOI: 10.1093/ajh/hpaa183] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/26/2020] [Accepted: 03/04/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Hypertension (HTN) has the greatest population-attributable risk for aortic dissection and is highly prevalent among patients with thoracic aortic aneurysms (TAAs). Although HTN is diagnosed based on brachial blood pressure (bBP), central HTN (central systolic blood pressure [cSBP] ≥130 mm Hg) is of interest as it better reflects blood pressure (BP) in the aorta. We aimed to (i) evaluate the prevalence of central HTN among TAA patients without a diagnosis of HTN, and (ii) assess associations of bBP vs. central blood pressure (cBP) with aneurysm size and growth. METHODS One hundred and five unoperated subjects with TAAs were recruited. With validated methodology, cBP was assessed with applanation tonometry. Aneurysm size was assessed at baseline and follow-up using imaging modalities. Aneurysm growth rate was calculated in mm/year. Multivariable linear regression adjusted for potential confounders assessed associations of bBP and cBP with aneurysm size and growth. RESULTS Seventy-seven percent of participants were men and 49% carried a diagnosis of HTN. Among participants without diagnosis of HTN, 15% had central HTN despite normal bBP ("occult central HTN"). In these patients, higher central systolic BP (cSBP) and central pulse pressure (cPP) were independently associated with larger aneurysm size (β ± SE = 0.28 ± 0.11, P = 0.014 and cPP = 0.30 ± 0.11, P = 0.010, respectively) and future aneurysm growth (β ± SE = 0.022 ± 0.008, P = 0.013 and 0.024 ± 0.009, P = 0.008, respectively) while bBP was not (P > 0.05). CONCLUSIONS In patients with TAAs without a diagnosis of HTN, central HTN is prevalent, and higher cBP is associated with larger aneurysms and faster aneurysm growth.
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Affiliation(s)
- Jasjit Rooprai
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Munir Boodhwani
- The Department of Surgery, Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Luc Beauchesne
- The Department of Medicine, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Kwan-Leung Chan
- The Department of Medicine, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Carole Dennie
- The Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada
| | - George A Wells
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Thais Coutinho
- The Department of Medicine, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- The Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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7
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Kolwelter J, Bosch A, Jung S, Stabel L, Kannenkeril D, Ott C, Bramlage P, Schiffer M, Achenbach S, Schmieder RE. Effects of the sodium-glucose cotransporter 2 inhibitor empagliflozin on vascular function in patients with chronic heart failure. ESC Heart Fail 2021; 8:5327-5337. [PMID: 34544205 PMCID: PMC8712907 DOI: 10.1002/ehf2.13622] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 09/04/2021] [Indexed: 01/01/2023] Open
Abstract
AIMS Impairment of vascular function contributes to the progression of chronic heart failure (HF) by increasing the afterload. Treatment with selective sodium-glucose cotransporter 2 (SGLT2) inhibitors improves the prognosis of HF, but the precise mechanisms remain unclear. The aim of this study was to analyse the effect of empagliflozin on vascular function in patients with HF. METHODS AND RESULTS In an investigator initiated, double-blind, randomized, placebo-controlled, parallel-group, clinical study, patients with HF NYHA II-III and an ejection fraction of 49% or less were randomized 2:1 to receive empagliflozin 10 mg once daily or placebo for 3 months. A total of 74 patients (15% female), aged 66 ± 9 years, with a mean ejection fraction of 39 ± 8% and a median NTproBNP of 558 pg/mL (IQR 219-1051 pg/mL), were included. Vascular parameters such as central systolic blood pressure (cSBP), central pulse pressure (cPP), forward (FPH), and reflected pressure pulse height (RPH) decreased under resting conditions after 1 and 3 months (1 month: cSBP -6.4 ± 8.3 mmHg, P < 0.001, cPP -3.0 ± 6.6 mmHg, P = 0.004, FPH -2.5 ± 4.5 mmHg, P = 0.001, RPH -1.6 ± 3.0 mmHg, P = 0.001; 3 months: cSBP -4.6 ± 8.4 mmHg, P = 0.001, cPP -3.1 ± 4.8 mmHg, P < 0.001, FPH -1.7 ± 3.7 mmHg, P = 0.004, RPH -1.4 ± 2.5 mmHg, P = 0.001) in patients treated with empagliflozin (n = 45). In accordance, cSBP and cPP decreased in patients with empagliflozin treatment under 24 h ambulatory conditions after 1 and 3 months (1 month: cSBP -4.8 ± 10.1 mmHg, P = 0.003, cPP -2.0 ± 5.7 mmHg, P = 0.026; 3 months: cSBP -4.7 ± 9.0 mmHg, P = 0.002, cPP -2.1 ± 6.4 mmHg, P = 0.044). In the placebo group, there was no significant change after 1 and 3 months. The decrease in cSBP under resting conditions (-5.7 ± 2.4 mmHg, P = 0.019) after 1 month and in cSBP (-6.0 ± 2.6, P = 0.027) as well as in pulse wave velocity (-0.5 ± 0.2 m/s, P = 0.021) under 24 h ambulatory conditions after 3 months was greater in the empagliflozin group than in the placebo group. CONCLUSIONS We found an improvement of vascular function after treatment with empagliflozin that indicates decreased afterload of the left ventricle and may contribute to the beneficial effects of SGLT2 inhibition in HF.
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Affiliation(s)
- Julie Kolwelter
- Department of Nephrology and HypertensionUniversity Hospital Erlangen, Friedrich‐Alexander University Erlangen‐Nuremberg (FAU)Ulmenweg 18Erlangen91054Germany
- Department of CardiologyUniversity Hospital Erlangen, Friedrich‐Alexander University Erlangen‐Nuremberg (FAU)ErlangenGermany
| | - Agnes Bosch
- Department of Nephrology and HypertensionUniversity Hospital Erlangen, Friedrich‐Alexander University Erlangen‐Nuremberg (FAU)Ulmenweg 18Erlangen91054Germany
| | - Susanne Jung
- Department of CardiologyUniversity Hospital Erlangen, Friedrich‐Alexander University Erlangen‐Nuremberg (FAU)ErlangenGermany
| | - Lena Stabel
- Department of Nephrology and HypertensionUniversity Hospital Erlangen, Friedrich‐Alexander University Erlangen‐Nuremberg (FAU)Ulmenweg 18Erlangen91054Germany
| | - Dennis Kannenkeril
- Department of Nephrology and HypertensionUniversity Hospital Erlangen, Friedrich‐Alexander University Erlangen‐Nuremberg (FAU)Ulmenweg 18Erlangen91054Germany
| | - Christian Ott
- Department of Nephrology and HypertensionUniversity Hospital Erlangen, Friedrich‐Alexander University Erlangen‐Nuremberg (FAU)Ulmenweg 18Erlangen91054Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive MedicineCloppenburgGermany
| | - Mario Schiffer
- Department of Nephrology and HypertensionUniversity Hospital Erlangen, Friedrich‐Alexander University Erlangen‐Nuremberg (FAU)Ulmenweg 18Erlangen91054Germany
| | - Stephan Achenbach
- Department of CardiologyUniversity Hospital Erlangen, Friedrich‐Alexander University Erlangen‐Nuremberg (FAU)ErlangenGermany
| | - Roland E. Schmieder
- Department of Nephrology and HypertensionUniversity Hospital Erlangen, Friedrich‐Alexander University Erlangen‐Nuremberg (FAU)Ulmenweg 18Erlangen91054Germany
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Dotson BL, Heiston EM, Miller SL, Malin SK. Insulin stimulation reduces aortic wave reflection in adults with metabolic syndrome. Am J Physiol Heart Circ Physiol 2021; 320:H2305-H2312. [PMID: 33861146 DOI: 10.1152/ajpheart.00975.2020] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Adults with metabolic syndrome (MetS) have increased fasting arterial stiffness and altered central hemodynamics that contribute, partly, to increased cardiovascular disease (CVD) risk. Although insulin affects aortic wave reflections in healthy adults, the effects in individuals with MetS are unclear. We hypothesized that insulin stimulation would reduce measures of pressure waveforms and hemodynamics in people with MetS. Thirty-five adults with obesity (27 women; 54.2 ± 6.0 yr; 37.1 ± 4.8 kg/m2) were selected for MetS (ATP III criteria) following an overnight fast. Pulse wave analysis was assessed using applanation tonometry before and after a 2-h euglycemic-hyperinsulinemic clamp (90 mg/dL, 40 mU/m2/min). Deconvolution analysis was used to decompose the aortic waveform [augmentation index corrected to heart rate of 75 beats/min (AIx@75); augmentation pressure (AP)] into backward and forward pressure components. Aerobic fitness (V̇o2max), body composition (DXA), and blood biochemistries were also assessed. Insulin significantly reduced augmentation index (AIx@75, 28.0 ± 9.6 vs. 23.0 ± 9.9%, P < 0.01), augmentation pressure (14.8 ± 6.4 vs. 12.0 ± 5.7 mmHg, P < 0.01), pulse pressure amplification (1.26 ± 0.01 vs. 0.03 ± 0.01, P = 0.01), and inflammation [high-sensitivity C-reactive protein (hsCRP): P = 0.02; matrix metallopeptidase 7 (MMP-7): P = 0.03] compared to fasting. In subgroup analyses to understand HTN influence, there were no insulin stimulation differences on any outcome. V̇o2max, visceral fat, and blood potassium correlated with fasting AIx@75 (r = -0.39, P = 0.02; r = 0.41, P = 0.03; r = -0.53, P = 0.002). Potassium levels were also associated with insulin-mediated reductions in AP (r = 0.52, P = 0.002). Our results suggest insulin stimulation improves indices of aortic reflection in adults with MetS.NEW & NOTEWORTHY This study is one of the first to investigate the effects of insulin on central and peripheral hemodynamics in adults with metabolic syndrome. We provide evidence that insulin infusion reduces aortic wave reflection, potentially through a reduction in inflammation and/or via a potassium-mediated vascular response.
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Affiliation(s)
- Brielle L Dotson
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia
| | - Emily M Heiston
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia.,Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Stephanie L Miller
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia
| | - Steven K Malin
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia.,Department of Kinesiology and Health, Rutgers University, New Brunswick, New Jersey.,Division of Endocrinology, Metabolism and Nutrition; Rutgers University, New Brunswick, New Jersey.,New Jersey Institute for Food, Nutrition and Health, Rutgers University, New Brunswick, New Jersey.,Institute of Translational Medicine and Science, Rutgers University, New Brunswick, New Jersey
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9
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Vishram-Nielsen JKK, Kristensen AMD, Pareek M, Laurent S, Nilsson PM, Linneberg A, Greve SV, Palmieri L, Giampaoli S, Donfrancesco C, Kee F, Mancia G, Cesana G, Veronesi G, Grassi G, Kuulasmaa K, Salomaa V, Palosaari T, Sans S, Ferrieres J, Dallongeville J, Söderberg S, Moitry M, Drygas W, Tamosiunas A, Peters A, Brenner H, Grimsgaard S, Savallampi M, Olsen MH. Predictive Importance of Blood Pressure Characteristics With Increasing Age in Healthy Men and Women: The MORGAM Project. Hypertension 2021; 77:1076-1085. [PMID: 33641358 DOI: 10.1161/hypertensionaha.120.16354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Julie K K Vishram-Nielsen
- From the Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark, Copenhagen, Frederiksberg (J.K.K.V.-N., A.L.).,Department of Cardiology, Rigshospitalet (J.K.K.V.-N.), University of Copenhagen, Denmark
| | | | - Manan Pareek
- Department of Cardiology, North Zealand Hospital, Hillerød, Denmark (A.M.D.K., M.P.).,Department of Internal Medicine, Yale New Haven Hospital, Yale University School of Medicine, New Haven, CT (M.P.)
| | - Stephane Laurent
- Department of Clinical Pharmacology and INSERM U 970, team 7, Paris CV Research Center (PARCC), Hôpital Européen Georges Pompidou, France (S.L.)
| | - Peter M Nilsson
- Department for Clinical Sciences Medicine, University Hospital, Malmö, Sweden (P.M.N.)
| | - Allan Linneberg
- From the Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark, Copenhagen, Frederiksberg (J.K.K.V.-N., A.L.).,Department of Clinical Medicine, Faculty of Health and Medical Sciences (A.L.), University of Copenhagen, Denmark
| | - Sara V Greve
- Cardiovascular and Metabolic Preventive Clinic, Department of Endocrinology, Odense University Hospital, Denmark (S.V.G.)
| | - Luigi Palmieri
- Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, Istituto Superiore di Sanità (ISS), Rome, Italy (L.P., S. Giampaoli, C.D.)
| | - Simona Giampaoli
- Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, Istituto Superiore di Sanità (ISS), Rome, Italy (L.P., S. Giampaoli, C.D.)
| | - Chiara Donfrancesco
- Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, Istituto Superiore di Sanità (ISS), Rome, Italy (L.P., S. Giampaoli, C.D.)
| | - Frank Kee
- Centre for Public Health, The Queen´s University of Belfast, Northern Ireland (F.K.)
| | - Giuseppe Mancia
- University of Milano-Bicocca and Policlinico di Monza, Italy (G.M.)
| | - Giancarlo Cesana
- Research Centre on Public Health (G.C.), University of Milano Bicocca, Villa Serena, Monza, Italy
| | - Giovanni Veronesi
- Research Centre in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, University of Insubria, Italy (G.V.)
| | - Guido Grassi
- Clinica Medica, Department of Medicine and Surgery (G.G.), University of Milano Bicocca, Villa Serena, Monza, Italy
| | - Kari Kuulasmaa
- Finnish Institute for Health and Welfare (THL), Helsinki, Finland (K.K., V.S., T.P., M.S.)
| | - Veikko Salomaa
- Finnish Institute for Health and Welfare (THL), Helsinki, Finland (K.K., V.S., T.P., M.S.)
| | - Tarja Palosaari
- Finnish Institute for Health and Welfare (THL), Helsinki, Finland (K.K., V.S., T.P., M.S.)
| | - Susana Sans
- Catalan Department of Health, Barcelona, Spain (S. Sans)
| | - Jean Ferrieres
- Department of Cardiology, Toulouse University School of Medicine, Rangueil Hospital, France (J.F.)
| | | | - Stefan Söderberg
- Department of Public Health and Clinical Medicine, Cardiology and Heart Centre, Umeå University, Sweden (S. Söderberg)
| | - Marie Moitry
- Department of Epidemiology and Public Health, University of Strasbourg and University Hospital of Strasbourg, France (M.M.)
| | - Wojciech Drygas
- Department of Epidemiology, CVD Prevention and Health Promotion, National Institute of Cardiology, Warsaw, Poland (W.D.)
| | - Abdonas Tamosiunas
- Lithuanian University of Health Sciences, Institute of Cardiology, Kaunas (A.T.)
| | - Annette Peters
- German Research Center for Environmental Health, Institute of Epidemiology II, Neuherberg, Germany (A.P.)
| | - Hermann Brenner
- German Cancer Research Center, Heidelberg, Germany (H.B.).,Network Aging Research, University of Heidelberg, Germany (H.B.)
| | - Sameline Grimsgaard
- Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway (S. Grimsgaard)
| | - Matti Savallampi
- Finnish Institute for Health and Welfare (THL), Helsinki, Finland (K.K., V.S., T.P., M.S.)
| | - Michael H Olsen
- Department of Internal Medicine, Holbaek Hospital, Denmark (M.H.O.).,Centre of Individualized Medicine in Arterial Diseases (CIMA), Department of Regional Health Research, University of Southern Denmark (M.H.O.)
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10
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Jadidi M, Razian SA, Habibnezhad M, Anttila E, Kamenskiy A. Mechanical, structural, and physiologic differences in human elastic and muscular arteries of different ages: Comparison of the descending thoracic aorta to the superficial femoral artery. Acta Biomater 2021; 119:268-283. [PMID: 33127484 DOI: 10.1016/j.actbio.2020.10.035] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/28/2020] [Accepted: 10/22/2020] [Indexed: 12/23/2022]
Abstract
Elastic and muscular arteries differ in structure, function, and mechanical properties, and may adapt differently to aging. We compared the descending thoracic aortas (TA) and the superficial femoral arteries (SFA) of 27 tissue donors (average 41±18 years, range 13-73 years) using planar biaxial testing, constitutive modeling, and bidirectional histology. Both TAs and SFAs increased in size with age, with the outer radius increasing more than the inner radius, but the TAs thickened 6-fold and widened 3-fold faster than the SFAs. The circumferential opening angle did not change in the TA, but increased 2.4-fold in the SFA. Young TAs were relatively isotropic, but the anisotropy increased with age due to longitudinal stiffening. SFAs were 51% more compliant longitudinally irrespective of age. Older TAs and SFAs were stiffer, but the SFA stiffened 5.6-fold faster circumferentially than the TA. Physiologic stresses decreased with age in both arteries, with greater changes occurring longitudinally. TAs had larger circumferential, but smaller longitudinal stresses than the SFAs, larger cardiac cycle stretch, 36% lower circumferential stiffness, and 8-fold more elastic energy available for pulsation. TAs contained elastin sheets separated by smooth muscle cells (SMCs), collagen, and glycosaminoglycans, while the SFAs had SMCs, collagen, and longitudinal elastic fibers. With age, densities of elastin and SMCs decreased, collagen remained constant due to medial thickening, and the glycosaminoglycans increased. Elastic and muscular arteries demonstrate different morphological, mechanical, physiologic, and structural characteristics and adapt differently to aging. While the aortas remodel to preserve the Windkessel function, the SFAs maintain higher longitudinal compliance.
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Affiliation(s)
- Majid Jadidi
- Department of Mechanical and Materials Engineering, University of Nebraska-Lincoln, Lincoln, NE, USA
| | | | - Mahmoud Habibnezhad
- Department of Computer Science, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Eric Anttila
- Department of Mechanical and Materials Engineering, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Alexey Kamenskiy
- Department of Biomechanics, University of Nebraska Omaha, Omaha, NE, USA.
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11
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Vilela-Martin JF. Parameters of Central Hemodynamics as New Biomarkers of Cardiovascular Risk. Arq Bras Cardiol 2020; 115:1133-1134. [PMID: 33470312 PMCID: PMC8133714 DOI: 10.36660/abc.20201218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- José Fernando Vilela-Martin
- Faculdade de MedicinaFAMERPSão José do Rio PretoSPBrasilFaculdade de Medicina de São José do Rio Preto (FAMERP),São José do Rio Preto, SP — Brasil,Clínica de HipertensãoFAMERPSão José do Rio PretoSPBrasilClínica de Hipertensão da FAMERP, São José do Rio Preto, SP — Brasil
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12
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Katzelnick CG, Weir JP, Pinto Zipp G, LaFountaine MF, Bauman WA, Dyson-Hudson TA, Wecht JM. Increased pulse wave velocity in persons with spinal cord injury: the effect of the renin-angiotensin-aldosterone system. Am J Physiol Heart Circ Physiol 2020; 320:H272-H280. [PMID: 33095646 DOI: 10.1152/ajpheart.00544.2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Increased pulse wave velocity (PWV), a marker of cardiovascular disease (CVD), has been reported in otherwise healthy individuals with spinal cord injury (SCI) compared with age-matched uninjured controls. Due to decentralized descending sympathetic vascular control, individuals with injuries above T6 are prone to orthostatic hypotension and, as a result, depend on the renin-angiotensin-aldosterone system (RAAS) to maintain orthostatic blood pressure (BP). The purpose of this study was to determine resting PWV, a noninvasive surrogate of central arterial stiffness, in individuals with cervical (C4-T1; n = 11) and thoracic (T6-T12; n = 11) SCI, compared with age-matched controls (controls; n = 11). Next, our aim was to describe group differences in BP, plasma norepinephrine (NE), and renin response to head-up tilt (HUT). Finally, we sought to determine the relationship between PWV and the orthostatic change in BP, NE, and the plasma renin during HUT among the groups. PWV was significantly increased in both cervical (8.81 ± 1.91 m/s) and thoracic (7.36 ± 1.58 m/s) SCI compared with the controls (5.53 ± 0.95 m/s; P < 0.05). The change from supine to 60° HUT in BP and NE was significantly reduced and change in plasma renin was significantly increased in the cervical group compared with the thoracic and control groups. Group affiliation and change in plasma renin were significant predictors of PWV (R2 = 0.63, P = 0.001). These data suggest that dependency on the RAAS for orthostatic BP maintenance may be associated with increased PWV and risk of CVD in the SCI population.NEW & NOTEWORTHY Our novel findings suggest that increased arterial stiffness in individuals with SCI may be due to greater dependency on the RAAS to maintain hemodynamic stability during an orthostatic challenge. Asymptomatic orthostatic hypotension can occur in persons with SCI during transition from the supine to the seated position and during other upright activities of daily living; however, it is seldom addressed by clinicians.
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Affiliation(s)
- Caitlyn G Katzelnick
- James J Peters Veterans Affairs Medical Center, Bronx, New York.,Kessler Foundation, West Orange, New Jersey.,Department of Interprofessional Health Sciences and Health Administration, School of Health and Medical Sciences, Hackensack Meridian School of Medicine at Seton Hall University, Nutley, New Jersey
| | - Joseph P Weir
- Department of Health, Sport, and Exercise Sciences, University of Kansas, Lawrence, Kansas
| | - Genevieve Pinto Zipp
- Department of Interprofessional Health Sciences and Health Administration, School of Health and Medical Sciences, Hackensack Meridian School of Medicine at Seton Hall University, Nutley, New Jersey
| | - Michael F LaFountaine
- James J Peters Veterans Affairs Medical Center, Bronx, New York.,Department of Physical Therapy, School of Health and Medical Sciences, Seton Hall University, South Orange, New Jersey.,Department of Medical Sciences and Neurology, Hackensack Meridian School of Medicine at Seton Hall University, Nutley, New Jersey.,Icahn School of Medicine at Mount Sinai, New York City, New York
| | - William A Bauman
- James J Peters Veterans Affairs Medical Center, Bronx, New York.,Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Trevor A Dyson-Hudson
- Kessler Foundation, West Orange, New Jersey.,Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Jill M Wecht
- James J Peters Veterans Affairs Medical Center, Bronx, New York.,Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey
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13
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Differential Effects of Combination of Renin-Angiotensin-Aldosterone System Inhibitors on Central Aortic Blood Pressure: A Cross-Sectional Observational Study in Hypertensive Outpatients. Cardiovasc Ther 2020; 2020:4349612. [PMID: 32983258 PMCID: PMC7495159 DOI: 10.1155/2020/4349612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/05/2020] [Accepted: 08/19/2020] [Indexed: 02/05/2023] Open
Abstract
Background Central aortic blood pressure (CABP) indices, central hemodynamics, and arterial stiffness are better predictors of cardiovascular events as compared with brachial cuff pressure measurements alone. The present study is aimed at assessing the effects of different antihypertensive drug combination regimens involving renin-angiotensin-aldosterone system (RAAS) inhibitors on CABP indices in Indian patients with hypertension. Methods This was a cross-sectional, single-center study conducted in patients treated for hypertension for >6 weeks using different treatment regimens involving the combination of RAAS inhibitors with drugs from other classes. CABP indices, vascular age, arterial stiffness, and central hemodynamics were measured in patients using the noninvasive Agedio B900 device (IEM, Stolberg, Germany) and compared between different treatment regimens. Results A total of 199 patients with a mean age of 54.22 ± 10.15 years were enrolled, where 68.8% had hypertension for over three years and 50.25% had their systolic blood pressure (SBP) < 140 mmHg. Combination treatment with angiotensin II receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEIs) was given to 77.9% and to 20.1% patients, respectively. The mean vascular age was higher than the actual age (58.13 ± 12.43 vs. 54.22 ± 10.15, p = 0.001). The SBP and diastolic blood pressure (DBP) levels in patients treated with ACEI-based combinations were lower than those in patients treated with ARB-based combinations (p < 0.05). The mean central pulse pressure amplification, augmentation pressure, and augmentation index were lower in patients treated with ACEI-based combinations than those treated with other treatments (p = 0.001). In a subgroup analysis, patients given perindopril and calcium channel blockers (CCBs) or diuretics had significantly lower CABP and pulse wave velocity than those given other treatments (p < 0.05). A total of 6.5% patients experienced any side effects. Conclusion The majority of central hemodynamic parameters, including vascular age, were found to improve more effectively in patients treated with ACEIs than with ARBs. Our results indicate a gap between routine clinical practice and evidence-based guidelines in Indian settings and identify a need to reevaluate the current antihypertensive prescription strategy.
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14
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Effect of direct renin inhibition on vascular function after long-term treatment with aliskiren in hypertensive and diabetic patients. J Hypertens 2020; 39:169-180. [PMID: 32740409 DOI: 10.1097/hjh.0000000000002595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We tested the hypothesis that chronic treatment with the direct renin inhibitor aliskiren improves vascular function in resistance and conduit arteries of type two diabetic and hypertensive patients. METHOD Sixteen patients with mild essential hypertension and with a previous diagnosis of noninsulin-dependent diabetes mellitus were included in the study. Patients were then randomized to aliskiren (150 mg once daily, n = 9), or ramipril (5 mg once daily, n = 7). Each patient underwent a biopsy of the subcutaneous tissue and small arteries were dissected and mounted on a pressurized micromyograph to evaluate endothelium dependent vasorelaxation in response to acetylcholine ± N omega-nitro-L-arginine methyl ester hydrochloride in vessels precontracted with norepinephrine. Endothelial function has been quantified also in large conduit arteries by flow-mediated dilation. RESULTS A similar office blood pressure-lowering effect was observed with the two drugs, although changes in DBP were not statistically significant in the ramipril group. Aliskiren significantly improved endothelium-dependent relaxation in subcutaneous resistance arteries, as well as increased flow-mediated dilation in conduit arteries, whereas the effects induced by ramipril did not reach statistical significance. Only aliskiren significantly increased the expression of p1177-endothelial nitric oxide synthase in the endothelium. Both aliskiren and ramipril had a negligible effect on markers of oxidative stress. CONCLUSION Aliskiren restored endothelial function and induced a more prompt peripheral vasodilation in hypertensive and diabetic patients possibly through the increased production of nitric oxide via the enhanced expression and function of the active phosphorylated form of endothelial nitric oxide synthase.
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15
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Reference values of office central blood pressure, pulse wave velocity, and augmentation index recorded by means of the Mobil-O-Graph PWA monitor. Hypertens Res 2020; 43:1239-1248. [PMID: 32533101 DOI: 10.1038/s41440-020-0490-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 04/27/2020] [Accepted: 05/17/2020] [Indexed: 11/08/2022]
Abstract
Assessment of central blood pressure (BP), pulse wave velocity (PWV), and augmentation index (AIx) measurements may improve cardiovascular risk stratification. This study aimed to establish reference office values for central BP, PWV, and AIx by means of a Mobil-O-Graph PWA monitor and to evaluate the impact of cardiovascular risk factors (CVRFs) on these measurements. We cross-sectionally evaluated clinical characteristics, central BP, PWV, AIx, and peripheral BP measurements among 867 apparently healthy individuals (age = 46.0 ± 15.5 years, 39% males) who were free of obesity, hypertension, active smoking, dyslipidemia, and diabetes (CVRF-No) and 5632 individuals (age = 57.0 ± 14.7 years, 44% males) with at least one of these major CVRFs (CVRF-Yes). Reference values for central BP, PWV, and AIx were provided for the CVRF-No and CVRF-Yes groups, stratified by age and sex. PWV and AIx exhibited curvilinear increases with age, and there was an interaction between age and sex for central systolic BP and PWV in both the CVRF-No and CVRF-Yes groups. The results of a multivariable analysis including the whole sample (n = 6499) showed that obesity had a direct association with central BP, while diabetes was directly related to PWV. In addition, alcohol intake was directly associated with central BP, while performance of physical activity was inversely related to AIx. In conclusion, values of office-measured central BP, PWV, and AIx obtained in an apparently healthy population and in a population with CVRFs are now available according to age and sex and may be useful to build thresholds for use in clinical practice.
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16
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Turi V, Dragan S, Iurciuc M, Moleriu L, Bungau S, Tit DM, Toader DO, Diaconu CC, Behl T, Petre I. Arterial Function in Healthy Pregnant Women vs. Non-Pregnant Women-A 10-Year Study. Diagnostics (Basel) 2020; 10:diagnostics10060374. [PMID: 32516990 PMCID: PMC7344931 DOI: 10.3390/diagnostics10060374] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 06/01/2020] [Accepted: 06/03/2020] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Maternal age for the first pregnancy is increasing and so, the prevalence of cardiovascular risk factors in pregnancy is also increasing. Heart disease is the main reason for maternal death during pregnancy in developed countries. Arterial stiffness is an independent risk factor for atherosclerosis and a predictor of cardiovascular morbidity and mortality. The most widespread parameters for detecting subclinical atherosclerosis are augmentation index (AIx) and pulse wave velocity (PWV). The objective of this prospective study was to assess the differences between arterial function in pregnant vs. non-pregnant women of the same age, and its changes throughout the gestation period. MATERIALS AND METHODS Between 2010-2019, 887 patients were enrolled into 2 groups: pregnant (N1 = 471) and non-pregnant (N2 = 416). Data about their anthropometric characteristics, arterial function (for group 1 in all three trimesters and 6 weeks post-partum), smoking status and physical activity were collected. RESULTS There were statistically significant differences (p < α, α = 0.05) between the two groups regarding the body mass index, brachial AIx, systolic, diastolic and central blood pressure, and pulse pressure values. In the first group, there was a decrease of both brachial AIx and PWV in the second and third trimester, followed by a post-partum increase; better outcomes were noticed in physically active women. CONCLUSIONS Arterial function modifies during pregnancy and these alterations differ according to the trimester of gestation. Further research is needed to establish the cut-off values for this category. Pregnant women can have better outcomes through physical activity.
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Affiliation(s)
- Vladiana Turi
- Department of Cardiology, “Victor Babeş” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (V.T.); (S.D.); (M.I.)
| | - Simona Dragan
- Department of Cardiology, “Victor Babeş” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (V.T.); (S.D.); (M.I.)
| | - Mircea Iurciuc
- Department of Cardiology, “Victor Babeş” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania; (V.T.); (S.D.); (M.I.)
| | - Lavinia Moleriu
- Department III Functional Sciences, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania;
| | - Simona Bungau
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 29 N. Jiga St., 410028 Oradea, Romania;
- Correspondence: ; Tel.: +40-726-776-588
| | - Delia Mirela Tit
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 29 N. Jiga St., 410028 Oradea, Romania;
| | - Daniela-Oana Toader
- Department 13, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- “Alessandrescu–Rusescu” National Institute for Mother and Child Health, Bucharest, Polizu Clinical Hospital, 011062 Bucharest, Romania
| | - Camelia Cristina Diaconu
- Department 5, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Department of Internal Medicine, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania
| | - Tapan Behl
- Chitkara College of Pharmacy, Chitkara University, Punjab 140401, India;
| | - Izabella Petre
- Department XII of Obstetrics and Gynaecology, “Victor Babeş” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania;
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17
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Zou RH, Wallace WD, Nouraie SM, Chan SY, Risbano MG. Lower DLco% identifies exercise pulmonary hypertension in patients with parenchymal lung disease referred for dyspnea. Pulm Circ 2020; 10:2045894019891912. [PMID: 32128158 PMCID: PMC7031800 DOI: 10.1177/2045894019891912] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 11/11/2019] [Indexed: 01/13/2023] Open
Abstract
Exercise pulmonary hypertension is an underappreciated form of physical limitation related to early pulmonary vascular disease. A low diffusing capacity of lungs for carbon monoxide (DLco) can be seen in patients with resting pulmonary hypertension as well as parenchymal lung disease. It remains unclear whether low DLco% identifies early pulmonary vascular disease. We hypothesize that a reduced DLco% differentiates the presence of exercise pulmonary hypertension in patients with parenchymal lung disease. Fifty-six patients referred for unexplained exertional dyspnea with pulmonary function tests within six months of hemodynamic testing underwent exercise right heart catheterization. Exclusion criteria included resting pulmonary arterial or venous hypertension. Receiver operator characteristic curve determined the optimal DLco% cutoffs based on the presence or absence of parenchymal lung disease. Twenty-one (37%) patients had parenchymal lung disease, most common manifesting as chronic obstructive lung disease or interstitial lung disease. In patients with parenchymal lung disease, a DLco of 46% demonstrated 100% sensitivity and 73% specificity for detecting exercise pulmonary hypertension. In patients without parenchymal lung disease, a DLco of 73% demonstrated 58% sensitivity and 94% specificity for detecting exercise pulmonary hypertension. In both cohorts, DLco% below the optimum cutoffs were associated with higher peak mean pulmonary arterial pressure and peak total pulmonary resistance consistent with the hemodynamic definition of exercise pulmonary hypertension. Patients with a DLco < 46% were more often treated with pulmonary vasodilators and had a trend to higher mortality and lung transplant. DLco% is a simple non-invasive screening test for the presence of exercise pulmonary hypertension in our mixed referral population with progressive exertional dyspnea. DLco < 46% with parenchymal lung disease and DLco < 73% without parenchymal lung disease may play a role in differentiating the presence of pulmonary vascular disease prior to invasive hemodynamic testing.
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Affiliation(s)
- Richard H. Zou
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - William D. Wallace
- Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, USA
| | - S. Mehdi Nouraie
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Stephen Y. Chan
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Division of Cardiology, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Michael G. Risbano
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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18
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Resende LAPR, Silva MAV, Resende JAM, Resende EAMR, Silva VJD, Correia D. Comparison of pulse wave analysis parameters by oscillometry in hypertensive diabetic and nondiabetic patients in a Brazilian outpatient care. Medicine (Baltimore) 2019; 98:e18100. [PMID: 31852069 PMCID: PMC6922585 DOI: 10.1097/md.0000000000018100] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 10/29/2019] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Pulse wave analysis is an emerging approach that analyzes parameters comprising strong predictors of cardiovascular (CV) events and all-cause mortality, especially in patients with high CV risk based on established risk factors. This study used the oscillometric method, provided by the Mobil-o-Graph (PWA-EMI GmbH, Stolberg, Germany) device, to compare data regarding the pulse wave analysis parameters in hypertensive nondiabetic and diabetic patients. MATERIAL AND METHODS In this cross-sectional study, 276 individuals were examined in the academic hypertension outpatient care unit of the Federal University of the Triângulo, in Mineiro, Brazil, from January to December 2016. The pulse wave analysis was performed by oscillometry, and its parameters were acquired from all patients. RESULTS Of the 276 patients, 99 were diabetic and 177 nondiabetic. The mean systolic and pulse central blood pressure were significantly higher in diabetic patients than in nondiabetic patients (P = .008 and.0003, respectively). The mean peripheral systolic blood pressure and pulse pressure were also significantly higher in the diabetic group (P = .001 and P < .0001, respectively). The average pulse wave velocity (PWV, m/s) was 9.4 ± 1.6 and 8.8 ± 1.6 in the diabetic and nondiabetic groups, respectively (P = .003). CONCLUSION The group of hypertensive diabetic patients had significantly higher central blood pressure, peripheral blood pressure, and PWV than the hypertensive nondiabetic patients. The patients with overlapping established CV risk factors presented values of the pulse wave analysis parameters consistent with higher central pressure and greater arterial stiffness.
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Affiliation(s)
| | | | | | | | | | - Dalmo Correia
- Department of Internal Medicine
- Department of Tropical Medicine and Infectiology, Federal University of the Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
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19
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Zhou L, Cai G, Xu Z, Weng Q, Ye Q, Chen C. High positive end expiratory pressure levels affect hemodynamics in elderly patients with hypertension admitted to the intensive care unit: a prospective cohort study. BMC Pulm Med 2019; 19:224. [PMID: 31775701 PMCID: PMC6882021 DOI: 10.1186/s12890-019-0965-9] [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: 11/28/2017] [Accepted: 10/18/2019] [Indexed: 01/18/2023] Open
Abstract
Background To study the effects of different positive end expiratory pressure (PEEP) on blood pressure and heart function in elderly patients with hypertension. Methods Forty elderly patients above 65 years of age treated with mechanical ventilation were divided into two groups: a control group of non-hypertensive subjects (n = 18) and a hypertension group (n = 22) patients with essential hypertension. Changes in blood pressure, central venous pressure (CVP), central venous oxygen saturation (ScvO2), heart rate, and airway pressure were determined in response to different selected PEEP levels of 0, 2, 4, 6, 8, 10 and 12 cm H2O under SIMV(PC) + PSV mode throughout the study. Results In both groups, the increase in PEEP led to an increase in CVP and airway pressure. When PEEP was above 4 cm H2O in the hypertension group, a decrease in blood pressure and ScvO2, and an increase of heart rate were observed. These results indicated that cardiac output significantly decreased. Conclusion High levels of PEEP can significantly influence changes in blood pressure and heart function in elderly patients with hypertension. Trial registration This trial was retrospectively registered, The Chinese trial registration number is ChiCTR-ROC-17012873. The date of registration is 10-2-2017.
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Affiliation(s)
- Lili Zhou
- Department of Geriatrics, Union Hospital, Fujian Medical University, Fuzhou, Fujian, 350001, People's Republic of China.,Department of Critical Care Medicine, Union Hospital, Fujian Medical University, Fuzhou, Fujian, 350001, People's Republic of China
| | - Guoen Cai
- Department of Geriatrics, Union Hospital, Fujian Medical University, Fuzhou, Fujian, 350001, People's Republic of China.,Department of Neurology, Union Hospital, Fujian Medical University, Fuzhou, Fujian, 350001, People's Republic of China
| | - Zhihui Xu
- Department of Geriatrics, Union Hospital, Fujian Medical University, Fuzhou, Fujian, 350001, People's Republic of China.,Department of Critical Care Medicine, Union Hospital, Fujian Medical University, Fuzhou, Fujian, 350001, People's Republic of China
| | - Qinyong Weng
- Department of Geriatrics, Union Hospital, Fujian Medical University, Fuzhou, Fujian, 350001, People's Republic of China.,Department of Critical Care Medicine, Union Hospital, Fujian Medical University, Fuzhou, Fujian, 350001, People's Republic of China
| | - Qinyong Ye
- Department of Geriatrics, Union Hospital, Fujian Medical University, Fuzhou, Fujian, 350001, People's Republic of China.,Department of Neurology, Union Hospital, Fujian Medical University, Fuzhou, Fujian, 350001, People's Republic of China
| | - Cunrong Chen
- Department of Geriatrics, Union Hospital, Fujian Medical University, Fuzhou, Fujian, 350001, People's Republic of China. .,Department of Critical Care Medicine, Union Hospital, Fujian Medical University, Fuzhou, Fujian, 350001, People's Republic of China.
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20
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Soppa VJ, Shinnawi S, Hennig F, Sasse B, Hellack B, Kaminski H, Quass U, Schins RP, Kuhlbusch TA, Hoffmann B. Effects of short-term exposure to fine and ultrafine particles from indoor sources on arterial stiffness – A randomized sham-controlled exposure study. Int J Hyg Environ Health 2019; 222:1115-1132. [DOI: 10.1016/j.ijheh.2019.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 07/13/2019] [Accepted: 08/06/2019] [Indexed: 01/19/2023]
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Phillygenin, a lignan compound, inhibits hypertension by reducing PLCβ3-dependent Ca2+ oscillation. J Funct Foods 2019. [DOI: 10.1016/j.jff.2019.103432] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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Ibrahim B, Mrugala D, Jafari R. Effects of Bio-Impedance Sensor Placement Relative to the Arterial Sites for Capturing Hemodynamic Parameters. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2019; 2019:6569-6573. [PMID: 31947347 DOI: 10.1109/embc.2019.8857585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Accurate measurement of the heart pulse waveform based on blood volume changes inside the arteries is crucial for reliable estimation of hemodynamic parameters such as blood pressure and cardiac output. Placement of blood volume sensors such as bio-impedance sensors close to the arterial sites is essential for the accurate measurement of the pulse waveform. The effect of sensor location relative to the wrist arteries on the pulse waveform had not been studied previously on human subjects. In this paper, we explore the effect of arterial and off-arterial placement of the bio-impedance sensor on important pulse waveform features such as pulse transit time (PTT), which is the travel time of the arterial pressure pulse between two sensors, and diastolic peak error (DPE), a measure of pulse signal sharpness. Placing the current injection and voltage sensing electrodes of a bio-impedance sensor on the radial artery provide greater accuracy for such features. We find that arterial PTT has a significantly lower standard deviation compared to off-arterial PTT indicating better signal quality. Similarly, we observe that DPE is much smaller for arterial bio-impedance which confirms our expectations. Based on these features, the location of the artery can be determined using an array of sensors placed around the artery.
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A multilocus genetic risk score is associated with arterial stiffness in hypertensive patients: the CARE NORTH study. J Hypertens 2019; 36:1882-1888. [PMID: 29878972 DOI: 10.1097/hjh.0000000000001773] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Arterial stiffness is recognized as an intermediate phenotype and predictor of cardiovascular disease. Arterial stiffness is complex in origin with contributions from lifestyle and genetic factors. However, the association between single nucleotide polymorphisms (SNPs) and arterial stiffness remains unclear. OBJECTIVE The aim is to assess whether a multilocus genetic risk score (GRS), composed of selected SNPs linked to cardiovascular traits and outcomes, is associated with arterial stiffness in patients with hypertension. DESIGN AND METHODS This study included 730 participants derived from the CARE NORTH study. The arterial stiffness was evaluated by carotid-femoral pulse wave velocity (cfPWV). An adjusted linear regression was used to evaluate the association between cfPWV and each individual SNP using multiple genetic models. The association between a constructed GRS and cfPWV was tested in an unadjusted and adjusted model. RESULTS We selected 13 SNPs found to be associated with cfPWV (P < .05): 6 SNPs in additive, 4 SNPs in recessive and 3 SNPs in dominant mode of inheritance. The GRS based on these SNPs was positively associated with cfPWV both in unadjusted and adjusted models (β = 0.2 m/s, 95% CI 0.11 - 0.29, P = 7.6 × 10 and β = 0.22 m/s, 95% CI 0.15 - 0.28, P = 1.4 × 10, respectively). The GRS explained an additional 3.6% cfPWV variance above clinical covariates. CONCLUSION We demonstrate that the GRS composed of 13 SNPs related to cardiovascular phenotypes is associated with an increased arterial stiffness in hypertensive patients. Our findings may help to clarify genetic basis of arterial stiffening and provide insight into mechanisms underlying this phenotype.
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Nuckowska MK, Gruszecki M, Kot J, Wolf J, Guminski W, Frydrychowski AF, Wtorek J, Narkiewicz K, Winklewski PJ. Impact of slow breathing on the blood pressure and subarachnoid space width oscillations in humans. Sci Rep 2019; 9:6232. [PMID: 30996273 PMCID: PMC6470142 DOI: 10.1038/s41598-019-42552-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 03/29/2019] [Indexed: 02/08/2023] Open
Abstract
The aim of the study was to assess cardiac and respiratory blood pressure (BP) and subarachnoid space (SAS) width oscillations during the resting state for slow and fast breathing and breathing against inspiratory resistance. Experiments were performed on a group of 20 healthy volunteers (8 males and 12 females; age 25.3 ± 7.9 years; BMI = 22.1 ± 3.2 kg/m2). BP and heart rate (HR) were measured using continuous finger-pulse photoplethysmography. SAS signals were recorded using an SAS monitor. Oxyhaemoglobin saturation (SaO2) and end-tidal CO2 (EtCO2) were measured using a medical monitoring system. Procedure 1 consisted of breathing spontaneously and at controlled rates of 6 breaths/minute and 6 breaths/minute with inspiratory resistance for 10 minutes. Procedure 2 consisted of breathing spontaneously and at controlled rates of 6, 12 and 18 breaths/minute for 5 minutes. Wavelet analysis with the Morlet mother wavelet was applied for delineation of BP and SAS signals cardiac and respiratory components. Slow breathing diminishes amplitude of cardiac BP and SAS oscillations. The overall increase in BP and SAS oscillations during slow breathing is driven by the respiratory component. Drop in cardiac component of BP amplitude evoked by slow-breathing may be perceived as a cardiovascular protective mechanism to avoid target organ damage. Further studies are warranted to assess long-term effects of slow breathing.
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Affiliation(s)
- Magdalena K Nuckowska
- Department of Human Physiology, Faculty of Health Sciences, Medical University of Gdansk, Gdansk, Poland
| | - Marcin Gruszecki
- Department of Radiology Informatics and Statistics, Faculty of Health Sciences, Medical University of Gdansk, Gdansk, Poland
| | - Jacek Kot
- National Centre for Hyperbaric Medicine, Institute of Maritime and Tropical Medicine, Faculty of Health Sciences, Medical University of Gdansk, Gdynia, Poland
| | - Jacek Wolf
- Department of Hypertension and Diabetology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Wojciech Guminski
- Department of Computer Communications, Faculty of Electronics, Telecommunications and Informatics, Gdansk University of Technology, Gdansk, Poland
| | | | - Jerzy Wtorek
- Department of Biomedical Engineering, Faculty of Electronics, Telecommunications and Informatics, Gdansk University of Technology, Gdansk, Poland
| | - Krzysztof Narkiewicz
- Department of Hypertension and Diabetology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Pawel J Winklewski
- Department of Human Physiology, Faculty of Health Sciences, Medical University of Gdansk, Gdansk, Poland. .,Department of Clinical Anatomy and Physiology, Faculty of Health Sciences, Pomeranian University of Slupsk, Slupsk, Poland.
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How does empagliflozin improve arterial stiffness in patients with type 2 diabetes mellitus? Sub analysis of a clinical trial. Cardiovasc Diabetol 2019; 18:44. [PMID: 30922297 PMCID: PMC6440009 DOI: 10.1186/s12933-019-0839-8] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 03/03/2019] [Indexed: 02/08/2023] Open
Abstract
Background Empagliflozin has been shown to reduce cardiovascular mortality, but the underlying pathogenetic mechanisms are poorly understood. It was previously demonstrated that empagliflozin improved arterial stiffness. Methods Our analysis comprising 58 patients with type 2 diabetes mellitus identifies factors triggering the improvement of arterial stiffness. All patients participated in an investigator-initiated, prospective, double-blind, randomized, placebo-controlled, interventional clinical trial (http://www.ClinicalTrials.gov: NCT02471963, registered 15th June 2015, retrospectively registered) and received either 6-weeks treatment with 25 mg empagliflozin orally once daily or placebo (crossover). Central systolic pressure and central pulse pressure were recorded by the SphygmoCor System (AtCor Medical). Now, we investigated the impact of parameters of glucose metabolism, volume status, sympathetic activation, lipids, uric acid, blood pressure and inflammation on vascular parameters of arterial stiffness using multivariate regression analysis. Results As previously reported, therapy with empagliflozin improved arterial stiffness as indicated by reduced central systolic blood pressure (113.6 ± 12.1 vs 118.6 ± 12.9 mmHg, p < 0.001), central pulse pressure (39.1 ± 10.2 vs 41.9 ± 10.7 mmHg, p = 0.027) forward (27.1 ± 5.69 vs 28.7 ± 6.23 mmHg, p = 0.031) as well as reflected wave amplitude (18.9 ± 5.98 vs 20.3 ± 5.97 mmHg, p = 0.045) compared to placebo. The multivariate regression analysis included age, sex and change between empagliflozin and placebo therapy of the following parameters: HbA1c, copeptin, hematocrit, heart rate, LDL-cholesterol, uric acid, systolic 24-h ambulatory blood pressure and high sensitive CRP (hsCRP). Besides the influence of age (beta = − 0.259, p = 0.054), sex (beta = 0.292, p = 0.040) and change in systolic 24-h ambulatory blood pressure (beta = 0.364, p = 0.019), the change of hsCRP (beta = 0.305, p = 0.033) emerged as a significant determinant of the empagliflozin induced reduction in arterial stiffness (placebo corrected). When replacing HbA1c with fasting plasma glucose in the multivariate regression analysis, a similar effect of the change in hsCRP (beta = 0.347, p = 0.017) on arterial stiffness parameters was found. Conclusion Besides age and sex, change in systolic 24-h ambulatory blood pressure and change in hsCRP were determinants of the empagliflozin induced improvement of vascular parameters of arterial stiffness, whereas parameters of change in glucose metabolism and volume status had no significant influence. Our analysis suggests that empagliflozin exerts, at least to some extent, its beneficial vascular effects via anti-inflammatory mechanisms. Trial registrationhttp://www.ClinicalTrials.gov: NCT02471963, registered 15th June 2015, retrospectively registered
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Kotovskaya YV, Rogoza AN, Orlova YA, Posokhov IN. Ambulatory pulse wave monitoring: current and future. Opinion paper of Russian Experts. ACTA ACUST UNITED AC 2018. [DOI: 10.15829/1728-8800-2018-6-95-109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The predictive value of vascular biomarkers such as pulse wave velocity (PWV), central arterial pressure (CAP), and augmentation index (AIx), obtained through pulse wave analysis (PWA) in resting conditions, has been documented in a variety of patient groups and populations. There are appropriate recommendations on their clinical use in clinical practice guidelines of various scientific societies. Operator-independent methods are currently available for estimating vascular biomarkers also in ambulatory conditions. The acceptable accuracy and reproducibility of ambulatory PWA makes it be a promising tool for evaluating vascular biomarkers in daily-life conditions. This approach may provide an opportunity to further improve the early cardiovascular screening in subjects at risk. However, there is no sufficient evidence to support the routine clinical use of PWA in ambulatory conditions at the moment. In particular, long-term outcome studies are needed to show the predictive value of ambulatory PWV, CAP and AIx values.
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Affiliation(s)
- Yu. V. Kotovskaya
- Russian Gerontology Clinical Research Center of the Ministry of Health
| | - A. N. Rogoza
- Scientific Medical Research Center of Cardiology of the Ministry of Health
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Chang YC, Hsu BG, Liou HH, Lee CJ, Wang JH. Serum levels of sclerostin as a potential biomarker in central arterial stiffness among hypertensive patients. BMC Cardiovasc Disord 2018; 18:214. [PMID: 30482161 PMCID: PMC6260557 DOI: 10.1186/s12872-018-0955-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 11/14/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Sclerostin is known to be a canonical Wnt/β-catenin signaling pathway inhibitor, while the Wnt/β-catenin signaling pathway is proposed to be involved in the development of arterial stiffness. This study aims to investigate the relationship between serum sclerostin levels and carotid-femoral pulse wave velocity (cfPWV) among hypertensive patients. METHODS Fasting blood samples were obtained from 105 hypertensive patients. Patients with cfPWV values of > 10 m/s were classified in the high arterial stiffness group, whereas those with cfPWV values of ≤10 m/s were assigned to the low arterial stiffness group. Serum sclerostin and Dickkopf-1 (DKK1) levels were quantified using commercially available enzyme-linked immunosorbent assays. RESULTS Thirty-six hypertensive patients (34.3%) who belonged to the high arterial stiffness group were generally older (p < 0.001), presented with lower estimated glomerular filtration rates (eGFR, p = 0.014), higher incidence of diabetes mellitus (p = 0.030), average systolic blood pressures (SBP, p = 0.013), pulse pressure (p = 0.026), serum creatinine levels (p = 0.013), intact parathyroid hormone levels (iPTH, p = 0.003), and sclerostin levels (p < 0.001) than their counterparts in the low arterial stiffness group. A multivariable logistic regression analysis identified sclerostin as an independent predictor of arterial stiffness in hypertensive patients (odds ratio, 1.042; 95% confidence interval (CI), 1.017-1.068; p = 0.001). Multivariable forward stepwise linear regression analysis also showed that serum sclerostin level (β = 0.255, adjusted R2 change: 0.146, p = 0.003) was positively associated with cfPWV values in patients with hypertension. CONCLUSIONS In this study, serum sclerostin level, but not DKK1, is found to be positively correlated with cfPWV values and is identified as an independent predictor of arterial stiffness in hypertensive patients after adjusting for significant confounders.
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Affiliation(s)
- Yu-Chi Chang
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Bang-Gee Hsu
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Division of Nephrology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Hung-Hsiang Liou
- Division of Nephrology, Hsin-Jen Hospital, New Taipei City, Taiwan
| | - Chung-Jen Lee
- Department of Nursing, Tzu Chi College of Technology, Hualien, Taiwan
| | - Ji-Hung Wang
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Division of Cardiology, Buddhist Tzu Chi General Hospital, No. 707, Section 3, Chung-Yang Road, Hualien, 97004 Taiwan
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Mandini S, Conconi F, Mori E, Myers J, Grazzi G, Mazzoni G. Walking and hypertension: greater reductions in subjects with higher baseline systolic blood pressure following six months of guided walking. PeerJ 2018; 6:e5471. [PMID: 30186685 PMCID: PMC6119598 DOI: 10.7717/peerj.5471] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 07/28/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The aim of the study was to assess the effects of walking on the blood pressure in sedentary adults with differing degrees of systolic blood pressure (SBP). METHODS A total of 529 subjects with SBP above 120 mmHg were enrolled. Blood pressure, body weight, body mass index, waist circumference and walking speed were determined at enrolment and after six months. Walking sessions were supervised by exercise physiologists. RESULTS The weekly walking time of the subjects completing the project was uniform and reached 300 minutes by the second month. 56% of participants completed the 6 months intervention (182 women 59.6 ± 9.0 years, and 114 men, 65.4 ± 8.6 years) 27 had a baseline SBP >160 mm Hg, 35 between 150-159, 70 between 140-149, 89 between 130-139 and 75 between 120-129 mmHg. Following six months of supervised walking, SBP was significantly reduced in all subgroups (p < 0.001), with the greatest reduction (-21.3 mmHg) occurring in subjects with baseline SBP >160 and the smallest reduction (-2.6 mmHg) occurring in subjects with baseline SBP of 120-129 mmHg. Diastolic blood pressure, body weight, body mass index and waist circumference were also significantly reduced following the walking intervention (p < 0.001). These reductions were nearly identical within the various groups. DISCUSSION In a large group of sedentary adults with varying degrees of SBP, 6 months of supervised walking elicited a marked reduction in systolic blood pressure with the largest reductions in pressure occurring in individuals with higher baseline SBP.
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Affiliation(s)
- Simona Mandini
- Center of Biomedical Studies Applied to Sport, University of Ferrara, Ferrara, Italy
- Public Health Department, AUSL Ferrara, Ferrara, Italy
| | - Francesco Conconi
- Center of Biomedical Studies Applied to Sport, University of Ferrara, Ferrara, Italy
| | - Elisa Mori
- Center of Biomedical Studies Applied to Sport, University of Ferrara, Ferrara, Italy
| | - Jonathan Myers
- Health Care System Cardiology, VA Palo Alto Health Care System Cardiology, Palo Alto, CA, USA
- School of Medicine, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Giovanni Grazzi
- Center of Biomedical Studies Applied to Sport, University of Ferrara, Ferrara, Italy
- Public Health Department, AUSL Ferrara, Ferrara, Italy
| | - Gianni Mazzoni
- Center of Biomedical Studies Applied to Sport, University of Ferrara, Ferrara, Italy
- Public Health Department, AUSL Ferrara, Ferrara, Italy
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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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Moreno B, de Faria AP, Ritter AMV, Yugar LBT, Ferreira-Melo SE, Amorim R, Modolo R, Fattori A, Yugar-Toledo JC, Coca A, Moreno H. Glycated hemoglobin correlates with arterial stiffness and endothelial dysfunction in patients with resistant hypertension and uncontrolled diabetes mellitus. J Clin Hypertens (Greenwich) 2018; 20:910-917. [PMID: 29729072 DOI: 10.1111/jch.13293] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 03/07/2018] [Accepted: 03/18/2018] [Indexed: 12/29/2022]
Abstract
This study aimed to evaluate the effects of glycated hemoglobin (HbA1c ) on flow-mediated dilation, intima-media thickness, pulse wave velocity, and left ventricular mass index in patients with resistant hypertension (RHTN) comparing RHTN-controlled diabetes mellitus and RHTN-uncontrolled type 2 diabetes mellitus. Two groups were formed: HbA1c <7.0% (RHTN-controlled diabetes mellitus: n = 98) and HbA1c ≥7.0% (RHTN-uncontrolled diabetes mellitus: n = 122). Intima-media thickness and flow-mediated dilation were measured by high-resolution ultrasound, left ventricular mass index by echocardiography, and arterial stiffness by carotid-femoral pulse wave velocity. No differences in blood pressure levels were found between the groups but body mass index was higher in patients with RHTN-uncontrolled diabetes mellitus. Endothelial dysfunction and arterial stiffness were worse in patients with RHTN-uncontrolled diabetes mellitus. Intima-media thickness and left ventricular mass index measurements were similar between the groups. After adjustments, multiple linear regression analyses showed that HbA1c was an independent predictor of flow-mediated dilation and pulse wave velocity in all patients with RHTN. In conclusion, HbA1c may predict the grade of arterial stiffness and endothelial dysfunction in patients with RHTN, and superimposed uncontrolled diabetes mellitus implicates further impairment of vascular function.
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Affiliation(s)
- Beatriz Moreno
- Laboratory of Cardiovascular Pharmacology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | - Ana Paula de Faria
- Laboratory of Cardiovascular Pharmacology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | | | | | - Silvia Elaine Ferreira-Melo
- Laboratory of Cardiovascular Pharmacology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | | | - Rodrigo Modolo
- Faculty of Medical Sciences, Department of Internal Medicine-Cardiology Division, University of Campinas, Campinas, SP, Brazil
| | - André Fattori
- Faculty of Medical Sciences, Department of Internal Medicine-Cardiology Division, University of Campinas, Campinas, SP, Brazil
| | | | - Antonio Coca
- Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clínic (IDIBAPS) Effect, University of Barcelona, Barcelona, Spain
| | - Heitor Moreno
- Laboratory of Cardiovascular Pharmacology, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil.,Faculty of Medical Sciences, Department of Internal Medicine-Cardiology Division, University of Campinas, Campinas, SP, Brazil
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Yoon H, Lee JH, Kim GS, Kim YJ, Hwang EY, Park CE, Park J. The relationship between anemia and pulse pressure and hypertension: The Korea National Health and Nutrition Examination Survey 2010–2012. Clin Exp Hypertens 2018; 40:650-655. [DOI: 10.1080/10641963.2017.1416123] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Hyun Yoon
- Department of Biomedical Laboratory Science, Hanlyo University, Gwangyang-si, South Korea
| | - Jun Ho Lee
- Department of Biomedical Laboratory Science, Wonkwang Health Science University, Iksan-si, South Korea
| | - Gwang Seok Kim
- Department of Emergency Medical Technology, Chungbuk Health and Science University, Cheongju-si, South Korea
| | - Yu Jeong Kim
- Department of Nursing, Chosun Nursing College, Gwangju, South Korea
| | - Eun Young Hwang
- Department of Nursing Graduate School, Chosun University, Gwangju, South Korea
| | - Chang Eun Park
- Department of Biomedical Laboratory Science, Namseoul University, Cheonan-si, South Korea
| | - Jong Park
- Department of Preventive Medicine, Chosun University Medical School, Gwangju, South Korea
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Twenty-Four-Hour Ambulatory Pulse Wave Analysis in Hypertension Management: Current Evidence and Perspectives. Curr Hypertens Rep 2017; 18:72. [PMID: 27659178 DOI: 10.1007/s11906-016-0681-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The predictive value of vascular biomarkers such as pulse wave velocity (PWV), central arterial pressure (CAP), and augmentation index (AIx), obtained through pulse wave analysis (PWA) in resting conditions, has been documented in a variety of patient groups and populations. This allowed to make appropriate recommendations in clinical practice guidelines of several scientific societies. Due to advances in technologies, largely operator-independent methods are currently available for estimating vascular biomarkers also in ambulatory conditions, over the 24 h. According to the acceptable accuracy and reproducibility of 24-h ambulatory PWA, it appears to be a promising tool for evaluating vascular biomarkers in daily life conditions. This approach may provide an opportunity to further improve the early cardiovascular screening in subjects at risk. However, concerning the clinical use of PWA over the 24 h in ambulatory conditions at the moment, there is no sufficient evidence to support its routine clinical use. In particular, long-term outcome studies are needed to show the predictive value of 24-h PWV, CAP, and AIx values, provided by these devices, over and beyond peripheral blood pressure, and to answer the many technical and clinical questions still open. To this regard, the VASOTENS Registry, an international observational prospective study recently started, will help providing answers on a large sample of hypertensive patients recruited worldwide.
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Ma XX, Zheng SZ, Shu Y, Wang Y, Chen XP. Association between Carotid Intima-media Thickness and Aldehyde Dehydrogenase 2 Glu504Lys Polymorphism in Chinese Han with Essential Hypertension. Chin Med J (Engl) 2017; 129:1413-8. [PMID: 27270535 PMCID: PMC4910363 DOI: 10.4103/0366-6999.183413] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Aldehyde dehydrogenase 2 (ALDH2) is involved in the pathophysiological processes of cardiovascular diseases. Recent studies showed that mutant ALDH2 could increase oxidative stress and is a susceptible factor for hypertension. In addition, wild-type ALDH2 could improve the endothelial functions, therefore reducing the risk of developing atherosclerosis. The aim of the present study was to explore the frequency of the Glu504Lys polymorphism of the ALDH2 gene and its relation to carotid intima-media thickness (CIMT) in a group of patients with essential hypertension (EH) and to investigate the association between the Glu504Lys polymorphism and CIMT in Chinese Han patients with EH. METHODS In this study, 410 Chinese Han patients with EH who received physical examinations at the People's Hospital of Sichuan Province (China) were selected. DNA microarray chip was used for the genotyping of the Glu504Lys polymorphism of the ALDH2 gene. The differences in CIMT among patients with different Glu504Lys ALDH2 genotypes were analyzed. RESULTS The mean CIMT of the patients carrying AA/AG and GG genotypes was 1.02 ± 0.31 mm and 0.78 ± 0.28 mm, respectively. One-way ANOVA showed that the CIMT of the patients carrying the AA/AG genotype was significantly higher than in the ones carrying the GG genotype (P < 0.001). Multivariate logistic regression showed that the Glu504Lys AA/AG genotype of the ALDH2 gene was one of the major factors influencing the CIMT in patients with EH (odds ratio = 3.731, 95% confidence interval = 1.589-8.124, P = 0.001). CONCLUSIONS The Glu504Lys polymorphism of the ALDH2 gene is associated with the CIMT of Chinese Han patients with EH in Sichuan, China.
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Affiliation(s)
- Xiao-Xiang Ma
- Center of Health Physical Examination and Health Management, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan 610072; Department of Cardiovascular Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Shu-Zhan Zheng
- Department of Cardiology, The Affiliated Hospital of Luzhou Medical College, Luzhou, Sichuan 646000, China
| | - Yan Shu
- Department of Cardiology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan 610072, China
| | - Yong Wang
- Department of Cardiovascular, Xinqiao Hospital, Third Military Medical University, Chongqing, Sichuan 400037, China
| | - Xiao-Ping Chen
- Department of Cardiovascular Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
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Maksuti E, Bini F, Fiorentini S, Blasi G, Urban MW, Marinozzi F, Larsson M. Influence of wall thickness and diameter on arterial shear wave elastography: a phantom and finite element study. Phys Med Biol 2017; 62:2694-2718. [DOI: 10.1088/1361-6560/aa591d] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Ott C, Jumar A, Striepe K, Friedrich S, Karg MV, Bramlage P, Schmieder RE. A randomised study of the impact of the SGLT2 inhibitor dapagliflozin on microvascular and macrovascular circulation. Cardiovasc Diabetol 2017; 16:26. [PMID: 28231831 PMCID: PMC5324272 DOI: 10.1186/s12933-017-0510-1] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 02/05/2017] [Indexed: 01/24/2023] Open
Abstract
Background The sodium–glucose cotransporter 2 inhibitor, dapagliflozin, has been shown to improve diabetic control and reduce blood pressure in patients with type 2 diabetes mellitus. Its effects on micro- and macrovascular structure and function have not yet been reported. Methods This was a prospective, single-centre, placebo-controlled, double-blind, randomised crossover phase IIIb study conducted between March 2014 and February 2015. After a 4-week run-in/washout phase, patients (N = 59) received 6 weeks of either dapagliflozin 10 mg or placebo once daily. They then underwent a 1-week washout before crossing over to the other treatment. Changes in retinal capillary flow (RCF) and arteriole remodelling were evaluated using scanning laser Doppler flowmetry, while micro- and macrovascular parameters in the systemic circulation were assessed using pulse wave analysis. Results Six weeks of dapagliflozin treatment resulted in improvements in diabetes control, including blood glucose and insulin resistance, and reduced office and 24-h ambulatory blood pressure values. RCF decreased from 324 AU at baseline to 308 AU after treatment with dapagliflozin (p = 0.028), while there was little difference after the placebo (318 AU; p = 0.334). Furthermore, the arteriole remodelling that was seen after the placebo phase was not evident after the dapagliflozin phase. Central systolic and diastolic blood pressure values were significantly lower after 6 weeks of dapagliflozin, by 3.0 and 2.2 mmHg, respectively (p = 0.035 and 0.020, respectively vs. baseline). Conclusions Six weeks of dapagliflozin treatment resulted in numerous beneficial effects. In addition to achieving superior diabetes control and blood pressure, parameters associated with the early stages of vascular remodelling were also improved. Trial registrationhttp://www.clinicaltrials.gov (NCT02383238)
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Affiliation(s)
- Christian Ott
- Department of Nephrology and Hypertension, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054, Erlangen, Germany
| | - Agnes Jumar
- Department of Nephrology and Hypertension, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054, Erlangen, Germany
| | - Kristina Striepe
- Department of Nephrology and Hypertension, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054, Erlangen, Germany
| | - Stefanie Friedrich
- Department of Nephrology and Hypertension, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054, Erlangen, Germany
| | - Marina V Karg
- Department of Nephrology and Hypertension, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054, Erlangen, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Mahlow, Germany
| | - Roland E Schmieder
- Department of Nephrology and Hypertension, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054, Erlangen, Germany.
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Vogrin B, Slak Rupnik M, Mičetić-Turk D. Increased augmentation index and central systolic arterial pressure are associated with lower school and motor performance in young adolescents. J Int Med Res 2017; 45:1892-1900. [PMID: 28703627 PMCID: PMC5805191 DOI: 10.1177/0300060516678717] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objective In adults, improper arterial function has been linked to cognitive
impairment. The pulse wave velocity (PWV), augmentation index (AIx) and
other vascular parameters are useful indicators of arterial health. In our
study, we monitored arterial properties, body constitution, school success,
and motor skills in young adolescents. We hypothesize that reduced cognitive
and motor abilities have a vascular origin in children. Methods We analysed 81 healthy school children aged 11–16 years. Anthropometry
central systolic arterial pressure, body mass index (BMI), standard
deviation scores (SDS) BMI, general school performance grade, and eight
motor tests were assessed. PWV, AIx, and central systolic arterial pressure
(SBPao) were measured. Results AIx and SBPao correlated negatively with school performance grades. Extremely
high AIx, PWV and SBPao values were observed in 5% of children and these
children had average to low school performance. PWV correlated significantly
with weight, height, and waist and hip circumference. AIx, PWV, school
success, and BMI correlated strongly with certain motor functions. Conclusions Increased AIx and SBPao are associated with lower school and motor
performance in children. PWV is influenced by the body’s constitution.
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Affiliation(s)
| | - Marjan Slak Rupnik
- 2 Institute of Physiology, Medical faculty, University of Maribor, Slovenia.,4 Center of physiology and pharmacology, Medical University Vienna, Austria
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Central Systolic Hypertension in Patients with Well-Controlled Hypertension. BIOMED RESEARCH INTERNATIONAL 2017; 2017:8158974. [PMID: 28127560 PMCID: PMC5239837 DOI: 10.1155/2017/8158974] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Revised: 11/27/2016] [Accepted: 12/13/2016] [Indexed: 01/20/2023]
Abstract
Background. Central systolic blood pressure (CSBP) has prognostic significance and simplified devices for its estimation have been introduced recently. The aim of this study was to assess the achievement of the target CSBP in treated hypertensive patients. Subjects and Methods. One hundred patients with well-controlled hypertension were analysed. For CSBP estimation, we used the Arteriograph (TensioMed Ltd.), which uses one cuff for all measurements, the “single-point measurement” approach. Results. We found that 62% of patients had CSBP ≥ 130 mmHg, the suggested cut-off value for hypertension. When sex-specific classification was employed (CSBP ≥ 137 mmHg for female and CSBP ≥ 133 mmHg for male), only 13% of patients (mainly women) remained in the hypertensive range. We also found that 55% of patients had a CSBP higher than brachial pressure. Multiple analyses showed that CSBP was significantly associated with sex, height, and return time. Conclusions. A high proportion of treated hypertensive patients had CSBP levels that exceeded their brachial BP. CSBP positively correlated with lower height and shorter return time of the reflected pressure wave and was significantly higher in females compared to males. These findings suggest that, for CSBP classification, it is important to take height and sex-specific differences into account.
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Ruddy JM, Akerman AW, Kimbrough D, Nadeau EK, Stroud RE, Mukherjee R, Ikonomidis JS, Jones JA. Differential hypertensive protease expression in the thoracic versus abdominal aorta. J Vasc Surg 2016; 66:1543-1552. [PMID: 28034583 DOI: 10.1016/j.jvs.2016.07.120] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 07/24/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Hypertension (HTN), which is a major risk factor for cardiovascular morbidity and mortality, can drive pathologic remodeling of the macro- and microcirculation. Patterns of aortic pathology differ, however, suggesting regional heterogeneity of the pressure-sensitive protease systems triggering extracellular matrix remodeling in the thoracic (TA) and abdominal aortas (AA). This study tested the hypothesis that the expression of two major protease systems (matrix metalloproteinases [MMPs] and cathepsins) in the TA and AA would be differentially affected with HTN. METHODS Normotensive (BPN3) mice at 14-16 weeks of age underwent implantation of osmotic infusion pumps for 28-day angiotensin II (AngII) delivery (1.46 mg/kg/day; BPN3+AngII; n = 8) to induce HTN. The TA and AA were harvested to determine levels of MMP-2, MMP-9, and membrane type 1-MMP, and cathepsins S, K, and L were evaluated in age-matched BPN3 (n = 8) control and BPH2 spontaneously hypertensive mice (non-AngII pathway; n = 7). Blood pressure was monitored via CODA tail cuff plethysmography (Kent Scientific Corporation, Torrington, Conn). Quantitative real-time polymerase chain reaction and immunoblotting/zymography were used to measure MMP and cathepsin messenger RNA expression and protein abundance, respectively. Target protease values were compared within each aortic region via analysis of variance. RESULTS Following 28 days infusion, the BPN3+AngII mice had a 17% increase in systolic blood pressure, matching that of the BPH2 spontaneously hypertensive mice (both P < .05 vs BPN3). MMP-2 gene expression demonstrated an AngII-dependent increase in the TA (P < .05), but MMP-9 was not altered with HTN. Expression of tissue inhibitor of metalloproteinases-1 was markedly increased in TA of BPN3+AngII mice, but tissue inhibitor of metalloproteinases-2 demonstrated decreased expression in the AA of both hypertensive groups (P < .05). Only cathepsin K responded to AngII-induced HTN with significant elevation in the TA of those mice, but expression of cathepsin L and cystatin C was inhibited in AA of both hypertensive groups (P < .05). Apoptotic markers were not significantly elevated in any experimental group. CONCLUSIONS By using two different models of HTN, this study has identified pressure-dependent as well as AngII-dependent regional alterations in aortic gene expression of MMPs and cathepsins that may lead to differential remodeling responses in each of the aortic regions. Further studies will delineate mechanisms and may provide targeted therapies to attenuate down-stream aortic pathology based on demonstrated regional heterogeneity.
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Affiliation(s)
- Jean Marie Ruddy
- Division of Vascular Surgery, Medical University of South Carolina, Charleston, SC; Division of Cardiothoracic Research, Medical University of South Carolina, Charleston, SC.
| | - Adam W Akerman
- Division of Cardiothoracic Research, Medical University of South Carolina, Charleston, SC
| | - Denise Kimbrough
- Division of Cardiothoracic Research, Medical University of South Carolina, Charleston, SC
| | - Elizabeth K Nadeau
- Division of Cardiothoracic Research, Medical University of South Carolina, Charleston, SC
| | - Robert E Stroud
- Division of Cardiothoracic Research, Medical University of South Carolina, Charleston, SC
| | - Rupak Mukherjee
- Division of Cardiothoracic Research, Medical University of South Carolina, Charleston, SC
| | - John S Ikonomidis
- Division of Cardiothoracic Research, Medical University of South Carolina, Charleston, SC; Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, SC
| | - Jeffrey A Jones
- Division of Cardiothoracic Research, Medical University of South Carolina, Charleston, SC
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Pulmonary Function and Arterial Stiffness in Chronic Heart Failure. BIOMED RESEARCH INTERNATIONAL 2016; 2016:5478394. [PMID: 28097138 PMCID: PMC5209595 DOI: 10.1155/2016/5478394] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 11/28/2016] [Accepted: 11/30/2016] [Indexed: 12/21/2022]
Abstract
Arterial stiffness contributes to heart failure and is decreased by angiotensin receptor blockers (ARBs). This cross-sectional study aimed to assess associations of lung function and ARB with arterial stiffness in patients with chronic heart failure. 354 outpatients (168 males; 186 females; 68.2 ± 7.2 years old) with chronic heart failure were evaluated. Lung function parameters, including forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and FEV1 to FVC ratio (FEV1/FVC), were assessed. The cardio-ankle vascular index (CAVI) was used to estimate arterial stiffness. Unadjusted correlation analyses revealed a positive association of CAVI with ARB but not ACEI, and a negative correlation with FEV1 (r = −0.2987, p < 0.0001). Multiple stepwise regression analyses showed that ARB and FEV1 (p < 0.0001) were independent predicting factors for CAVI. These findings suggest that reduced pulmonary function is associated with increased CAVI. Pulmonary function protection could be used to improve the prognosis in heart failure, but additional studies are necessary.
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Harvey RE, Barnes JN, Hart ECJ, Nicholson WT, Joyner MJ, Casey DP. Influence of sympathetic nerve activity on aortic hemodynamics and pulse wave velocity in women. Am J Physiol Heart Circ Physiol 2016; 312:H340-H346. [PMID: 27923789 DOI: 10.1152/ajpheart.00447.2016] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 11/14/2016] [Accepted: 11/29/2016] [Indexed: 01/21/2023]
Abstract
Central (aortic) blood pressure, arterial stiffness, and sympathetic nerve activity increase with age in women. However, it is unknown if the age-related increase in sympathetic activity influences aortic hemodynamics and carotid-femoral pulse wave velocity (cfPWV), an index of central aortic stiffness. The goal of this study was to determine if aortic hemodynamics and cfPWV are directly influenced by sympathetic nerve activity by measuring aortic hemodynamics, cfPWV, and muscle sympathetic nerve activity (MSNA) in women before and during autonomic ganglionic blockade with trimethaphan camsylate. We studied 12 young premenopausal (23 ± 4 yr) and 12 older postmenopausal (57 ± 3 yr) women. These women did not differ in body mass index or mean arterial pressure (P > 0.05 for both). At baseline, postmenopausal women had higher aortic pulse pressure, augmented pressure, augmentation index adjusted for a heart rate of 75 beats/min, wasted left ventricular pressure energy, and cfPWV than young women (P < 0.05). During ganglionic blockade, postmenopausal women had a greater decrease in these variables in comparison to young women (P < 0.05). Additionally, baseline MSNA was negatively correlated with the reductions in aortic pulse pressure, augmented pressure, and wasted left ventricular pressure energy during ganglionic blockade in postmenopausal women (P < 0.05) but not young women. Baseline MSNA was not correlated with the changes in augmentation index adjusted for a heart rate of 75 beats/min or cfPWV in either group (P > 0.05 for all). Our results suggest that some aortic hemodynamic parameters are influenced by sympathetic activity to a greater extent in older postmenopausal women than in young premenopausal women.NEW & NOTEWORTHY Autonomic ganglionic blockade results in significant decreases in multiple aortic pulse wave characteristics (e.g., augmented pressure) and central pulse wave velocity in older postmenopausal women but not in young premenopausal women. Certain aortic pulse wave parameters are negatively influenced by sympathetic activity to a greater extent in older postmenopausal women.
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Affiliation(s)
- Ronée E Harvey
- Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota.,Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota; and
| | - Jill N Barnes
- Department of Kinesiology, University of Wisconsin-Madison, Madison, Wisconsin
| | | | - Wayne T Nicholson
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota; and
| | - Michael J Joyner
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota; and
| | - Darren P Casey
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, Iowa
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Brodmerkel DW, Taylor JA. Passive heat therapy: a ready route to vascular health? J Physiol 2016; 594:5039-40. [PMID: 27629074 DOI: 10.1113/jp272933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Daniel W Brodmerkel
- Cardiovascular Research Laboratory, Spaulding Hospital Cambridge, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Cambridge, MA, USA
| | - J Andrew Taylor
- Cardiovascular Research Laboratory, Spaulding Hospital Cambridge, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Cambridge, MA, USA.
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Potthoff SA, Stamer S, Grave K, Königshausen E, Sivritas SH, Thieme M, Mori Y, Woznowski M, Rump LC, Stegbauer J. Chronic p38 mitogen-activated protein kinase inhibition improves vascular function and remodeling in angiotensin II-dependent hypertension. J Renin Angiotensin Aldosterone Syst 2016; 17:17/3/1470320316653284. [PMID: 27407119 PMCID: PMC5843849 DOI: 10.1177/1470320316653284] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 03/19/2016] [Indexed: 11/16/2022] Open
Abstract
Introduction: An excess of angiotensin II (Ang II) causes hypertension and vascular injury. Activation of mitogen-activated protein kinase p38 (p38-MAPK) plays a substantial role in Ang II-dependent organ damage. Recently, we showed that p38-MAPK activation regulates the pressor response to Ang II. This study evaluates the effect of chronic p38-MAPK inhibition in Ang II-dependent hypertension. Materials and methods: C57Bl/6J mice were infused with Ang II for 14 days and either treated with the p38-MAPK inhibitor BIRB796 (50 mg/kg/day) or the vehicle as the control. We assessed vascular function in the aorta and isolated perfused kidneys. Results: Chronic p38-MAPK inhibition did not alter blood pressure at the baseline, but attenuated Ang II-induced hypertension significantly (baseline: 122 ± 2 versus 119 ± 4 mmHg; Ang II: 173 ± 3 versus 155 ± 3 mmHg; p < 0.001). In addition, BIRB796 treatment improved vascular remodeling by reducing the aortic media-to-lumen ratio and decreasing the expression of the membrane metalloproteinases (MMP) MMP-1 and MMP-9. Moreover, renal vascular dysfunction induced by chronic Ang II infusion was significantly ameliorated in the BIRP796-treated mice. Acute p38-MAPK inhibition also improved vascular function in the aorta and kidneys of Ang II-treated mice, highlighting the important role of p38-MAPK activation in the pathogenesis of vascular dysfunction. Conclusions: Our findings indicated there is an important role for p38-MAPK in regulating blood pressure and vascular injury, and highlighted its potential as a pharmaceutical target.
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Affiliation(s)
- S A Potthoff
- Department of Nephrology, University Hospital Düsseldorf, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - S Stamer
- Department of Nephrology, University Hospital Düsseldorf, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - K Grave
- Department of Nephrology, University Hospital Düsseldorf, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - E Königshausen
- Department of Nephrology, University Hospital Düsseldorf, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - S H Sivritas
- Department of Nephrology, University Hospital Düsseldorf, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - M Thieme
- Department of Nephrology, University Hospital Düsseldorf, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Y Mori
- Department of Nuclear Medicine, University Hospital Düsseldorf, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - M Woznowski
- Department of Nephrology, University Hospital Düsseldorf, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - L C Rump
- Department of Nephrology, University Hospital Düsseldorf, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - J Stegbauer
- Department of Nephrology, University Hospital Düsseldorf, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
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Effects of baroreflex activation therapy on arterial stiffness and central hemodynamics in patients with resistant hypertension. J Hypertens 2016; 33:181-6. [PMID: 25232758 DOI: 10.1097/hjh.0000000000000361] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND High central blood pressure, augmentation index and pulse wave velocity are independent cardiovascular risk factors. Little is known of the effect of baroreflex activation therapy on central hemodynamics. METHOD In this prospective clinical trial, radial artery applanation tonometry and pulse wave analysis were used to derive central aortic pressure and hemodynamic indices (i.e. augmentation pressure, augmentation index, pulse wave velocity, systolic and diastolic pressure time integral, subendocardial viability index) at baseline and 6 months after starting baroreflex activation therapy in 25 patients with resistant hypertension. RESULTS Apart from peripheral blood pressure reduction, 6 months of baroreflex activation therapy significantly reduced mean central aortic blood pressure from 109.7 ± 20.5 to 97.4 ± 18.8 mm Hg (P < 0.01) and aortic pulse pressure from 62.9 ± 18.6 to 55.2 ± 16.0 mm Hg (P < 0.01). Aortic augmentation pressure and augmentation index at a heart rate of 75 b.p.m. were significantly reduced by 4.3 ± 7.9 mm Hg (P = 0.01) and 3.5 ± 6.8% (P = 0.02). Additionally, pulse wave velocity decreased from 10.3 ± 2.6 to 8.6 ± 1.3 m/s (P < 0.01) 6 months after starting baroreflex activation therapy. Systolic pressure time integral was significantly reduced (P = 0.03), whereas subendocardial viability index remained unchanged. CONCLUSION Apart from peripheral blood pressure, baroreflex activation therapy reduces central blood pressure, augmentation index at a heart rate of 75 b.p.m. and pulse wave velocity in patients with resistant hypertension, suggesting strong potential to reduce cardiovascular risk.
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Anstey KJ, Eramudugolla R, Hosking DE, Lautenschlager NT, Dixon RA. Bridging the Translation Gap: From Dementia Risk Assessment to Advice on Risk Reduction. J Prev Alzheimers Dis 2015; 2:189-198. [PMID: 26380232 PMCID: PMC4568745 DOI: 10.14283/jpad.2015.75] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Dementia risk reduction is a global health and fiscal priority given the current lack of effective treatments and the projected increased number of dementia cases due to population ageing. There are often gaps among academic research, clinical practice, and public policy. We present information on the evidence for dementia risk reduction and evaluate the progress required to formulate this evidence into clinical practice guidelines. This narrative review provides capsule summaries of current evidence for 25 risk and protective factors associated with AD and dementia according to domains including biomarkers, demographic, lifestyle, medical, and environment. We identify the factors for which evidence is strong and thereby especially useful for risk assessment with the goal of personalising recommendations for risk reduction. We also note gaps in knowledge, and discuss how the field may progress towards clinical practice guidelines for dementia risk reduction.
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Affiliation(s)
- Kaarin J. Anstey
- Centre for Research on Ageing, Health and Wellbeing, Research School of Population Health, Australian National University
| | - Ranmalee Eramudugolla
- Centre for Research on Ageing, Health and Wellbeing, Research School of Population Health, Australian National University
| | - Diane E. Hosking
- Centre for Research on Ageing, Health and Wellbeing, Research School of Population Health, Australian National University
| | - Nicola T. Lautenschlager
- Academic Unit for Psychiatry of Old Age, St. Vincent's Health, Department of Psychiatry, University of Melbourne
- School of Psychiatry and Clinical Neurosciences & WA Centre for Health and Ageing, University of Western Australia
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Hill LK, Sims Wright R, Aiken-Morgan AT, Gamaldo A, Edwards CL, Whitfield KE. Perceived Control Predicts Pulse Pressure in African American Men: The Baltimore Study of Black Aging. Ethn Dis 2015; 25:263-70. [PMID: 26676156 DOI: 10.18865/ed.25.3.263] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Poorer health profiles among African American men throughout the life course evince greater rates of cardiovascular disease (CVD) and significantly earlier mortality compared with other groups. Despite growing emphasis on identifying how psychosocial factors influence disparate disease risk, little of this research has focused intently on African American men. METHODOLOGY Using hierarchical linear regression, we explored the additive influence of stress, depression, and perceived control on pulse pressure, an established marker of CVD risk, in a sample (N = 153) of African American men (mean age = 66.73 ± 9.29) from the Baltimore Study of Black Aging (BSBA). RESULTS After accounting for age and health status indicators, perceived control emerged as a significant predictor of pulse pressure. DISCUSSION These findings suggest that greater belief in one's own efficacy is a protective factor for cardiovascular health among African American men. Future research should examine whether enhancing perceived control can have an appreciable impact on the immense CVD burden in this and other at-risk populations.
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Affiliation(s)
- LaBarron K Hill
- 1. Duke University Medical Center - Center for the Study of Aging and Human Development ; 2. Duke University - Department of Psychiatry and Behavioral Sciences ; 3. Duke University - Center on Biobehavioral Health Disparities Research
| | | | | | | | - Christopher L Edwards
- 2. Duke University - Department of Psychiatry and Behavioral Sciences ; 3. Duke University - Center on Biobehavioral Health Disparities Research
| | - Keith E Whitfield
- 3. Duke University - Center on Biobehavioral Health Disparities Research ; 4. Duke University - Department of Psychology and Neuroscience
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Moore JP, Vinh A, Tuck KL, Sakkal S, Krishnan SM, Chan CT, Lieu M, Samuel CS, Diep H, Kemp-Harper BK, Tare M, Ricardo SD, Guzik TJ, Sobey CG, Drummond GR. M2 macrophage accumulation in the aortic wall during angiotensin II infusion in mice is associated with fibrosis, elastin loss, and elevated blood pressure. Am J Physiol Heart Circ Physiol 2015; 309:H906-17. [PMID: 26071547 DOI: 10.1152/ajpheart.00821.2014] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 06/08/2015] [Indexed: 11/22/2022]
Abstract
Macrophages accumulate in blood vessels during hypertension. However, their contribution to vessel remodeling is unknown. In the present study, we examined the polarization state of macrophages (M1/M2) in aortas of mice during hypertension and investigated whether antagonism of chemokine receptors involved in macrophage accumulation reduces vessel remodeling and blood pressure (BP). Mice treated with ANG II (0.7 mg·kg(-1)·day(-1), 14 days) had elevated systolic BP (158 ± 3 mmHg) compared with saline-treated animals (122 ± 3 mmHg). Flow cytometry revealed that ANG II infusion increased numbers of CD45(+)CD11b(+)Ly6C(hi) monocytes and CD45(+)CD11b(+)F4/80(+) macrophages by 10- and 2-fold, respectively. The majority of macrophages were positive for the M2 marker CD206 but negative for the M1 marker inducible nitric oxide synthase. Expression of other M2 genes (arginase-1, Fc receptor-like S scavenger receptor, and receptor-1) was elevated in aortas from ANG II-treated mice, whereas M1 genes [TNF and chemokine (C-X-C motif) ligand 2] were unaltered. A PCR array to identify chemokine receptor targets for intervention revealed chemokine (C-C motif) receptor 2 (CCR2) to be upregulated in aortas from ANG II-treated mice, while flow cytometry identified Ly6C(hi) monocytes as the main CCR2-expressing cell type. Intervention with a CCR2 antagonist (INCB3344; 30 mg·kg(-1)·day(-1)), 7 days after the commencement of ANG II infusion, reduced aortic macrophage numbers. INCB334 also reduced aortic collagen deposition, elastin loss, and BP in ANG II-treated mice. Thus, ANG II-dependent hypertension in mice is associated with Ly6C(hi) monocyte and M2 macrophage accumulation in the aorta. Inhibition of macrophage accumulation with a CCR2 antagonist prevents ANG II-induced vessel fibrosis and elevated BP, highlighting this as a promising approach for the future treatment of vessel remodeling/stiffening in hypertension.
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Affiliation(s)
- Jeffrey P Moore
- Department of Pharmacology, Monash University, Clayton, Victoria, Australia
| | - Antony Vinh
- Department of Pharmacology, Monash University, Clayton, Victoria, Australia
| | - Kellie L Tuck
- School of Chemistry, Monash University, Clayton, Victoria, Australia
| | - Samy Sakkal
- School of Biomedical Sciences, Victoria University, St Albans, Victoria, Australia
| | - Shalini M Krishnan
- Department of Pharmacology, Monash University, Clayton, Victoria, Australia
| | - Christopher T Chan
- Department of Pharmacology, Monash University, Clayton, Victoria, Australia
| | - Maggie Lieu
- Department of Pharmacology, Monash University, Clayton, Victoria, Australia
| | - Chrishan S Samuel
- Department of Pharmacology, Monash University, Clayton, Victoria, Australia
| | - Henry Diep
- Department of Pharmacology, Monash University, Clayton, Victoria, Australia
| | | | - Marianne Tare
- Department of Physiology, Monash University, Clayton, Victoria, Australia
| | - Sharon D Ricardo
- Department of Anatomy and Developmental Biology, Monash University, Clayton, Victoria, Australia
| | - Tomasz J Guzik
- Translational Medicine Laboratory, Department of Internal and Agricultural Medicine, Jagiellonian University School of Medicine, Cracow, Poland; and
| | - Christopher G Sobey
- Department of Pharmacology, Monash University, Clayton, Victoria, Australia; Department of Surgery, Monash Medical Centre, Southern Clinical School, Monash University, Clayton, Victoria, Australia
| | - Grant R Drummond
- Department of Pharmacology, Monash University, Clayton, Victoria, Australia; Department of Surgery, Monash Medical Centre, Southern Clinical School, Monash University, Clayton, Victoria, Australia
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Piskorz D, Bongarzoni L, Citta L, Citta N, Citta P, Keller L, Mata L, Tommasi A. Functional Organ Damage in Cardiovascular Low Risk Patients with High Central Aortic Pressure. High Blood Press Cardiovasc Prev 2015; 22:281-7. [PMID: 26014836 DOI: 10.1007/s40292-015-0105-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 05/15/2015] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The loss of the viscoelastic properties of central arteries independently of blood pressure loads could stimulate the development of left ventricular hypertrophy and dysfunction, renal failure, or cerebral vascular injury. OBJECTIVE The aim of the present study is to determine if an elevated systolic aortic pressure is a marker of more frequent target organ damage (TOD) in hypertensive low cardiovascular risk (CVR) patients. METHODS Hypertensive non treated consecutive patients (p) assisted at first visit in a specialized center with a CVR according to WHO Americas B area score less than 10 % were included. Left ventricular mass index (LVMI) and tissue Doppler diastolic and systolic function were measured as Lang et al. (J Am Soc Echocardiogr 18:1440-1463, 2005) and Nagueh et al. (J Am Soc Echocardiogr 22:107-133, 2009). Cardiac TOD was considered according to 2013 European Society of Hypertension/European Society of Cardiology. Glomerular filtration rate (GFR) was calculated by MDRD formula, a value <60 ml/min/1.73 m(2) was considered TOD. Systolic aortic pressured (CAoP) was measured by radial tonometry and classified according to criteria proposed by Herbert et al. (Eur Heart J 35:3100-3132, 2014). Continue variables are reported as means with standard deviation and discrete variables as absolute values and percentages. Statistical analysis was performed with Students t test, significant differences were considered with a p value < 0.05 RESULTS: 155 p were included; 23 p (14.8 %) had elevated CAoP while 132 p (85.2 %) had normal CAoP. Sample mean age was 54.1 + 12.9 years; 85 p (54.8 %) were males. Dyslipidemia was detected in 44 p (28.4 %), and 18 p (11.6 %) were smokers. Mean blood pressure was 143.7 + 17.1 mmHg/86.4 + 12.3 mmHg in p with normal (n) CAoP and 140.3 + 12 mmHg/81.9 + 6.8 mmHg in p with CAoP elevated e (p = NS). Mean CAoP in p with normal values was 117.4 + 10.9 mmHg and 116.9 + 10.7 in p with elevated values (p = NS). The average s wave was 7.42 + 1 cm/sec in n CAoP p vs 6.6 + 1 cm/sec in e CAoP p (p < 0.05) while and E/e' ratio >13 was detected in 14.4 % n CAoP p vs 8.7 % e CAoP p (p = NS). Mean GFR was 105.4 + 40.5 ml/min/1.73 m(2) in n CAoP p vs 103.9 + 45.6 ml/min/1.73 m(2) in e CAoP p (p = NS) and GFR <60 ml/min/1.73 m(2) was present in 4.5 % n CAoP p vs 26.1 % e CAoP p (p < 0.0125). CONCLUSIONS At the same level of CVR according to WHO Americas B score patients with elevated CAoP had lower longitudinal left ventricular systolic function and renal function was more deteriorated.
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Affiliation(s)
- Daniel Piskorz
- British Sanatorium Cardiology Institute, Paraguay 40, 2000, Rosario, Argentina,
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PGC-1α overexpression suppresses blood pressure elevation in DOCA-salt hypertensive mice. Biosci Rep 2015; 35:BSR20150076. [PMID: 26182379 PMCID: PMC4613682 DOI: 10.1042/bsr20150076] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 05/15/2015] [Indexed: 02/02/2023] Open
Abstract
Increasing evidences have accumulated that endothelial dysfunction is involved in the pathogenesis of hypertension. Peroxisome proliferator-activated receptor γ (PPARγ) coactivator-1α (PGC-1α) has been identified as an essential factor that protects against endothelial dysfunction in vascular pathologies. However, the functional role of PGC-1α in hypertension is not well understood. Using an adenovirus infection model, we tested the hypothesis that PGC-1α overexpression retards the progression of hypertension in deoxycorticosterone acetate (DOCA)-salt mice model through preservation of the function of endothelium. We first demonstrated that PGC-1α expression not only in conductance and resistance arteries but also in endothelial cells was decreased after DOCA-salt treatment. In PGC-1α adenovirus-infected mice, the elevation of blood pressure in DOCA-salt mice was attenuated, as determined using tail-cuff measurement. Furthermore, PGC-1α overexpression inhibited the decrease in nitric oxide (NO) generation and the increase in superoxide anion (O2 (-)) production in DOCA-salt-treated mice, in parallel with improved endothelium-dependent relaxation. Rather than affecting endothelial NO synthase (eNOS) total expression and phosphorylation, PGC-1α significantly inhibited eNOS uncoupling, as evidenced by increased eNOS homodimerization, BH4 levels, GTP-cyclohydrolase 1 (GTPCH1) and dihydrofolate reductase (DHFR) expression and heat-shock protein (Hsp)90-eNOS interaction. Our findings demonstrate that PGC-1α overexpression preserves eNOS coupling, enhances NO generation, improves endothelium-dependent relaxation and thus lowers blood pressure, suggesting that up-regulation of PGC-1α may be a novel strategy to prevent and treat hypertension.
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Laptev DN. Аrterial stiffness and cardiovascular autonomic neuropathy relationship in children and adolescents with type 1 diabetes mellitus. DIABETES MELLITUS 2015. [DOI: 10.14341/dm2015194-100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Aim. To evolve the association between cardiac autonomic function and arterial stiffness in children and adolescents with type 1 diabetes mellitus (T1DM). Materials and methods. 72 T1DM patients aged 7?18 years without history of macrovascular complications or renal disease, including microalbuminuria, were involved in the study. Cardiac function was assessed by the cardiovascular tests and 24-hour ECG monitoring with automatic calculation of QT interval and heart rate variability (HRV) parameters. Artery stiffness was assessed by measurement of pulse wave velocity (PWV) and augmentation index (AI) obtained from arterial blood pressure monitoring for 24 hours. Results. Estimated prevalence of cardiovascular autonomic neuropathy (CAN) was 31,9%. CAN+ patients had significantly higher PWV and AI than those without CAN. A negative correlation between PWV and AI with some cardiovascular tests and HRV parameters was observed. In multivariable analysis, AI was independent predictor of autonomic dysfunction defined as number of positive cardiovascular tests, HRV parameters below normal values and prolongation of QT interval (?. =0,18; p=0,035). Conclusion. Cardiac autonomic function is an independent predictor of arterial stiffness, in children and adolescents with T1D without macrovascular and renal complications. The presence of cardiovascular risk factors and arterial stiffness in children and adolescents with T1DM may contribute to the increased cardiovascular morbidity and mortality in adulthood in patients with CAN.
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Raptis AE, Markakis KP, Mazioti MC, Ikonomidis I, Maratou EP, Vlahakos DV, Kotsifaki EE, Voumvourakis AN, Tsirogianni AG, Lambadiari VA, Lekakis JP, Raptis SA, Dimitriadis GD. Effect of aliskiren on circulating endothelial progenitor cells and vascular function in patients with type 2 diabetes and essential hypertension. Am J Hypertens 2015; 28:22-9. [PMID: 24994608 DOI: 10.1093/ajh/hpu119] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate the effects of aliskiren on vascular function and endothelial progenitor cells (EPCs) in patients with type 2 diabetes and essential hypertension. METHODS The study enrolled type 2 diabetic patients aged >50 years under stable glycemic control and first diagnosed mild essential hypertension. In phase A (n = 20), patients received aliskiren 150-300 mg daily for 3 months. In phase B (n = 12), hydrochlorothiazide (HCTZ) 12.5-25mg daily substituted for aliskiren for 3 more months. At baseline and at the end of each phase, we assessed (i) brachial blood pressure (BBP); (ii) central aortic systolic pressure (CSP), aortic augmentation index (Aix), and pulse wave velocity (PWV) as markers of arterial stiffness; (iii) brachial artery flow-mediated dilatation (FMD) as a marker of endothelial function; (iv) left ventricular (LV) twisting and untwisting as markers of LV function and (v) EPC numbers in culture of peripheral blood mononuclear cells. RESULTS Aliskiren similarly reduced BBP and CSP, increased FMD (P < 0.001) and EPC numbers (P < 0.001), decreased PWV and Aix (P < 0.05), and improved LV twisting and untwisting (P < 0.05). Although substitution of HCTZ sustained BBP at similar levels, CSP and echocardiographic indices nearly returned at baseline levels, and the improvement of FMD, PWV, Aix, and EPC numbers was abolished. CONCLUSIONS Aliskiren had a favorable effect on endothelial function and EPCs, reduced arterial stiffness, and improved LV twisting and untwisting. These effects were independent of BBP lowering, as they were not observed after the achievement of similar values of BBP with HCTZ.
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Affiliation(s)
- Athanasios E Raptis
- 2nd Department of Medicine-Propaedeutic Clinic, Research Institute, and Diabetes Centre, Athens University Medical School, Attikon University General Hospital, Haidari, Athens, Greece
| | - Konstantinos P Markakis
- 2nd Department of Medicine-Propaedeutic Clinic, Research Institute, and Diabetes Centre, Athens University Medical School, Attikon University General Hospital, Haidari, Athens, Greece
| | - Maria C Mazioti
- 2nd Department of Medicine-Propaedeutic Clinic, Research Institute, and Diabetes Centre, Athens University Medical School, Attikon University General Hospital, Haidari, Athens, Greece
| | - Ignantios Ikonomidis
- 2nd Department of Cardiology, Athens University Medical School, Attikon University General Hospital, Haidari, Athens, Greece
| | - Eirini P Maratou
- Hellenic National Center for Research, Prevention and Treatment of Diabetes Mellitus and its Complications, Athens, Greece
| | - Dimitrios V Vlahakos
- 2nd Department of Medicine-Propaedeutic Clinic, Research Institute, and Diabetes Centre, Athens University Medical School, Attikon University General Hospital, Haidari, Athens, Greece
| | - Eleni E Kotsifaki
- Department of Experimental Physiology, Athens University Medical School, Athens, Greece
| | - Asterios N Voumvourakis
- 2nd Department of Cardiology, Athens University Medical School, Attikon University General Hospital, Haidari, Athens, Greece
| | | | - Vaia A Lambadiari
- 2nd Department of Medicine-Propaedeutic Clinic, Research Institute, and Diabetes Centre, Athens University Medical School, Attikon University General Hospital, Haidari, Athens, Greece
| | - John P Lekakis
- 2nd Department of Cardiology, Athens University Medical School, Attikon University General Hospital, Haidari, Athens, Greece
| | - Sotirios A Raptis
- 2nd Department of Medicine-Propaedeutic Clinic, Research Institute, and Diabetes Centre, Athens University Medical School, Attikon University General Hospital, Haidari, Athens, Greece Hellenic National Center for Research, Prevention and Treatment of Diabetes Mellitus and its Complications, Athens, Greece
| | - George D Dimitriadis
- 2nd Department of Medicine-Propaedeutic Clinic, Research Institute, and Diabetes Centre, Athens University Medical School, Attikon University General Hospital, Haidari, Athens, Greece
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